Misconceptions, service provision failure, insecurity and foreign involvement are to blame for Pakistan’s polio crisis.
As the number of polio cases reached 74, the inevitable finally happened: The World Health Organization (WHO) imposed a six-month international travel restriction on Pakistanis to prevent the possible spread of the polio virus from Pakistan to other countries. Of the 74 cases registered worldwide, 59 occurred in Pakistan.
The government is now left with no other option except to ensure that all people residing in Pakistan and long-term visitors receive a dose of oral polio vaccine (OPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to travelling overseas.
The WHO slapped travel restrictions on Pakistanis after identifying Pakistan as one of three countries at risk of further spreading poliovirus to the rest of the world.
For the past few years, Pakistan’s government has failed to reduce the numbers of polio cases to acceptable levels, despite WHO warnings. A number of campaigns for vaccinations across the country were not successful in eliminating the disease. The question is why?
Failure on many levels
Pakistan reached this embarrassing point for a number of reasons.
First, rumours and misconceptions about the polio vaccine have run free across the country. Some say that this vaccine is being used to control the birth rate and decrease women’s fertility; others claim that it weakens children. Whatever the misconception, little has been done by the state to change people’s minds about the vaccine. The high polio rates have been a failure of education, in a way.
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Second, failed services and negligence have also contributed to the problem. In a number of regions like Federally Administrated Tribal Areas (FATA) and remote regions of the Khyber Pakhtoonkhaw Province, anti-polio campaigns have used the expired vaccines scandal to discourage people from getting the vaccine. At the same time, in some areas suffering regular blackouts refrigeration and storage of the vaccines has been a challenge. Because of the systematic service provision failure of the government, some village leaders have taken to boycotting polio campaigns to pressure the authorities to take care of their electricity needs.
Third, it is also clear that the international community shares part of the blame. The fact that these organisations have focused only on polio, when babies need a set of nine vaccines has not been well received in Pakistan. Furthermore, revelations that Dr Shakil Afridi, who led a fake polio drive to help the CIA capture Osama bin Laden, worked for some UN agencies, has not helped the situation either. In fact, because of the continuous use of drones by the US in the northern parts of the country, the Taliban decided to banall polio vaccination campaigns.
Fourth, the government has failed to protect anti-polio medical workers. Recent years have seen more than 100 attacks on polio teams and workers in which at least 50 polio workers lost their lives. Despite the frequency of the attacks, none of the perpetrators have been identified or arrested by the security agencies. If the government was to show true commitment to eradicating polio from the country, it would put much more effort into protecting vaccination teams.
What needs to be done?
After the WHO imposed travel restrictions on Pakistan, the Khyber Pakthoonkhaw Province under the leadership of Imran Khan, a former cricketer, launched a health programme called “Sehat Ka Insaaf” (Justice for Health). I travelled to Peshawar with the Sehat Ka Insaaf organisers to observe their work, but in the two days of my stay there I did not see even a single polio team in the city. Campaigns such as Sehat Ka Insaaf cannot end polio. All they can do is provide their leaders with the publicity and political gains they are hoping for.
A senior official at WHO’s Pakistan office told me that the polio cases are concentrated in Peshawar, FATA and Karachi, while the rest of the country is polio free for now. With this in mind, it is time to revamp the polio vaccination drive and focus it on the areas experiencing high incidences.
The government should develop better security services for polio workers as well as better plans to cope with the reach and penetration of vaccination campaigns. Government officials should also try to engage regional and tribal leaders in this initiative to minimise security concerns and encourage local communities to trust the vaccination teams. An education campaign should focus on dispelling negative misconceptions about the vaccine and explain what exactly it does. Finally, the international community and organisations need to back the Pakistani government’s efforts by providing funding and effective support on the ground that reflects the real needs of the population.
Only a sincere effort on the part of all stakeholders could help to eradicate polio from Pakistan.