Polio confusion
THIS year so far, Pakistan has recorded 82 cases of polio. Of these, 64 cases emanate from Fata with 53 reported from North Waziristan alone. An overwhelming number of cases come from children under two years, implying they never received a single dose of the vaccine due to the Taliban ban in effect since July 2012. Fata alone accounts for more than 60pc of worldwide polio cases this year.
As of June 1, travellers from Pakistan must produce government-issued polio vaccination certificates. Far from implementing the decision, the federal and provincial governments have wasted time deciding who the responsibility falls on. The polio drops are free and must be obtained from a government hospital, with a certificate issued by a health official.
There has been no formal announcement by the government regarding locations thus creating much confusion and prompting travellers to receive the polio drops only when they arrive at the airports. Incorrect information, bolstered by conspiracy theories and myths, has also led many to believe that the vaccine is a sterilisation tool. This is one reason why some citizens are reportedly obtaining vaccination certificates without receiving the vaccine itself.
At the official level, efforts are half-hearted with few airport staff asking to see the certificate. The absence of monitoring and strict checks makes the situation even more precarious.
Travel curbs alone will not help end the crisis.
Travel restrictions alone will not help end the polio crisis or Pakistan’s status as a polio-exporting country. Pakistan, having exported polio to five other countries already, poses an imminent threat to the global community; the severity of this doesn’t seem to have quite sunk into the mind of the current government.
Travel restrictions have also been considered to contain those going to conflict zones abroad and spreading the poliovirus, as well as for those moving from polio reservoirs in KP, Fata or Karachi to other parts of the country. However, it was expected that the elite, who are potentially prevented from taking summer vacations in Thailand, would pressurise the government to address the polio crisis. The private sector has instead chosen to confine itself within its own bubble and remain detached from the crisis, opting to selfishly seek individual immunity.
First, nationwide mobilisation and awareness campaigns are imperative to stamp out polio. This can only be possible if stakeholders from the ulema to national celebrities, from teachers to the army, and from government officials to CEOs are actively united in eradicating polio. By disseminating information, creating awareness and providing measures within its own ambit, a nationwide, multi-pronged solution can be introduced.
Second, the government must be willing and able to introduce such measures. The government’s lack of response signals that the polio threat has not been internalised. No matter how involved international agencies may be polio will never be eradicated if the government does not take ownership to eradicate it. Political will is imperative along with involving national assets such as the army that is already administering drops at border check posts. However, a greater and more coordinated effort with a rigid monitoring system remains wanting.
Third, following the restrictions, it was expected that the government would introduce strategic measures to address the security threats faced by health workers and security personnel, 56 of whom have been killed in militant attacks since December 2012. A drastic decrease in health workers willing to go into the field has dealt a heavy blow to polio eradication efforts.
The government has done little to create an integrated security force that can protect workers who now display low morale. The government’s inability and public showing of weakness when it comes to responding to militant attacks does not bode well for the health sector that already receives little attention in comparison to strategic security threats.
Fourth, a major overhaul of Pakistan’s abysmal health infrastructure is urgently required. Polio reservoirs in Karachi, Peshawar and Fata can only be isolated and eventually eliminated if a robust health sector is efficient, informed and committed to finding solutions. Refusal cases, especially in Fata, are abundant and require a variety of strategies to be addressed. High-risk areas, though isolated, deserve special attention.
The public health system must be bolstered to a level where it can participate in follow-up campaigns and awareness and mobilisation programmes, from the federal to the district level.
Fourth, and most importantly, until health workers do not gain access to Fata to immunise children and the Taliban ban isn’t lifted, polio will prevail. Previously, the government’s weak position and growing security threats made it unlikely that it would negotiate with militants on a topic where there seems to be little flexibility. And with the commencement of Operation Zarb-i-Azb, it remains to be seen whether health concerns are addressed at all alongside bigger strategic and security aims.
The writer is a journalist.
Published in Dawn, June 17th, 2014