Herald exclusive: A dose of reason

Less than 500 vaccinators are available for entire Fata which means one vaccinator covers a big area spanning four square kilometres. – File Photo/Herald

Health officials told Ghulam Rasool, a mason from Bara tehsil of Khyber Agency, in March this year that his 18-month-old son had tested positive for polio and has been crippled for life by the virus. Angry over his decision to follow the ban that the Taliban had imposed on administering polio drops in the tribal areas, he cannot restrain himself from cursing the militants and their leaders.

“I accepted all their orders without any if and but [not knowing the consequences],” he says. “I was helpless against them.” His son was born in 2009 when the militancy was at its peak in Khyber Agency and the Taliban were so much in control that no one – neither the parents nor the health officials –  could defy their orders and have the children vaccinated.

Ghulam Rasool is one of scores of parents across the non-descript towns and villages in the Federally Administered Tribal Areas (Fata) whose children have fallen victim to the ill-directed Taliban ban on polio vaccination, which had been termed as Western conspiracy to sterilise future generations of local Muslims. The trend in the number of children succumbing to the disease in fact reads like the story of the militancy’s ebb and rise in Fata, revealing an inexorable link between the rise in its incidence and the intensity of the Taliban’s control in the region. In 2010, of the 144 polio cases detected in Pakistan 95 were from Fata whereas of the 53 cases reported in the first six months of 2011, 18 have been reported from the tribal areas.

Swat is another region that categorically links an increase in polio cases to the rise in militancy but with a vastly different trend. The first polio case there was reported in 2007. Next year, the number went up to four and in 2009, when the militants were totally in control, Swat recorded 20 cases. Now that the Taliban have been driven out of the region and polio vaccination campaign has re-started in earnest after a hiatus of about two years, there has been only one polio case detected in Swat in 2010 and none so far in 2011.

That the situation in Fata is alarming seems like an understatement when seen in comparison to global statistics on polio. According to the World Health Organisation (WHO), only four countries – Nigeria, India, Afghanistan and Pakistan – are yet to be rid of the disease. But in the first five months of the ongoing year, only eight cases were reported from Nigeria and one each from India and Afghanistan. Put together, all these cases are four times less than the number of cases reported from Pakistan in the same time period.

According to the World Health Organisation (WHO), only four countries – Nigeria, India, Afghanistan and Pakistan – are yet to be rid of the disease. – File Photo/Herald

Unfortunately, it looks likely that polio cases continue appearing in Fata because a large part of the region still remains inaccessible to the health officials, mainly because of the militancy. Officials say that they do not have access to 25 per cent (272,110 out of 1,086,682) children in Fata. Dr Jan Baz Afridi, deputy director of the vaccination programme in Khyber Pakhtunkhwa, provides an agency-wise breakdown (see table) which shows that in some agencies such as Khyber and Orakzai over 50 per cent of the children have missed out on vaccination campaigns.

Local government and other NGO officials cite a number of reasons for their inability to access these children in Fata — and all of these reasons are directly or indirectly linked to militancy. Take, for instance, Khyber Agency where many parts are virtual no-go areas for health staff since long and seven per cent children are inaccessible in villages that are under the militants’ control. Health officials are afraid of visiting such villages after four of their colleagues, including a doctor, were killed and four others abducted there in the last two years while administering polio drops.

Consequently, with the threat to life, there is also a fear factor that makes the health workers reluctant to join the ranks of vaccinators. Less than 500 vaccinators are available for entire Fata which means one vaccinator covers a big area spanning four square kilometres.

But perhaps the most important factor is the lack of local cooperation, again instigated by the Taliban. Misconceptions about the polio vaccines abound and parents refuse to give up their blind faith in the Taliban’s propaganda. In at least seven polio cases reported in 2011 from Fata, the refusal to administer vaccine had come from the parents. In all, 21,000 children have remained unvaccinated in Khyber Pakhtunkhwa and Fata owing to refusal by their parents.

Ten-month-old Mohammad Arif, son of Zulfiqar Shah of Hissara village in Khyber Agency’s Tirah Valley, is one of them. Going by his age, he should have received polio drops at least four times but did not get even a single dose because his parents had refused. In March this year when he tested positive for the polio virus, the militants never bothered to explain to his parents as to how the child had contracted the disease, let alone sympathise with them over an ailment that they hindered from being prevented and that has made Arif a handicapped person for life.

“The oral polio vaccine is in line with the specifications set by the international expert committee on biological standardisation of WHO,” says Dr Abdul Jamil who is working with the United Nations Children’s Fund (Unicef). These specifications make it impossible for the vaccine to contain any other undeclared biologically active substances such as viruses, hormones or other materials, he says. Since 1995 it has been administered to more than one billion children globally and “no side-effects have been reported in this period,” he points out.

But given the high level of illiteracy and the failure of the official media campaigns to reach the people in the tribal areas, reiterating such technical details have had little impact as far as changing perceptions is concerned. Perhaps aware of this drawback, WHO and Unicef warned the Pakistani authorities early this year that funding for the vaccination would stop if the government did not take steps to rectify the situation. This prompted the government to review its strategy. Rather than relying on media campaigns to allay fears about the vaccine’s perceived side-effects, it employed the services of local ulema in an attempt to use their influence in convincing people.

The Fata Health Department, in collaboration with a non-government agency, the National Research and Development Foundation (NRDF), is now working with local ulema in Khyber Agency to reverse the apprehensions of the local people vis-à-vis vaccination. The two agencies claim to have “sensitised” all influential ulema of the agency and claim they now support the vaccinators in terms of educating and convincing people to allow their children to be vaccinated.

“We have got the services of 1,500 religious scholars, local clerics and prayer leaders, who are persuading the parents,” says Tahseenullah Khan, a coordinator with NRDF. He tells the Herald that workers of his organisation go from house to house along with the ulema who argue that it is the religious responsibility of the parents to immunise their children and save them from becoming permanently handicapped. “We have obtained fatwas from known scholars due to which the people accept our argument,” he says.

They have even risked travelling to areas under the control of the militants — and small gains have also been made there. Irked by such attempts, the Tehrik-e-Taliban Pakistan (TTP) had warned WHO officials on March 28, 2011 not to conduct polio vaccination campaign in Ghundai union council of Khyber Agency’s Jamrud tehsil. Responding to the warning, the health department refused to send its teams for vaccination but when the WHO brought this refusal to the notice of the NRDF, the organisation promptly planned a visit to the area along with local ulema. They met the Taliban the next day and told them about their involvement in polio vaccination campaigns and showed them a fatwa issued by leading religious scholars of Pakistan in the vaccine’s support. After two-hours, the Taliban were convinced and even admitted their mistake. “They promised to make announcements in favour of vaccination during Friday sermons,” a participant of the meeting tells the Herald.

The results were encouraging. A month later, teams conducted a full-scale campaign in the area without any fear and vaccinated around 2,900 children who otherwise would have been skipped. Unfortunately, militants in other areas have not so far responded positively to the prompting of the ulema working with vaccinators.

Afridi acknowledges that the collaboration with NRDF has been helpful in convincing the parents: “Only 106 families refused to let their child be vaccinated in Swat whereas in 2007 about 13,000 children were left out of vaccination programme due to refusals by their parents.” In Khyber, Bajaur and other hard-to-reach areas, the number of refusals has dwindled to less than 1,000 due to the aggressive efforts by local religious scholars, he adds. “In many districts, religious leaders are themselves administering polio vaccine to children,” says Tahseenullah.

Clearly, children and their parents in Swat and many tribal areas who are now accessible by vaccinators may heave a sigh of relief at averting the fate of Rasool’s son, but further gains must be made as scores of children across the tribal belt still have a steady chance of having their future blighted.

The Herald is Pakistan’s premier current affairs magazine published by the Dawn Media Group every month from Karachi.

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Comments (6) Closed

Dr. Saad
Jul 17, 2011 09:23am
I have been a proponent of discontinuing the oral polio vaccine for a long time. Contrary to the WHO's reassurances, the US govt and FDA in US have banned the use of oral vaccine and have been using injectable vaccines for a long time. The reasons are simple, the major one being that the oral vaccine is live attenuated and can easily get reactivated by the presence of and interaction with the wild virus. I have discussed this issue with pediatricians and doctors in the US, all highly against the mass immunization with the ORAL vaccine. Can somebody please take note of the issue that some of these vaccines may be the cause of the symptoms itself. Its time to start questioning, atleast scientifically, the use of such poractices in our part of the world.
rk singh
Jul 17, 2011 12:08pm
A dose of reason. Unfortunately reason is not a word associated with muslim world. This polio menace is basically the adamant attitude of some muslim sections which opposed the vaccination. Their reasoning was- this vaccination is a scam by USA to reduce the fertility of muslims and reduce their population. Even in India only muslims kids are effected by polio. Sadly many muslim bigots oppose the polio drive every year and prevent total elimination of the virus in India.
Muhammad Abid Khan
May 27, 2012 10:08am
Our poor arise the question that we mostly affected with malaria, typhied and other such common diseases. why not our govt and US government is looking for the eridication of that diseases, which is not serious but badly suffer our income. The polio is just in percentage to 0.00001% to other diseases?????????????????
Jun 02, 2012 06:05am
We hope and will pray that whole country is vaccinated. There is need of awareness, the media should play its due role.
Jul 08, 2012 12:14pm
Well such articles are meant to create awareness regarding the importance of vaccination. Only if the targeted habitants of the tribal areas could read this and learn from Ghulam Rasool's experience.
Asif Ansari
Jul 25, 2012 09:27pm
polio drops are essentials for every Pakistani children. So please keep it and take part for this world cause important issue, this is the need of every Pakistani that his/her country is free for polio dieseas.