Saturday, July 20, 2019

Why isn’t Pakistan polio-free? If India and Bangladesh can eradicate polio, why can’t Pakistan?

Samia Altaf

IN April 2019 Dawn ran an article ‘Will Pakistan ever become polio free?” I think the pertinent question should be: ‘Why isn’t Pakistan polio-free?’
The number of cases of polio has continued to increase from 17 in April 2019 to 41 till early July and counting; 33 in KP including the newly merged tribal districts, three each in Punjab and Sindh, and two in Balochistan. These numbers demonstrate a backsliding from last year’s total of 12 cases and eight in 2017. Here we are after three decades of efforts, generous international funding — GAVI alone disbursed $1,291,736,081 and the 2018 Pakistan government budget allocated Rs.7.83 billion for the Expanded Programme on Immunisation. All governments of the past three decades had vociferously declared polio eradication their priority, so there was no lack of political will.
The reason given by policymakers and programme administrators for failure of polio eradication range from lack of quality vaccinations and the mishandling of vaccine by eradication teams, parental/community refusals, religious issues, fear of vaccines and poorly paid vaccinators. Overarching climate change and worsening environmental conditions leading to severe and frequent droughts, settlements without basic sanitation and clean drinking water are recent additions to the list. For example, there are 564 slums in Karachi where drains are full of raw sewage. Poliovirus has been isolated from sewage of cities in KP and is suspected in sewage of other cities as well. Senior government officials blame the ‘culture’ of Pakistan.
If India and Bangladesh can eradicate polio, why can’t Pakistan?
These explanations may ring true. However, they ignore what lies at the heart of this persistent failure. That is the failure of programme leadership to undertake serious analysis to determine reasons for poor performance of the eradication programme, lack of a coherent appropriate strategy based on this analysis, and blind overreliance on antiquated vaccination drives. In this context, hoping to improve vaccination rates by tinkering at the margins of the vaccine delivery programme is not likely to work in future.
What is likely to work?
It is instructive here to look at other countries that have successfully eradicated polio. The example of United States was cited in an earlier op-ed by the writer in this paper (‘Polio: no quick-fix solutions’, Dawn, July 1). Granted United States’ development level is way above Pakistan’s so it may not be considered a useful comparison. Countries closer to home, such as India and Bangladesh have also achieved polio-free status. Even the little Southeast Asian ones, eg Vietnam, are polio-free. Meanwhile Nigeria, one of the three countries — Pakistan and Afghanistan being the other two — harbouring the virus, is on its way to becoming polio-free. Nigeria has not had any case for the past 22 months and even Afghanistan has had only 10 cases this year.
How did India and Bangladesh that are culturally similar to Pakistan and have more or less similar levels of development do it? Briefly, they did it because their leaders did not resort to gimmicks, engaged seriously with the issues, analysed data to design overall programme strategy and a mix of activities, all tailored to local conditions and challenges peculiar to different communities.
For example, India, which as recently as 2009 had 60 per cent of all global polio cases, was declared polio-free five years later in 2014.This achievement was the result of India’s Expert Advisory Group’s recommendation of a strategy designed to ensure that no polio cases are overlooked and no children missed by vaccinators.
Each state conducted a detailed risk analysis and had an emergency plan to deal with any new cases, in line with recommendations from the Independent Monitoring Board. These risk analyses included review of surveillance gaps to allow supplementary immunisation activities to focus on areas with gaps in immunity. Serosurveys were conducted in the highest-risk areas to provide definitive information on children’s immunity status. The analysis led to focus on Uttar Pradesh and Bihar, two of the poorest states which had uninterrupted polio transmission, to target the children of migrant workers. The polio vaccine was given to each child along the trail followed by workers, as they moved in and out of the two states.Although only 2pc of Bangladeshi children under five years old were immunised before 1985, this number jumped to 60pc within 10 years in spite of the overwhelming challenges faced by the country in the aftermath of it independence from Pakistan. By 2006, Bangladesh was polio-free. This result was possible because the government made the commitment to develop a national strategy in context of local conditions, and by instituting sanitary reforms. The cornerstone of the national strategy was routine immunisations. The strategy was based on local data and micro-planning that included mapping the community down to the most basic level to ensure all children could be reached by routine immunisations.
Sanitary reforms consisted of building latrines to reduce open defecation, to interrupt the faecal-oral route of transmission of virus. The strategy also included Regular National Immunisation Days and development of strong multisectoral collaborations such as mobilising 250,000 youth/student volunteers to educate communities. Bangladesh is now concentrating on quality surveillance and case detection (acute flaccid paralysis) to maintain its polio-free status.
If India and Bangladesh can eradicate polio, why can’t Pakistan?
Pakistan’s prime minister in his address on July 12, as he launched the low-income housing scheme in Islamabad acknowledged the learning and useful consultations he had, amongst others, with people who have done similar work successfully on low-cost housing in Mumbai (Bombay), India. Maybe his technical team for polio eradication should take a leaf from the prime minister’s book and learn from polio eradication experience of Uttar Pradesh and Bihar.

Historic election held in Pakistan's former tribal districts

By Asad Hashim
Millions were expected to vote in elections for the first time since Pakistani constitution was extended to region.
Pakistanis in the country's northwestern tribal districts have voted in provincial elections for the first time in the country's history, marking a key step in the merger of these areas into Pakistan's administrative and constitutional mainstream.
Polls took place across the seven districts that composed the former Federally Administered Tribal Areas (FATA) on Saturday morning, with 16 seats in the Khyber Pakhtunkhwa provincial assembly up for grabs.FATA, where the Tehreek-e-Taliban Pakistan (TTP) once thrived, was ruled directly by Pakistan's president under British-era colonial laws until last year, when the territories were merged into Khyber Pakhtunkhwa province by a constitutional amendment.
The move fulfilled a long-standing demand in the tribal districts, home to some five million people.
"We are very happy to vote in the tribal areas for the first time in elections for the provincial assembly," said Rahidullah Afridi, a 29-year-old voter at a polling station in Jamrud area of Khyber district.
"We are getting an opportunity to get the same rights as all other people [in Pakistan]." More than 280 candidates, including two women, are standing for election, according to Election Commission data. The majority of the contenders are independents, but all the major national parties are represented in the historic polls.
Some 2.7 million people were eligible to vote, with large turnouts reported at polling stations as polls progressed through the day.
Composed of seven main districts, the territories flank Pakistan's border with its northwestern neighbour, Afghanistan. In the past, they have been a haven for armed groups such as the TTP and its allies.
A series of military operations undertaken since 2007 has seen the country retake control of the districts, with most remaining elements of the Pakistani Taliban driven into Afghanistan, according to the Pakistani military.
Afghanistan and the United States, however, allege that elements of the Afghan Taliban continue to find safe haven in parts of the region.
'More energy'
The merger of FATA and the extension of regular Pakistani law and constitutional rights has been a controversial subject since it was passed in May last year, with many residents of the former tribal districts complaining that nothing has changed on the ground.
"We have not seen any real changes so far," Afridi said. "Right now, it is the same old and corrupt system from before, including the [colonial laws]," he added. "No changes have come, only the names have changed."
Afridi said he had voted for Prime Minister Imran Khan's ruling Pakistan Tehreek-e-Insaf (PTI) party in previous elections, but that this time he was voting for an independent candidate.
The same sentiment was also echoed by others in Jamrud, with some voters saying they were backing independent candidates against the mainstream political parties.
"Today we are seeing even more energy [at the polls] than we saw in the general election," said Shahji Gul Afridi, 50, a former member of parliament whose 25-year-old son Bilal was standing in the election.
"Men and women are both participating, it is an atmosphere of happiness."
Women's political participation has historically been low in this socially conservative belt of the country, although there were two female candidates standing in Saturday's polls."I am taking part in the tribal areas elections because women in the tribal areas do not take part in these types of activities, and it is very difficult for women here," Naheed Afridi, a candidate from the Awami National Party (ANP) told Al Jazeera."I am breaking the chains [for women] and there will be more women after me taking part in elections in the tribal areas. This is the first step of change."
Unofficial election results are due to come in after polls close at 5:00pm local time (12:00 GMT) on Saturday, the Election Commission said. Officials figures are likely to be announced by Sunday.

#Pakistan - Risks to the IMF programme - A lack of political consensus and the FATF

Pakistan has received the first immediate tranche of the latest IMF Extended Fund Facility (EFF) of $1 billion out of a total of $6 billion, giving the SBP reserves a much-needed boost to reach $8 billion after almost reaching a dangerously low level of below $7 billion, last seen in 2013. Future tranches will however come in after periodic review and in much lower volumes over the next three years. Those review meetings will mostly be an assessment by the Fund of whether or not Pakistan is fulfilling the financial conditions of the EFF so that they remain on track as the programme progresses. That the IMF resident representative Teresa Sanchez feels that the programme faces ‘significant risk from a failure to build political consensus around its key components’ means that there are political conditionalities attached to this bailout as well. Her concern is valid considering that the PTI does not have a majority in the Upper House and a very thin majority in the Lower. There are certain requirements in the latest EFF like amendments to the State Bank Act, NEPRA Act, Anti-Money Laundering Act and the State-Owned Enterprise Act, that will require legislation and therefore the opposition’s vote.
Clearly, the Fund too is observing how relations between the government and opposition are deteriorating by the day with no let-up by either side. While the government continues to lock up the top tier leadership of major opposition parties on unproven innovative charges, the opposition too is not taking it lying down as it dials up the temperature both in and outside of Parliament. Ms Sanchez also pointed out that remaining in the FATF grey list will make it difficult to secure much-needed private capital inflows in this fiscal year; however the listing did not affect disbursements of multilateral loans. It is still however essential to meet satisfactorily the FATF terms to avoid blacklisting and get off the grey list for long-term financial stability. The government must realise that if it wants to take full advantage of the IMF programme it will need to create some consensus with the opposition but if it continues push them up against the wall they will be unable to meet some key conditions set forth by the Fund.

#Pakistan - More arrests, no results

 The National Accountability Bureau (NAB) continues with its newfound mission of arresting politicians belonging to the previous regimes. The latest performance of the NAB officials is the arrest of former prime minister and Pakistan Muslim League-Nawaz Senior Vice President Shahid Khaqan Abbasi. By the time he was arrested, everyone was clueless about the ground for his arrest, however, according to media reports, the purported corruption in the LNG (liquefied natural gas) import contract case might be the reason. The arrest warrant issued by NAB Chairman Justice (r) Javed Iqbal says: “Shahid Khaqan Abbasi is accused of commission of the offence of corruption and corrupt practices under Section 9(a) of NAB Ordinance 1999 and Schedule therefore I direct his arrest.” The warrant statement is an open-ended statement. The NAB chairman should have stated plausible reasons for the decision. Abbasi’s arrest does not come as a shocking surprise as he himself was predicting this, while the media was also full of reports in recent days that it was the matter of time.
NAB arrested Abbasi without any event, but in Karachi, a NAB team raided the house of another opposition leader Miftah Ismail and was not successful to take him into custody. Again, NAB is not bothered to explain why Ismail’s house was raided and in what case he is wanted. The continuous wave of arrests has muddied the already murky political situation of Pakistan. Every arrest, right or wrong, is being dubbed as political victimisation by the opposition parties. They are right in calling it a political victimisation era because of the way opposition members are being treated. A cursory look at the list of the arrested leaders reveals that all of them were arrested unnecessarily. PPP Co-Chairman Asif Zardari and his sister Faryal Talpur were fully cooperating with NAB investigators, while those arrested in the fake accounts case, months ago, have yet to be framed in any reference. Similarly, Opposition Leader Shehbaz Sharif and former minister Abdul Aleem Khan were arrested and kept in custody for months but only to be released when the watchdog body found no ground to institute a reference against them. The case of Aleem Khan is a textbook case for NAB has been investigating it since 2009 and still unable to go ahead. The NAB action cost Aleem Khan the ministry portfolio.
NAB’s performance on arrest count is exemplary, whereas the conviction rate is pathetic. For years, it has ruled with outdated regulations and incompetent investigators. This must end now. Pakistan needs an effective, powerful and modern accountability watchdog. The government must step towards the formation of the new body.

#Pakistan - PM has Saudi crown prince to thank for US visit

By Kamran Yousaf
Prime Minister Imran Khan is set to embark on an official visit to the United States on Saturday — made possible by the role played by Saudi Crown Prince Mohammed bin Salman — aiming to mend strained relations and attract much-needed investment for the country.
The prime minister is undertaking the maiden trip to Washington on the invitation of US President Donald Trump.
He will be accompanied by Chief of the Army Staff (COAS) Gen Qamar Javed Bajwa, meaning the discussions would be wide-ranging. Analysts believe he will play a key role in discussions away from the media glare where much of the serious business of the visit will take place, with the military looking to persuade Washington to restore aid and cooperation.
When Imran walks into the White House and meets Trump on July 22 that would be culmination of hectic behind-the-scene diplomatic efforts spanning many months for arranging the summit.
According to officials with direct knowledge of the efforts, Saudi Crown Prince Mohammed bin Salman used his personal contacts with Trump’s son-in-law Jared Kushner to arrange the invitation for the prime minister to the White House.
Kushner is also a senior adviser to Trump.
Efforts to arrange the prime minister’s trip to the US began in December last year after Trump wrote a letter to Imran, seeking his help in facilitating the Afghan peace process.An official, who is familiar with the development, told The Express Tribune that the prime minister was keen to have a face-to-face interaction with Trump because he was of the view that “such a meeting would help dispel many misperceptions the US president may have about Pakistan and its role in the region”.But given the apparent tensions in relations and deepening trust deficit between the two countries, it was not possible to convince the American establishment for the Trump-Imran summit.
The only possibility was if Pakistan could bypass the US bureaucracy and made a direct contact with Trump.
“That’s when the idea of using unconventional channel came,” revealed the official, who requested not to be named since he was not authorised to speak to the media.
Pakistan then decided to approach the Saudi crown prince knowing his ‘close contacts’ with Kushner.
Since assuming his office, Prime Minister Imran held several meetings with the Saudi crown prince in short span, something that helped him develop personal relationship with the future Saudi king.Sources confirmed that the Saudi crown prince used his ‘good offices’ to convince Trump through his son-in-law for a meeting with the prime minister.Another figure that complemented those unprecedented efforts was Republican Senator Lindsey Graham, who is considered close to Trump.Graham visited Islamabad in January and was ‘highly impressed’ with the ‘vision’ of Prime Minister Imran for Afghanistan and the region.
Graham believes Trump and Imran had ‘similar personalities’ and they would surely go along well with each other.
“If President Trump ever met Prime Minister Imran and he listen to what I have listen today, I think he will be far more enthusiastic about the region than he is today,” the influential Republican had told reporters after meeting Imran.The sources said Foreign Minister Shah Mehmood Qureshi stayed in touch with Senator Graham, who made personnel request to Trump for extending an invitation to the prime minister.The idea behind pushing for Imran-Trump summit was to have ‘candid and open’ discussions on some of the pressing issues facing both the countries and the region.Officials familiar with the agenda of the prime minister’s visit said discussions would focus on bilateral ties and regional issues — including Afghanistan and beyond.But unlike the previous visits, Prime Minister Imran may not necessarily stick to the ‘official brief’ on bilateral ties and other issues.He is likely to share his own vision for the future of Pak-US ties as well as for the region with particular focus on Afghanistan.
Observers believe that given the unconventional nature of both leaders, it will be interesting to watch if Trump and Imran click together. If that happens, analysts say, things could turn for the positive.
Trump’s main concern is Afghanistan while Imran is looking at reviving bilateral ties with the US in a manner that helps Pakistan’s faltering economy.
Some officials claimed that the fact Imran was invited at the White House was an acknowledgement of Pakistan’s ‘positive role’ in facilitating the Afghan peace talks.
The visit is not only being watched closely by many Pakistanis back home but also in neighbouring India.
The officials said they were aware of the ‘influential’ Indian lobby in Washington and; hence, the preparation was made accordingly.
The prime minister’s visit comes just days after authorities arrested Hafiz Saeed, the alleged mastermind of November 2008 Mumbai attacks.His arrest was welcomed by Trump, who claimed that it was possible after ‘great pressure’ exerted on Pakistan for last two years.
The arrest of Hafiz Saeed would help neutralise Indian propaganda that Pakistan was not going after all militant groups, officials maintained.