A FIRM stand by WHO has jerked the Pakistan government into action. Since Sunday all travellers going abroad are required to take polio drops. Last month WHO’s director general had declared the international spread of polio a “public health emergency of international concern” warranting “temporary recommendations for coordinated international efforts”.
Since Pakistan was named as one of the three ‘polio-exporting countries’ the matter made banner headlines in the media at home. Ironically, the prospects of a country with an inordinately large number of crippled children had not caused much alarm.
With most regions of the world certified as polio-free, the idea that a handful of countries where polio is still endemic could nullify all efforts put into eradicating this disease since 1988 is horrifying. Pakistan bears heavy responsibility in the matter.
It is a pity that after the incidence of the disease had dropped to 28 in 2005, polio has made a comeback with 198 cases being confirmed in 2011. Since then the graph has been zigzagging — there were 58 cases in 2012 and 93 in 2013. This year 70 cases have been reported so far.
The need is to reassess our approach to preventive medicine.
This pattern is worrying and if no effective measures are taken there is bound to be a surge in polio cases. Travel restrictions will not affect the prevalence of the disease within the country. Most travellers are adults and polio is basically a childhood disease with children developing immunity against it by age five.
Those in need of vaccines are under five years, but not all in this age group in Pakistan are fully covered. In the immunisation drive undertaken recently, the authorities admitted that 370,000 children in Fata were left out. The vicious attacks by the Taliban on polio workers — 22 of them have fallen victim to terrorism since 2012 — has been described as a major factor hampering the polio eradication campaign in Waziristan.
Also being blamed is the American strategy of using a fake immunisation campaign to trace Osama bin Laden in Abbottabad. This unethical move earned its protagonists bad publicity in 2011. Yet there was a drastic fall in polio cases in 2012 until the Taliban’s ban on immunisation campaigns led to polio’s resurgence, prompting the US to announce that the CIA would not use fake immunisation drives for espionage again.
This, however, doesn’t explain fully why the polio situation in Pakistan is as bad as it is today. The need is to reassess our approach to preventive medicine which doesn’t receive the importance it deserves. Of course the war and terrorism have played a key role in the failure of the anti-polio campaign. But equally at fault is our collapsing public health system.
The fact is that in the last several years no mobilisation drives to bring about health awareness and changes in social behaviour and lifestyle have been undertaken.
A World Bank report prepared in 2012 on the Expanded Programme for Immunisation observed: “The target population for immunisation is huge, and millions of doses of vaccine are delivered successfully by government services every year. Nonetheless as many as 40 pc of the children below five years remain unimmunised or under-immunised, particularly in the poor and rural sections of the country. There are tremendous challenges to overcome in delivering these services, not least, the sheer numbers involved.”
Dr Samia Altaf, who worked with communities in Sindh and KP, says she found that many people did not understand the preventive dimension of drugs and healthcare at all. Citing a Unicef survey of 2012 she reported that 46pc of respondents lacked awareness of vaccinations against polio. She calls for a review of the anti-polio strategy after involving the stakeholders in the policymaking process.
One would not deny that conflict has complicated matters but it would not help to overlook the other flaws in our public health system. The polio campaign cannot be viewed in isolation. The fact is every programme related to the health sector is failing. The family planning programme has lost its vigour and the population growth rate continues to be the highest in South Asia. Malaria, tuberculosis and malnourishment are rife. In some cases, children have reportedly contracted polio even after being administered polio drops.
Whether it was a break in the cold chain that rendered the vaccine ineffective or the malnourished state of the child that prevented him from developing immunity can only be known after proper investigations. The growing level of insanitation and declining ratio of population receiving potable water has inevitably increased the vulnerability of children to polio. It is hardly a coincidence that polio has emerged as a disease of poverty and illiteracy. All the more reason for policymakers to rethink the health policy.
Published in Dawn, June 4th, 2014