Polio travel restrictions

The travel restrictions are a direct result of the export of the polio virus to countries like Syria.

The World Health Organisation had little choice but to recommend strict travel restrictions on Pakistan when it met in Geneva on April 28, 2014. The evidence was clear and unequivocal — Pakistan is an exporter of the wild polio virus and the work of decades, the complete eradication of polio, is under threat. The restrictions are tied to the exporting aspect of the crisis rather than the failure to internally eradicate polio, though the two are themselves umbilically linked. The WHO, which is the global health arm of the United Nations (UN), has recommended that Pakistanis travelling abroad by land, sea or air should present a valid polio vaccination certificate. Pakistan will have to institute an efficient and transparent mechanism that generates such certificates at federal or provincial levels, and the establishment of polio vaccination points at all airports, seaports and land crossings is a massive logistical exercise, and there have to be doubts as to the capacity of the government to deliver such a complex infrastructure at short notice.



There does not appear to be any global precedent for the quarantine of entire countries (Syria and Cameroon are to be subject to identical restrictions on their nationals). Some countries, such as India and the Kingdom of Saudi Arabia, already require valid polio vaccination documents, but the rest of the world has never had to deal with the challenge of polio-endemic countries reinfecting countries that had been declared polio free, before.

The WHO report sets out a number of conditions to be met before it reconsiders its recommendations, the first of these being that Pakistan officially declare at head of state level that the interruption of poliovirus transmission is a national public health emergency. We are also required to put in place a system that ensures that travellers are provided with an International Certificate of Vaccination or Prophylaxis as specified in Annexe 6 of the International Health Regulations (2005) as proof of vaccination. The implications of the WHO report are far-reaching and the government cannot claim it was not forewarned.

Forewarned it most certainly was and there have been indications that the WHO was considering travel restrictions at least for the last three years. One would have reasonably expected that the government would have done some contingency planning but that does not appear to be so. An official of the Ministry of National Health Services Regulation and Coordination (NHRSC) speaking to this newspaper on May 1 admitted that the government had not yet worked out a strategy as to how to deal with restrictions if they were imposed. On top of this, the prime minister’s focal person on polio displayed an astonishing ignorance of the matter for which she is the focal person by saying that “We have clearly told them (the WHO) that 90 per cent of Pakistan is polio-free, however, the issue is only in Fata and in Karachi due to the security situation.” This misses the point completely. For one thing the WHO only deals with countries on the basis of their entirety — and that is clearly stated — and for another, the travel restrictions are a direct result of the export of the wild virus to countries that have been reinfected like Syria, Egypt, Palestine and Israel. That the polio virus is currently corralled to Karachi and Fata is of supreme indifference to the WHO as that has not stopped it crossing international borders.

These measures have initially been put in place for a period of six months only, after which they will be reviewed. Pakistan must make the most of this time to improve the situation so that the curbs are removed. According to the WHO, 60 per cent of the ‘international spread’ of the virus has been caused by adult travellers. The government has indicated that it will set up polio vaccination counters at airports, seaports and all other border crossings. Though this may turn out to be a bureaucratic nightmare, this is perhaps the only way forward.

Published in The Express Tribune, May 7^th, 2014.

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