Pakistan: Polio: turning point

AROUND this time last year, approximately 48,000 families in Pakistan had refused vaccinations. In 2013, that number stands at 65,947. On the eve of World Polio Day 2013, this highlighted an ever-increasing trust deficit between the government and the parents of at-risk children in outlying communities, a deficit that is costing Pakistani lives. We are at a strange turning point, where our indisputable success is marred by our unfortunate failures. The polio eradication campaign’s numbers are certainly impressive on paper. 33.4 million children under the age of five are targeted for vaccinations. Over 200,000 people assist in a campaign that stretches across the country in 102 districts. But inefficiency, deep-seated corruption, lack of proper security for health workers and inaccessibility to certain regions continue to act as a debilitating counterweight to the immunisation efforts. Chief among these, compromised access between children and health workers is what truly gives polio free rein. Pages 115 through 127 of the Abbottabad Commission Report narrate how Dr Shakeel Afridi latched his work on hepatitis with local vaccination campaigns. The Tehreek-i-Taliban Pakistan (TTP) has mandated that they are not against vaccinations in general, nor do they oppose comprehensive health for Muslims. Instead, they are wary of potential spying being conducted under the ruse of vaccinations. But the truth, as always, goes deeper than that. State Minister for Health Services, Regulations and Coordination Saira Tarrar recognises the political acumen behind this narrative. “The extremist elements recognise that there is a lot of international pressure on Pakistan to eradicate polio, and so they are using this to their advantage by clubbing other demands with this issue,” she says. “Through peace talks or any other means, immunisation must start in the tribal belt, or this problem will rapidly get out of control.” The ban has been in effect in Fata since June 2012. This fear, and the threat of violence associated with it, has now permeated the general psyche of families that now regularly refuse vaccinations. Unfortunately, a number of key questions about the unexpected fallout from this event remain unanswered, further exacerbating the issue. The media excels at asking pointed, scandalous questions about the inci-dent, but rarely quells any misconception. For example, in a vaccination campaign, there are no bodily fluid samples needed, blood or otherwise. It is a simple matter of two drops of oral polio vaccine being administered. Each exposed child puts an additional 200 — 5,000 children at risk. Dr Elias Durry, chief of the Polio Eradication Initiative at the World Health Organisation, who has developed expertise eliminating polio in 10 countries over two decades, feels that Pakistan has a great opportunity to capitalise on and interrupt polio. The numbers support his viewpoint. The current tally is now at 49 for this year. This number is just nine short of 2012’s 58 confirmed cases. However, it is important to note that the bulk of these cases, 36 to be exact, come from parts of the country where the TTP-imposed ban is in effect. The virus has thus been largely cornered. But if Pakistan does not immunise its children at this juncture, experts postulate that global eradication efforts may be put at risk, and that international travel restrictions may be applied to Pakistanis to curb the spread of polio. Cases springing up in other provinces also highlight the ugly truth that Pakistan is currently unable to immunise its children, irrespective of the disease. The number of measles deaths went from 64 in 2011 to 306 in 2012, and this has only worsened in 2013. Hiding behind the threat of violence for going into places like the North Waziristan and Khyber agencies may seem like a sound political excuse, convenient in its scope and clearly a detriment to national immunisation efforts. But this point becomes questionable when juxtaposed against the fact that the brunt of the recent measles epidemic was borne by Punjab and Sindh, not Fata. This is further reinforced by the Pakistan Demographic and Health Survey, which highlights the current coverage rate of fully immunised children at an abysmal 53.8pc. In Punjab and Sindh, 54pc of 8,844 children assessed between January 2012 and mid-May 2013 were not vaccinated against the disease. The point stands: Pakistan is unable to fully immunise its children. Ms Tarrar agrees. She feels that if we can build this infrastructure now, it will help us establish comprehensive, routine national vaccination campaigns. That is the only way forward. This issue has a lot of moving parts. Efficient campaign management, steps to eliminate corruption, resolution with the TTP, grass-roots campaigning to convince parents to immunise their children, stemming misconceptions, a media that responsibly answers the questions it raises with reckless impunity, security for health workers, a strong political will to see the campaign through, and sustaining the success we have achieved so far, they all contribute the smaller pieces to the larger picture. Once again, on paper, the strategy is impressive and comprehensive. But the execution is hampered by a myriad factors that must be countered with serious political resolve. Only then can we ensure optimal campaign activity in all parts of the country, including sustaining the campaign in the polio-free regions.