The enemy within
Hilda Saeed discusses the factors influencing the polio-eradication campaign in the country
Today, Pakistan, Afghanistan and Nigeria are the only three countries in the world where polio is endemic, with 0.5 million children unprotected against the scourge of polio. Tomorrow, this number will increase, and will continue to do so in swift geometric progression if the polio eradication campaign remains paralysed.
The recent nationwide alarm about the ‘hidden agenda’ of the polio eradication campaign has left many people doubtful about its efficacy, and yet the sad truth is that even if one child remains infected, children in all countries are at risk.
The enthusiasm of the polio eradication campaign’s early days has now been reduced to deep-seated worry, even alarm, over a situation that’s proving hard to resolve. At the start there were successful spells, and an initial count of 25,000 polio cases in 1994 was brought down to 198 cases by 2012 — clearly pinpointing the success of the campaign.
However now, a spate of deadly attacks on polio vaccination workers has led to the deaths of nine workers; the worst affected provinces have been Sindh and Khyber Pakhtunkhwa. So much so, that Unicef which was handling the campaign with World Health Organisation (WHO), has been forced to suspend all field activities.
The situation is a tricky one: the campaign cannot be stopped indefinitely — every day lost is placing more and more children at risk; but health workers, who have worked with commitment, even for low wages, are now reluctant to put their lives at stake.
Lady Health Worker Bushra Bibi who has eight years of experience in administering polio drops says this work is her passion and her commitment, “I cannot see the pain in the eyes of mothers whose children suffer from polio. I want to continue this work, but things are terrible now. There has never been so much risk, and I do have my own family to look after.”
In the brief space of a few months, a series of relatively ‘hidden’ problems have crystallised and become startlingly evident.
Poverty, illiteracy, and growing religious fundamentalism have been endemic in this region for many years. Each of these has been promoted by other associated factors, releasing frightening consequences. Poverty has engendered hunger, malnutrition and wasting; illiteracy has given rise to bigotry and medieval brands of violence.
In recent years, embroiled in this mix is the War on Terror; fleeing multitudes from Afghanistan, cross-border movement of war refugees into Pakistan, and the unrest and violence in Balochistan, all leading to huge numbers of internally displaced people.
Poor governance and weak administration are augmented with severe shortage of basic information on health, hygiene and the building of immunity /resistance to disease. Nor can this be remedied without consistent effort and more funds — but where can those funds come from? The national health budget is pathetically low; at less than one per cent of GNP, the end result is near-inevitable; financial constraints remain one of its biggest concerns.
Within these broad, macro-level problems are the smaller ones, such as the sub-optimal preparations for concerted eradication campaigns, most evident in Quetta, Qila Abdullah and Pishin in Balochistan. Dr Hussein Gezari, WHO’s special envoy on polio eradication is of the opinion that district health officials needed to work more efficiently, with greater accountability.
Shahnaz Wazir Ali, special assistant to the prime minister, blames polio resurgence to the religious mindset; the fatwas against polio immunisation have been several. The public resentment that has built up against polio vaccination workers and the vaccine itself is also considered a backlash of drone strikes. Militants accuse vaccination workers of dosing toddlers with drops that will make the community sterile; to them this is part of the US agenda.
People in far-flung communities are convinced that there is some sort of hidden agenda behind the administration of polio drops, just as there was in the finding of Osama Bin Laden by Dr Shakil Afridi.
In an effort to decrease these fears and change this negative mindset, Senator Haji Ghulam Ali of the Jamiat Ulema-i-Islam (Fazlur Rehman) (JUI-F) has urged the Ulema, especially those in remote isolated areas to include a special address after Friday prayers about polio eradication, so as to make an effective appeal to parents to get the children vaccinated.
Before things go from bad to worse, and take polio to epidemic levels, massive education and awareness campaigns in print and broadcast media are essential. Azmat Abbas, media specialist for polio at Unicef, rightly says, “The goal of a polio-free Pakistan can only be achieved with the consistent government involvement, ownership and accountability of the polio programme at each administrative level.” Can we expect that complete political commitment right now?