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WHEN is the decline of an offer — and a good offer at that — not so much a refusal but an expression of suspicious incredulity?
In the case of Pakistan, it would seem when the chasm between the state, its apparatus and intentions has widened to such an extent that a move that will benefit the citizenry is taken by some sections with outright distrust and perhaps even fear, leading to rejection.
For years now, progressive elements in this country and the rest of the world have been discussing with misgiving the problem of ensuring that every child within our borders is vaccinated against polio. There are a number of challenges involved in achieving this, and given the manner in which the issue has become calcified, it is worth picking the threads apart.
The active polio campaign has made some people suspicious.
To recap, then, first, there was the dangerous rhetoric that started being spread years ago, initially by Mullah Fazlullah, who through illegal radio disseminated the idea that the OPV drops were a conspiracy by the West to sterilise Pakistan’s young. Outrageous as the claim was, it took root in the mind of a population that had perhaps become resigned to being regarded by the state as a problem.
Fast forward to 2011 and the revelations of Dr Shakeel Afridi’s cynical use of a pretend vaccination campaign to gather information with the intention to track down Osama bin Laden. He and his backers used hepatitis as an excuse, but the fallout tainted the government’s vaccination drive in general.
These were in addition to the already existing impediments: the perennial challenge of access to remote villages and settlements, the porous border with Afghanistan, and a shifting population. The TTP too set its face against the polio campaign, with polio teams in places as far apart as Peshawar and Karachi coming under attack.
Concurrently, here and there, in the northwest it was reported that elders had linked permission to allow polio vaccinations to be administered to development: give us potable water and electricity, and we’ll let you do what you seem to desire so very much.
Which brings us to a survey, the results of which were referred to in a report published in this newspaper last week. The Karachi-based article was about a joint initiative undertaken a year ago by the Bill & Melinda Gates Foundation and the World Health Organisation to set up a Religious Support Programme where clerics were inducted to oversee the inoculation process in the eight union councils of the city’s Baldia Town. The latter is a Pakhtun-dominated area where the rate of polio-vaccination refusals has been very high.
“Until two years ago,” the report said, “a refusal from a family in any of Baldia Town’s neighbourhoods was taken simply as a ‘no’. But workers close to the programme say that they were eventually asked to inquire about the reasons for refusals and enter them into a form. The first reason … related to ‘religious’ perceptions ... [that] the vaccine ‘would cause infertility’. The second reason is marked ‘demand’ on the form.”
“Demand” was explained to the reporter as “suspicion over the maniacal polio drive specifically in Baldia Town”. Apparently, “the contradiction in provision of services; the lack of attention on infrastructure and apathy with regard to the Basic Health Units in Baldia Town make people question the sincerity behind attention given specifically to the polio drive, resulting in refusals”.
In other words, in the context of a thoroughly and historically inattentive state, the proactive movement on specifically polio makes some people suspicious and assume that this velvet glove conceals a knife. This sounds like a leap of imagination when one considers that the polio vaccination campaign has been at the forefront of the state’s healthcare agenda, and has been billed as such for years.
Even so, given the very poor economic and educational realities that characterise Baldia Town, it is not inconceivable that people have remained more or less ignorant of the reasons why this crippling disease has received such disproportionate attention, not the least of them being the prodding by international healthcare concerns and the generous funding that comes Pakistan’s way for being key to bringing the virus under global control for good.
And as such, this would mean that the challenge for Pakistan has dimensions further than so far understood. It is not just a matter of getting the medicine to the diseased man. It is also not just a matter of getting him to take it.
At the heart of the matter, is convincing the man that the provider of the medicine really does have his best interests at heart, even if that flies in the face of all the sick man has ever seen coming from this particular set of hands. It may be a case of having to holistically address and bridge all the trust deficits that have over the decades built up between the state and the citizenry.
The writer is a member of staff.
Published in Dawn, March 28th, 2016
