‘Silent refusal’ caused Bajaur polio cases

DHO says parents pretend their children have been vaccinated

SHABQADAR: A three-day polio eradication campaign started on Monday in the merged tribal district of Bajaur.

The inoculation exercise follows reporting of two polio cases from the district. National Emergency Operations Center (NEOC) Islamabad had notified two polio cases of 2018 from Bajaur tribal district K-P.

National institute of Health had isolated wild polio virus from stool sample of 36 months old boy Abdur Rehman and 78 months old girl Nabila: both of them were residents of village Jaba Manzai, UC Tali, Tehsil Salarzai of district Bajaur.

“The Bajaur Salarzai cases were of silent refusal. The main focus of present polio campaign is to sort out all such refusal cases while those who refused to immunise their children will be punished under law,” said a health official of Bajaur while talking to The Express Tribune.

Bajaur Deputy Commis­sioner Usman Mehsud, earlier in a media talk, said that the surfacing of polio cases in Bajaur was alarming.

“Strict action will be taken against men who refuse to immunise their children and disciplinary action will be taken against health officials showing negligence in the eradication campaign,” Mehsud said.

Separately, Bajaur District Health Officer Dr Wazir Safi told The Express Tribune that recent four cases in Salarzai were silent refusal cases.

Silent refusal means that parents pretend that their children have been immunised although they have not been, he said.

Dr Safi said that the village from where the cases have been reported from was on Pak-Afghan border and sometimes it was difficult for polio teams to reach there during the immunisation campaigns.

The top public health official of Bajaur said that apart from cross-border movement by tribesmen, inaccessibility was also main factor because the polio teams face life threats in these border areas, besides the vaccinators do not have facilities to reach these far flung mountainous areas.

The families of the two children affected by poliovirus had lied to the immunisation teams about vaccination. At times they had rudely turned away vaccinators insisting to immunise children, Dr Safi said.

He told that in Bajaur, due to life threats, lady health visitors are only working in the urban centres like Khar, Nawagai Pashat and cannot visit rural areas or villages on the border, whereas men cannot visit someone’s home to know about vaccination.

Another official, who did not want to disclosed his identity because he was not authorised to talk to the media, told The Express Tribune that polio eradication programme officials must differentiate between the social environment of Islamabad and Bajaur.

In Islamabad, there is no such restriction on teams to visit homes and inoculate children, whereas in Bajaur, women inoculators were not allowed in most of the areas while men vaccinators were also attacked here.

Moreover, no man can dare walk up to a tribal Bajauri’s home in the border regions and tell him to bring out his children to verify polio vaccination, the official explained the sensitivity of the social stigma linked to polio vaccine.

He said that polio vaccinators have no such incentive to take up the challenge of complete inoculation in the mountainous areas. Moreover, their honorarium was nominal and they were not getting any travel facilities either, then why would they put their lives in danger.

As against the local vaccinators, the WHO and Unicef field staff gets a much better incentives. The official said that at times it was not possible for the vaccinators to reach all the targeted areas in the mountains due to short span of time of three days.

Immunisation plan

The health authorities plan to immunise 231,380 children during the three-day drive in the Bajaur tribal district. At least 1,013 vaccination teams and 125 monitoring teams will be deployed in 38 UCs of the tribal district. DC Bajour and DHO Bajour have urged the local to cooperate with teams and in case of any children missing the vaccination, they must inform the officials at control room to root out the poliovirus from the tribal district. 

Published in The Express Tribune, January 22^nd, 2019.