Prioritising polio eradication

Nothing exemplifies the state of Pakistani society and its governance better than the resurgence of the polio virus. Here is a country boasting of world’s fifth largest army, a nuclear arsenal, and utterly defeated by a contagious virus. In fact, we may have beaten our own record with more than 200 cases having been reported this year already. The world wants us to present a vaccination certificate when we travel outside the country. And the killing spree of health workers aiding the vaccination campaign continues unabated. Still, many Pakistanis ask, why is the world targeting Pakistan? Is it not enough for the world to be alarmed that more than 80 per cent of polio cases in the world are located in Pakistan?

In less than a year, Khyber-Pakhtunkhwa (K-P), Balochistan, Sindh and Fata have seen dramatic increases in the total number of reported cases. In 2013, K-P had nine cases; now the number has crossed 40. It is, however, the conflict-ridden Fata where children are most vulnerable. Last year, there were 37 reported cases and as of September 2014, 135 polio cases have been confirmed in the region.

Ask a common Pakistani and there will be a reference to Dr Shakil Afridi, a ‘spy’ who has undermined the credibility of immunisation campaigns by running a fake campaign in the hunt for Osama bin Laden. Dr Afridi, the international NGO and the CIA were irresponsible to say the least. But this is not the full story. Pakistani authorities and thousands of parents are far more irresponsible in failing to administer polio drops to vulnerable children.

Reading a news item that thousands of children are unvaccinated because of parent refusals reads like a leaf from a dark novel set in an Orwellian world. The mullahs, the media and the negligent public health machinery have all contributed to this impasse. Earlier, the stereotyping of Pashtuns suggested that the virus was a geographical issue. Now, as of end of September, 26 districts of the country have been affected. Cases have been reported from Karachi to Khyber and from Gadap to Chakwal, with thousands of children having become vulnerable. The key reasons for parent refusals entail misconceptions about immunisation, religious edicts (some clerics still declare that the vaccine is ‘haram’) and security issues, among others.

For the last few years, a high-level task force under the prime minister’s office has been coordinating the anti-polio campaign. International agencies such as the World Health Organisation and Unicef have been helping a state that should have prioritised its urgent needs itself. Like other urgent issues, the Sharif government has shown an abysmally slow response to this crisis. Since the government took over, the task force has only met once under the leadership of the prime minister. Now, there are reports of an intense turf war between the Expanded Programme on Immunisation of the health ministry and this polio task force. Both are headed by female PML-N legislators from powerful families and cannot work together on a national cause like this!

In June, it was suggested to the government that an emergency cell was needed to monitor and oversee anti-polio campaigns. It took three months for the government — a euphemism for a ring of slow-moving bureaucrats — to set up this mechanism.

Admittedly, the Sharif government has had no respite from a host of pressing problems and a chain of crises. But this can’t be an excuse for not dealing with a major crisis at hand. The PTI government that rules K-P made some initial efforts in this regard, but for the last few months, it has been busy with other things, such as mobilising protests against the federal government.

Polio eradication cannot be achieved without improving routine immunisation. In areas with poor routine immunisation, children do not develop immunity and become fragile victims of the poliovirus. Sadly, the levels of routine immunisation vary and are dangerously low in Sindh (25 per cent) and Balochistan (16 per cent). In K-P, the level is higher (52 per cent) and Punjab leads with a coverage of 65 per cent. Despite all the aid Pakistan has received for various social programmes, the target of 100 per cent has not been achieved in the past two decades. In the past two years, five polio cases have been detected in Balochistan and given the extremely low levels of routine immunisation, the virus may spread further.

Since July 2012, nearly 60 people have been killed in attacks on polio vaccination teams in Pakistan. Unicef data suggest that at least 24 health workers have died in recent months. What has been the progress in prosecuting those who kill these heroes of our times? None. Adding insult to this unforgivable injury is the fact that workers are paid late as a matter of routine. Sometimes, the lag is six months long. This is nothing but a tragic display of priorities that the political governments have set for themselves. It was expedient to plan a metrobus between Islamabad and Rawalpindi and provide billions for this project on an emergency basis, but an anti-polio campaign was not considered that important.

If Pakistan does not control and eradicate the virus, thousands of children in the country will be affected. Hundreds of children across the globe will be paralysed each day. Other than the financial implications, which run into billions of dollars according to experts, future generations will be denied their right to a healthy life.

What are the chances of the country overcoming this crisis? Given the current state of uncertainty in the country, the future prospects are bleak. The governance vacuum due to the absence of local governments makes immunisation drives even more difficult. Without adequate accountability mechanisms, service delivery is likely to remain ineffective. Until the anti-polio campaigns are not audited and officials not held accountable, how can we expect results?

The Pakistani state is fragmenting and appears to be incapable of fulfilling its basic constitutional mandates. If it does not change its direction and reverse its policy of patronising extremists, we are likely to see more crises brewing in the future. For course correction, the first step would be to punish those who attack polio teams and mobilise all resources to tackle this national polio emergency.

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

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