No short cuts to polio eradication

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 15^th, 2014.

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