Still a challenge

Oct 23 2015


The writer is a journalist.
The writer is a journalist.

JUST last year, Pakistan broke the global record by recording 306 cases of wild polio virus (WPV); 85pc of the global WPV count. Eighty-four per cent of the children identified were under the age of two while 62pc amongst the confirmed polio cases had never received a single dose of vaccine.

Fifty-eight per cent of these cases emerged from Fata — 94 cases from North and South Waziristan alone, where the Taliban had enforced a ban on vaccinations since 2012. As a result of the ban, some 290,000 children were missed from ever receiving the vaccine. In 2015 so far, 38 cases have been reported in Pakistan as compared to 205 during the same period last year. While commendable there is need to be cautious.

The foremost reason behind the substantial drop in polio cases this year has been the military operation, Zarb-i-Azb. Regaining access to high-risk areas and reaching children who would otherwise have been missed has proven crucial to the success.

On World Polio Day tomorrow, there is no need for celebration.

With the army providing security, health workers stationed at checkpoints on roads leading out of the tribal areas as well as IDP camps have been vaccinating people, including half a million children. However, polio in Pakistan is primarily a security issue which cannot simply be addressed by the health ministry; it requires a broader strategy involving all key stakeholders from women to religious leaders and from the army to health workers.

Since July 2012, 79 health workers and security personnel have been killed by militants while almost 60 have been injured. Cross-border movements have not only accentuated security concerns, they have led to the export of cases, whether in Afghanistan or as far as Syria.

Polio is preventable but not curable. The government has been focusing too much on the quantity as opposed to the quality of campaigns. Operational issues of ineffective payment mechanisms and inadequate training of vaccinators compound the problem.

Polio eradication efforts cannot adopt a piecemeal approach. Army efforts in Fata must be accompanied by robust campaigns in Karachi or the virus will travel from Karachi to Peshawar and back into Fata due to high population mobility.

While case counts are lower this year, environmental samples have tested positive in major cities including Karachi, Quetta, Peshawar, Lahore, Islamabad, implying that the virus still exists everywhere. Inaccessible areas are not limited to the Waziristan area alone. Vaccinators are unable to enter parts of Karachi and Peshawar either due to inadequate training or because ‘no one is there’. By simply working on the periphery, they miss children who become carriers of the virus in high-risk areas.

Eradicating polio requires ownership, dedicated oversight, and consistent political commitment regardless of a change in government. Previously, high-profile communication strategies have attracted negative attention making it easier for militants to target vaccinators. A more localised communication strategy that involves the deployment of informed health workers in high-risk communities is necessary to create awareness and address parental concerns and misconceptions.

It is imperative to focus on community stakeholders, particularly religious leaders and women, in an effort to build lasting trust and momentum. Polio reservoirs in Karachi and Peshawar continue to be problematic and any negligence in vaccination campaigns in Fata could be detrimental to the progress made this year. While regaining access in Fata has broken ground for Pakistan’s fight against polio, sustaining the campaign will be critical not only in gauging the direct effect of the government’s response but also its commitment. It will be of little surprise if the army is tasked with this programme as well in Fata while the government supplements the efforts with campaigns in other parts of the country.

Despite the challenges, Pakistan’s security concerns are not unique. In Nigeria vaccinators were targeted by militant groups such as Boko Haram while vaccination bans issued by Muslim clerics in 2003 halted programmes in the north of the country. In July, Nigeria was removed from the WHO list of polio-endemic countries.

Though it must continue the trend for another three years before it can receive the official certification, eradicating polio in Nigeria would mean eradicating polio from Africa. In 2014, India was officially declared polio-free essentially leaving Afghanistan and Pakistan as the remaining two polio endemic countries in the world.

On Oct 24, World Polio Day, undue celebration and exuberance will cause more damage to Pakistan not because we may see resurgence in cases given what data from environmental samples shows but because we will grow complacent when there is no need to. There is no reason to celebrate this success because possibly being the last country on earth to still record polio cases, anything short of complete eradication is not worthy of celebration.

The writer is a journalist.

Published in Dawn, October 23rd, 2015

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