The past few days have been tumultuous in Pakistan as far as the fight against polio is concerned. Polio is a crippling but preventable disease, which has brought Pakistan in global limelight once again after an incriminating report of the Independent Monitoring Board that has sharply criticised the efforts of the country and suggested that much more needs to be done in order to prevent polio’s spread. There are several reasons, which have brought Pakistan to the state where it is right now, with reference to the spread of polio. There is the community refusal aspect on religious and medical grounds; there are also administrative and logistical issues related to the vaccination campaigns. Those who are responsible for providing vaccinations, especially UN bodies like the World Health Organisation and Unicef, usually follow three criteria when deciding where to focus in the campaign. The first criterion is that of ‘reported cases,’ i.e., if a case of polio is reported from an area, that area must be vaccinated, whether the vaccination team is able to perform duties in that area or not is a different matter. The second criterion involves ‘environmental sample coming out as positive’, which refers to the samples from sewage drains containing the polio virus. A positive sample requires extraordinary efforts in vaccinating that community. The third criterion is that of ‘refusal’ by the community to immunise their children against the polio virus, which is another reason to vaccinate that community. This last criterion has exponentially increased in importance and has led to all kinds of issues, including tragic killings of female polio vaccinators all over Pakistan. Refusal to immunise is on the rise in certain areas of Karachi, and due to security concerns, vaccination campaigns have been ineffective.
As a public health professional, I have worked on two intervention projects related to polio eradication in the not-so-distant past in Karachi and other parts of Sindh. One of the hurdles that the vaccination teams in Karachi face is lack of support by law-enforcement agencies. Nowadays, the campaign in Karachi is so heavily dependent on security that it is virtually impossible to make any progress without their support. Unfortunately, the security support picture is grim and the police and other law-enforcement agencies are neither motivated nor prepared to provide proper protection to vaccination teams. On immunisation day, which has to start early in the morning to cover maximum population, the teams have to wait for hours for security without which they cannot move. By the time that is arranged, half the day is gone. Often, the security personnel do not carry weapons with them. It remains questionable whether the higher authorities in district management and law-enforcement agencies are completely aware of the issues faced by vaccination teams.
Refusal to vaccinate on the basis of religion is another factor leading to the spread of polio even though most religious scholars have supported anti-polio campaigns. However, many madrassas in Karachi are still reluctant to talk about polio immunisation with their followers. We have been advised by one such institution to get a ‘halal’ stamp on the polio vials. The process of getting the ‘halal’ stamp is not an easy task by any means. It involves certification by specialised food analysers and laboratories in different countries. UN organisations should consider doing this as this may help in reducing some of the hurdles that vaccination teams face.
Nevertheless, in an urban centre like Karachi, the role of law-enforcement agencies and their leaders is key at the moment, if any real progress has to be made in covering the population and vaccinating for polio.
Published in The Express Tribune, November 10th, 2014.
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