Preparing for the next one

Will we wait for a travel ban before we take serious action and put measles and Dengue high on the national agenda?

The recent debate on the travel ban in response to the ongoing polio crisis has, once again, brought ample confusion and little action to the forefront. The government, for reasons unclear to many, decided to take an aggressive approach. Unfortunately, the aggressive attitude was not against the disease, but against the WHO. The stance of the government that this ban is excessive, or that they should have been taken into confidence before any travel ban is rather confusing. It is not that we did not know the extent of the crisis or that the discussions of travel bans came out of nowhere. Or the fact that other countries, particularly in the Middle East and North Africa, had expressed grave concerns about seeing polio amongst their populations. While the travel ban or the possibility of a travel ban is concerning, the response of the authorities is more problematic.

The polio fiasco has exposed the inherent complexity of our current public health crises. Our crises are deeply rooted in our short-and long-term health policies, our inability to protect those brave men and women health workers who are working to protect our future, our inability to recognise the sociocultural challenges and, above all, our preparedness for calamities. While polio is getting serious attention and I hope that we come out stronger from this crisis, there is a basic and fundamental question that requires some thought and introspection.



Let us ask honestly if we would have paid the attention we are paying now if the international community was not involved? If there was no travel ban, no calls from Bill Gates to Imran Khan and no WHO concerns about us exporting the disease to other parts of the world, would we be doing the same we are doing now? If the problem was squarely a Pakistan only problem — would we be paying the same attention? I am not saying that we should not be team players on the international stage. All I am asking is if we pay enough attention to our problems before they become a global embarrassment? In the last few years we have seen a surge of measles and Dengue in various parts of the country. Some regions have managed it better than others, but the threat of a widespread problem continues to loom over our future. Will we wait for a travel ban, merciless killings of our healthcare workers and hue and cry from our neighbours before we take serious action and put it high on the national agenda?

Related to this point is the question of our level of preparedness. Last week, we found out that one of the challenges in issuing “polio vaccination certificates” at the airports is the fact that we just do not have enough vaccines. Procurement in our corner of the world takes time and it may take several months (if we are optimistic) before we may have enough vaccines to give to our travellers. The issue of quality control in those vaccines is a separate issue that has not even been brought up. But the question remains, how prepared are we? Why is our policy reactionary? Should there be a challenge in widespread measles outbreak or a Dengue outbreak, are we ready?

Finally, the issue of priorities cannot be ignored. Somehow the discussion on polio has gone from eradication to the travel ban. The travel ban is a manifestation of the problem, but it is being treated as the problem itself.

The goal of our policies and efforts should not be about how to get the certificates for vaccination for those who travel, but to have a society where you do not need such certificates. Analysing why our current priorities often mismatch core problems will go a long way in saving us global embarrassment, travel bans and countless precious lives.

Published in The Express Tribune, May 13^th, 2014.

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