THERE’S a three-year-old I know who uses mealtime as a weapon of blackmail.
A fussy eater, this child sees a meal as something his parents really, really want him to have. His rationality circuits haven’t developed enough to understand that it’s for his own good — but they have developed to the extent that he realises he can use what he perceives as their self-interest to wrest favours from them.
“I want to watch my movie”, he tells his father, who is pleading with him to have dinner. “Otherwise I won’t take a bite.” Or “I want to play in that puddle”, or else “Fine, then I won’t eat my lunch either.”
The parents are hanging in there. They realise that this too shall pass. You can’t rationalise with a three-year-old, but eventually the logic circuits will kick in.
But what do you do when you’re presented with the same sort of logic by groups of middle-aged men who have done all the growing up they were going to? Whatever logic they display now is probably the best most of them are ever going to achieve. How do you argue with them when they use something that is of benefit to themselves — not you — as a weapon of blackmail against you?
That’s the situation polio vaccination teams are facing in pockets of the country. The ambition of vaccinating every single child in Pakistan, from the rugged reaches of the Karakorum mountains to the sandy wastelands of interior Balochistan, was challenging enough. Even so, a few years ago the polio vaccination campaign was seeing enough success for us — and a concerned world — to believe that eradication could almost be within our grasp.
Today, we are one of only three polio-endemic countries left in the world (Nigeria and Afghanistan being the others). Far more worryingly, we’re the only country where there are indications of a resurgence of the dreaded disease. And the odds just keep getting stacked against us.
To rapidly recount, the resistance to the polio vaccination campaign seems to have started in pockets of the northwest when, a few years ago, some clerics irresponsibly declared that it was a Western conspiracy against Muslims and that the drops were actually a means of human sterilisation.
Such suspicions were given a fillip by Dr Shakil Afridi’s use of a public health campaign to try and track down old Osama. His excuse was in fact hepatitis, but since we’ve never let the truth stand in the way of smelling out conspiracies, in many people’s minds the shadow fell on the anti-polio campaign too.
Most recently, there were attacks on anti-polio campaign workers in Karachi and elsewhere, while the Taliban issued a general death threat to vaccinators. The last nail in the coffin was the decision of a team of tribal elders in the northwest that was sent in to try to make the Taliban see the light (yes, I know that sounds like an oxymoron) and came out saying that until drone strikes were halted, they too supported the ‘ban’.
District health officials from Fata and Khyber Pakhtunkhwa add that people are increasingly denying access to polio vaccination teams until material benefits, such as electricity supply or infrastructure, are provided. Like the child who won’t eat, they perceive the campaign as something that benefits not themselves but the vaccination teams who they see as undertaking it out of self-interest.
Why should we, far from the mountain fastness or urban slum from where polio cases are being reported, worry? The bulk of people infected with polio (95 per cent) never show any symptoms. The ‘softest’ form of the virus can lead to flu-like symptoms only, but in extreme cases the virus invades the nervous system and can cause irreversible paralysis in a matter of hours. After a person becomes infected, there is no cure.
Once in the body, wild poliovirus is shed into the environment through faeces and can spread through a community like wildfire. This is because patients are most infectious — and this is the scary bit — seven to 10 days before and after symptoms, if there are going to be any, are observed. Resultantly, such symptomless persons can silently spread the infection to thousands of others before the first case is even flagged.
Poliovirus usually spreads through contact with faeces from an infected person. Such a person can contaminate food and liquids with poliovirus, which will then infect the consumer. You can get it by touching contaminated surfaces or objects and then putting that hand in your mouth, or by sharing food and utensils with an infected person. Also, but less commonly, you can be infected by contact with contaminated respiratory droplets or saliva, such as by being sneezed on or by touching a surface that has been coughed on by an infected person. There is also evidence that flies can passively transfer poliovirus from faeces to food.
Because of the speed with which polio can spread, the World Health Organisation considers even a single confirmed case of polio paralysis as evidence of an epidemic, particularly in countries or areas where very few cases occur.
Now think about the hygiene practices prevalent across Pakistan and tell me you aren’t going to pause before popping that pakora into your mouth this evening.
It’s not a game — I’ll do what you advise if you give me what I desire. Few issues are in deadlier earnest. Ask the child who will never walk or the sufferer whose lungs have to be made to work through immobilising, artificial means. Think about the thousands upon thousands of children here on earth through no choice of their own and hostage to, among the many other monsters that stalk them, their fathers’ confidence in personal certainties over science.
You can wait for a child’s logic to eventually kick in, but what do you do with grown men?
The writer is a member of staff.