IF it is obvious that Pakistan — its population and its relations with the rest of the world — is in grave danger thanks to the growing presence of polio, it is also clear that neither the centre nor the provincial administrations have taken any action to prove they care about the threat.

On Saturday came a report by the Independent Monitoring Board of the Global Polio Eradication Initiative. It is a damning indictment of our failure to battle the “Pakistan poliovirus”.

The latter is being transported abroad, giving us the dubious distinction of harbouring 80pc of the world’s polio cases. The report has called domestic efforts to tackle the challenge a “disaster”, adding that “nothing short of transformative action will do”.

What has the state’s response been to this clarion call? As reported on Monday, Minister of State for National Health Services, Regulation and Coordination Saira Afzal Tarar said that “since the IMB report was issued over the weekend, we have not been able to review its recommendations thoroughly”.

A high-level meeting will be called “in a day or two”, she further promised, before reiterating that Pakistan knew best which of the IMB’s recommendations should be implemented.

If Pakistan does indeed know best, why has the polio eradication initiative — spread over two decades and having soaked up millions upon millions of dollars given largely by international donors — produced such an impressive state of shambles?

Pakistan is the only country where the virus is spreading, and as the IMB said in a letter to the Unicef executive director, if this country is not somehow induced into urgently implementing its recommendations, “hundreds of millions of dollars [would have to be] spent every year solely to keep [the] Pakistan poliovirus out of other countries”.

There are too many serious questions. Why are there cases of children having succumbed to the virus even though they had received the OPV? Possible answer: because the follow-up dosage schedule was not followed.

If access to children in North and South Waziristan made vaccination difficult, why do tens of thousands remain unvaccinated even though, having fled the military operation, they are now mainly housed in IDP camps in accessible areas?

Perhaps because the state’s coordination has been poor. Why is the virus surfacing in areas earlier thought to be polio-free, such as Punjab and Balochistan?

We do know that the central and provincial governments’ infrastructure is in utter disarray. Why are there still refusals in urban areas such as Karachi? Because nowhere do we see the government making any concerted effort to take control of the narrative and right the wrongs the vaccination campaign has suffered at the hands of various actors.

The picture is dismal, and the sluggishness of the authorities shocking. Currently, it is anybody’s guess what it will take to jolt the state out of its torpor. Meanwhile, other countries might start to pull up their drawbridges.

Published in Dawn, October 28th, 2014