No short cuts to polio eradication

The government has voiced its support, in theory, but those goals have not been translated into effective strategy.


Samia Altaf September 14, 2014

Pakistan’s most recent effort to eradicate polio is something like trying to put out a forest fire with few water guns. The evidence shows that 148 cases have been identified so far —the most recent in Khyber Agency and the numbers are expected to keep increasing. Moreover, there is a severe problem of unresponsive fixed centres, fatigued programme staff, and lack of support from federal authorities. There doesn’t seem to be enough water for the water guns, if there’s a way to get them to the fire in the first place.

Protection from polio requires herd immunity — when about 90 to 95 per cent of the population receives viable vaccines according to the established protocols, that means five doses of OPV at regular intervals. This, of course, is not happening in Pakistan. Over the past 20 years, vaccine coverage rates nationwide have come no higher than 52 per cent, and are even lower in some places. The current plan may be heroic and extremely detailed — the National Eradication Action Plan of 2014 and Khyber-Pakhtunkhwa’s Peshawar Plan lay out extensive information about management structure and polio control rooms (the former envisions a total of 25 management committees for each province, from the federal to the tehsil level) — but they are short on specific commitment from the government to ensure field level implementation of activities. Such plans will not help eradicate polio.

The only way to do so is to build herd immunity through consistent and easily available routine vaccinations for all children under the age of five. That needs more than the water gun of one-off campaigns with poorly trained staff and no support: It needs a functioning, responsive and accountable health system.

There is no short-cut to that goal. The government has voiced its support, in theory, but those goals have not been translated into effective strategy. Though it is a challenge to organise a one-off campaign under the current circumstances, fixing a chronically dysfunctional system is even more so. But that is exactly what needs to be done if the government is serious about containing polio.

The first challenge will be to undertake a consistent and honest appraisal of the system’s abilities, with recognition of its deficiencies and failures. There is ample evidence that focuses on specific local level problems that hamper services, such as timely payment to staff and absence of effective communication to the population regarding the usefulness of vaccines. These problems can and should be fixed by the provincial governments. All parties have to be included in this process — including the donors, such as USAID and the Department for International Development, UK, who have accepted theoretical commitments and then looked the other way when their taxpayers’ money is misspent. It will not be an easy process. It will probably not yield any dramatic photos of internally displaced children lining up for drops being administered from the back of the truck. But putting out a forest fire requires much more than just a water gun and good intentions.

Published in The Express Tribune, September 15th, 2014.

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COMMENTS (3)

SR | 9 years ago | Reply

Read your book, "So Much Aid, So Little Development" and loved it. I have worked in the Planning Commission and could relate to the remarkable vignettes of the officialdom. Keep on keeping on...

Hari Om | 9 years ago | Reply

The reason why “Pakistan’s most recent effort to eradicate polio is something like trying to put out a forest fire with few water guns” is pretty straight forward. It is the inevitable outcome of Pakistan’s obsession for boxing above her weight class and nurturing an outsize military in order to seek parity with India leaving limited resources of a “few water guns” for carrying out a sustained and widespread polio vaccination programme which is near 100% effective.

Till such time as Pakistan accepts the immutable reality that she is inferior to India and throttles back on parity seeking military expenditure, Pakistan’s civilians will have to make do with “few water guns” and continue to suffer the “forest fire” of an easily preventable diseases like Polio which requires nothing more than the administration of a vaccine to prevent.

Seeking parity with India by gorging on shiny new eye candy weapon systems, maintaining the Generals, Marshalls and Admirals of the Military in the princely Mughal style they are used to and strutting the world stage as the “Sole Islamic Nuclear Power” and “Citadel of Islam”, will as former Prime Minister Z.A. Bhutto put it require Pakistan “Eating Grass”.

The solution is thus rather straight forward. Pakistan needs to accept the reality that she is India’s inferior.

The big question that then remains is will Pakistan make the rational choice and junk the braggadocio of attempting to seek equality with India? Or will it accept the inevitable consequence of misallocation of resources entailing children of Pakistan’s civilians figuratively “Eating Grass” and suffering the scourge of a disease that can be eradicated with a simple vaccine?

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