Military Operation Opens Immunization Window In Pakistan

Author : Zofeen Ebrahim

The mass exodus of Pakistanis fleeing the dangers of war has a surprising bright side: polio vaccinators can finally reach previously unreachable children.

As the Pakistan army continues to flush out militants and destroy their hideouts, 1 million residents have fled North Waziristan in the Federally Administered Tribal Areas with nothing but the clothes on their backs.

They’re risking their lives to escape the dangers of war, and in the process, they’ve become another source of danger to others.

Yet many like Dr. Zulfiqar Bhutta, a pediatrician and immunization specialist at the Aga Khan University in Karachi, see this mass exodus as a welcome opportunity.

“This is a God-sent opportunity to reach families and children who, ‎to date, have been held hostage by obscurantists and terrorists who have held the entire community and the polio program hostage for so long,” he told MintPress News.

Since June 2012, no polio vaccinator has dared venture into Afghanistan-bordering FATA. Militants banned them from administering polio vaccine drops to an approximate 350,000 children living there unless the U.S. stopped drone strikes.

Dr. Elias Durry, the head of the World Health Organization’s Polio Eradication Initiativein Pakistan, could not agree more with Bhutta.

“The recent ground reality of massive population movement, since last month, provided a perfect opportunity to reach these unreached children,” Durry told MintPress.

When the exodus from North Waziristan began, the government set up hundreds of vaccination points at permanent transit points, including train stations and bus stops, so that all children could be administered the oral polio vaccine before entering neighboring Khyber Pakhtunkhwa province.

As displaced communities move into other parts of Pakistan (some have also gone into Afghanistan), feverish vaccination drives are taking place in host communities as well as at transit vaccination posts. Over 800,000 people have been vaccinated within Pakistan as part of these efforts, and over 35,000 in Afghanistan.

Success goes hand-in-hand with failure

For over 25 years, the world has been battling this crippling disease with significant success. In 1988, polio was endemic in 125 countries, but today, it is found in just three: Afghanistan, Nigeria and Pakistan.

Up to 116 cases have been reported so far this year, with 103 from the three endemic countries. Of the total, 91 are from Pakistan, 5 from Nigeria and 7 from Afghanistan.

Of the three endemic countries, Pakistan has the poorest record in fighting polio. In 2005, the country reported just 25 cases and was on the verge of eradicating the disease, but last year, 93 cases were reported.

Experts say the main reason for the rebound is that the war within and at its borders has derailed the polio eradication campaign. In fact, most cases have been sprung from security-compromised areas, despite the Pakistani government’s persistent pleas for the Taliban in North Waziristan to give safe passage to vaccination teams. (Of the 91 cases of polio reported this year, 55 are from North Waziristan.)

Experts say that until the virus is completely eliminated from the face of the Earth, it poses a danger to the world.

“Despite the progress achieved since 1988, as long as a single child remains infected with poliovirus, children in all countries are at risk of contracting the disease,” according to the WHO. “The poliovirus can easily be imported into a polio-free country and can spread rapidly amongst unimmunized populations.”

The war on polio virus continues

A month on, the influx of the internally displaced persons into Khyber Pakhtunkhwa province is down to a trickle. But health officials say the war on polio is far from over. As the internally displaced persons move from neighboring areas and spread to other parts of the country, the virus needs to be closely monitored. Dr. Nima Abid, former head of the WHO in Pakistan, fears there is imminent “risk due to possibility of the virus spreading to settled districts of Khyber Pakhtunkhwa province and beyond.”

“The risk of disseminating the virus in other parts of the country is definitely there,” Durry noted, emphasizing the need for continued vaccination of internally displaced persons living within host communities.

“That risk can be mitigated by immunizing children in possible host communities and also maintaining high immunization rates across the country through special campaigns and routine immunization,” he continued.

Abid said that while vaccination at the permanent transit points was good, vaccination of internally displaced persons within host communities needs to be improved in order to make full use of this unique opportunity, especially in Frontier Region Bannu in FATA and Bannu district in Khyber Pakhtunkhwa province.

“The transit points and house-to-house campaigns for polio vaccination should be part of every health and humanitarian intervention for [internally displaced persons],” he stressed.

“We are holding weekly three-day vaccination campaigns in all the areas and immunizing the under-five locals as well as displaced children,” Ahmed Ali told MintPress over the phone from Bannu.

He works in the government-run Lady Health Workers program. The Lady Health Workers are 100,000 female community workers who go door-to-door delivering basic health services. They are also the backbone of the immunization services in Pakistan.

“But people are getting tired of our polio teams knocking at their door at all odd times of the day — especially because it is happening too often — and have started refusing,” noted Ali.

Ali has observed that in the last five years more and more parents are refusing, and not only because of vaccination fatigue.

“Misinformation about the vaccine persists — some suspect it causes infertility among females and is a Western ploy to curb the Muslim population,” he said.

According to official data, the number of refusals increased from 4,200 during the polio vaccination drive carried out between June 6 and June 8, to 12,043 during the vaccination campaign run from June 23 to June 25.

On a visit to the camps set up for the new entrants, Ali said he overheard a displaced woman muttering angrily that making them leave their homes and beginning an army offensive in their villages was a conspiracy by anti-polio teams to vaccinate their children.

But they dared not refuse, as that would have meant not being able to enter the comparatively safer Khyber Pakhtunkhwa province or take advantage of the government’s aid packages for internally displaced persons.

With the displaced people posing a risk for “further dissemination of the virus,” as explained by Durry, the situation has been compounded by the refusals from the host communities.

But even if the displaced children are administered the oral polio vaccine, experts say the one-time administration is certainly no guarantee that the children are protected and that the disease will not spread.

“There is need for multiple doses, ideally weekly, to rapidly build the immunity amongst the [internally displaced persons],” Abid said.

Routine immunization takes a backseat

In the hurry to vaccinate the displaced children against the polio virus, Bhutta observed: “Sadly, the focus is not on other vaccinations. We should be using the opportunity to fully vaccinate these children.” “It seems that the agencies were unprepared for this, despite the operation clearly looming for weeks, if not months.”

Referring to the steps taken by the government based on the recommendations of the WHO, whereby since June 1, everyone leaving the country had to be vaccinated, he described the huge undertaking “an unnecessary distraction” and “a bit overblown.” Instead, he said what was most urgently needed was to “rapidly scale up immunizations so that there are no pockets of disease in Pakistan.”

http://www.mintpressnews.com/military-operation-opens-immunization-window-in-pakistan/194084/