No border control

August 26, 2014


DISEASE does not respect borders. It originates in one country and then crosses borders, afflicting hundreds and thousands in its destructive sweep. In the 14th century, vast swathes of central and northern Europe were destroyed by the plague, the scourge of the continent, facilitated partly by increased travel and movement of people and animals.

In more recent times, a worldwide influenza pandemic killed millions at the beginning of the 20th century. Thus in time the regional sequestration of infectious diseases and their international spread became a global concern as travel and movement of people expanded. In 1969, international health regulations (IHR) — covering yellow fever, the plague and cholera — came into effect.

These regulations more or less governed internal policy on infectious disease detection, monitoring and sequestration as well as international notification of these diseases with a view to triggering an international remedial response. With the world becoming ever more globalised and international travel becoming a mass industry, the spread of infectious disease is a recurring phenomenon.

In 2002, the Severe Acute Respiratory Syndrome, originating in China, spread to 26 countries in five continents. This gave a new push to hitherto glacial efforts to update IHRs in view of more infectious diseases emerging and their hindrance-free spread. The result was updated regulations in 2005, covering a wide array of diseases accompanied by a robust drive to enlist all WHO member states in their enforcement.

Pakistan will need to make more efforts to stave off the Ebola virus.

IHR 2005 came into effect in 2007. Pakistan has also signed up to IHR 2005. Yet action on meeting the obligations laid down in IHR 2005 has been half-hearted. This was apparent when Pakistan failed to check the ingress of H1N1 influenza which affected 262 people in 2009. The government’s inability to properly invigilate the flu and contain it led to a ban on the import of poultry from Pakistan.

The importation of the flu in Pakistan showed the inadequacy of robust public health activities at ports, airport and land entry points despite official claims of putting in place enhanced measures pertaining to detection, reporting and importation of infectious diseases contained in the IHR 2005.

As a corollary, Pakistan has been placed on a list of countries at risk of exporting polio virus, resulting in the requirement for all Pakistanis leaving the country or those visiting the country for more than four weeks to be administered polio drops and vaccination.

This yet again reflects our poor management of detection and control mechanisms of communicable diseases. Despite these dire warnings on the state of infectious disease management, Pakistan is still lagging behind in fulfilling commitments in the IHR 2005.

IHR requires the country to set up early warning and surveillance systems, initiate more robust public health actions at all entry points, improve the diagnostic, technical and laboratory system and have a focal point for IHR’s implementation and international coordination. But apart from fulfilling some commitments such as nomination of a national institute of health, there is a lot that needs to be done to conform to the IHR spirit.

Given this ill-preparedness, Pakistan will need to make more efforts to face the challenge of the spread of the Ebola virus. This latest WHO-declared public health emergency has killed more than 1,200 people in West Africa, particularly in Liberia, Sierra Leone, Guinea and Nigeria. There is considerable traffic between Pakistan and African countries which opens up the possibility of the disease spreading to Pakistan if no remedial public health action at entry points is instituted. (India has acted speedily to put in place screening and quarantine measures for those travelling from West Africa.)

In Pakistan already the requirement of filling out health cards by travellers from Africa and South America is honoured more in the breach than the observance. In most cases the filled-out forms are either ignored by immigration officers or thrown in the dustbin as soon as they are handed in.

More worryingly, there do not seem to be dedicated health desks set up to deal with those travelling from the pandemic-affected regions. This state of affairs hardly inspires confidence that Pakistan is taking seriously the danger that Ebola poses to the country despite the issuance of a health advisory.

A large part of the problem loops back to our progress on the IHR 2005 compliance. Though government has put in place some cosmetic measures, substantive measures that can put us in sight of full compliance are slow in coming.

According to a year-old report, the Pakistan government, while partially fulfilling the stipulations of the IHR 2005, has asked for an extension of two years to meet all requirements. This lethal complacency lends further gloom to the gathering health crisis already made worse by the growing incidence of dengue, measles, polio and Crimean-Congo Hemorrhagic fever.

The writer is an Islamabad-based development consultant and policy analyst.

Published in Dawn, August 26th, 2014