Despite hundreds of millions in international aid funds, vaccination drives and decades of awareness campaigns, Pakistan remains polio’s last refuge.
KARACHI, Pakistan — The number of reported cases of polio crossed the 200 mark this month, confirming Pakistani health officials’ worst fears: The viral disease is out of control.
In 2012 and 2013, polio cases were down significantly — 58 and 93, respectively. However, when the country reported its 212th case this week, it shattered its own 14-year record, which had stood at 198 cases in 2011.
Reproaching Pakistan, which is considered polio’s last refuge, Dr. Margaret Chan, director general of the World Health Organization, told a high-level meeting at the U.N. General Assembly in September: “Pakistan is the single most important stumbling block along the road to ending polio, once and for all.”
Polio is spreading within Pakistan’s borders, with cases reported in Karachi, the Federally Administered Tribal Areas and Lahore. Yet Dr. Durry Elias, the head of the WHO’s polio team in Pakistan, is worried it will soon spread to other countries and the 25-plus years of eradication work “will all come to naught.”
In Nigeria and Afghanistan, the other two countries where polio remains endemic, there has been a marked decrease in reported cases this year: Nigeria has reported six and Afghanistan 12.
The majority of the cases in Afghanistan can be traced back to the virus strain in Pakistan, Elias told MintPress News.
The reasons Pakistan can’t eradicate polio, he says, include the country’s “inability to reach children in North Waziristan and Khyber agency [tribal areas of Pakistan bordering Afghanistan where militancy is rife]; the attack on polio workers in Peshawar and Karachi; and lack of accountability and oversight at all administrative levels.”
Emphasizing that polio is “more than the health department’s concern,” Elias says the “highest level of political will and commitment” are needed to resolve what are ultimately complex issues.
“What I mean is, if we need to campaign in Karachi, we need enough police to go to all the difficult to access areas, so someone has to arrange it for the health department and this would mean a much higher level of leadership to make the decision.”
The international community slapped Pakistan with travel restrictions in May.
India, which was declared polio-free by the WHO in March, was the second country to impose travel restrictions on Pakistanis this year, after Saudi Arabia mandated polio vaccination drops for every person entering the country from Pakistan. (For its part, Pakistan also mandates polio drops for anyone residing in the country for over six months and planning to leave.)
Alleging that several Pakistanis applying for Indian visas had filed phony polio vaccination certificates, the Indian High Commission recently warned that such documents could result in a visa request being denied or even a permanent ban on travel to India.
Experts acknowledge that India has every reason to be cautious. In 2011, a strain of polio isolated in China’s Xinjiang province was traced back to Pakistan. In December 2012, a virus from Pakistan was detected in sewage in Cairo. In April 2013, Pakistan exported the virus to Israel, the West Bank and Gaza Strip, which had eradicated the disease decades ago, and then in October the same year polio was confirmed in 13 of 22 Syrian children in Deir al Zor province — the first cases in Syria in 14 years. Over and over again, the strain of the virus has been traced back to Pakistan.
Thus, pleading Pakistan’s case at the Global Polio Eradication Initiative’s Independent Monitoring Board Meeting, held in London on Sept. 30 and Oct. 1, must not have been easy for Ayesha Raza Farooq.
Farooq is the focal person of Pakistan Prime Minister Nawaz Sharif’s polio cell, which means she’s also the point person for international donors who are losing their patience with Pakistan’s inability to contain the spread of the virus. Aid agencies, including the WHO and UNICEF, have been spending hundreds of millions of dollars in Pakistan every year. The current three-year (2013-2015) polio eradication program will cost an estimated $300 million, $250 million of which will be financed by a loan from the Islamic Development Bank.
“I told them they had to set realistic targets, given the precarious and peculiar ground situation Pakistan is facing, instead of thinking of taking punitive measures,” she told MintPress over phone from Islamabad. “I assured the board Pakistan was not being negligent of its responsibility, nor was the country’s campaign a failure.”
Meanwhile, Dr. Zulfiqar Bhutta, founding director of the Centre for Excellence in Women and Child Health at Aga Khan University in Karachi, says that those criticizing Pakistan for its polio situation need to consider the “zillion other issues” the country is facing, including conflicts at its borders and domestic political squabbling.
“It’s unfair to be rapped on your knuckles all the time for just one issue which has become the albatross around the neck of the government in relation to public health,” he said.
In terms of polio, Bhutta says, Pakistan has had to face the “campaign fatigue that has set in after more than 150 national and sub-national campaigns, displacement of population, baseless propaganda that erupts every now and then against an effective vaccine that upsets the progress made.”
Perhaps worst of all is the issue of polio workers being killed. Since 2012, more than 60 health workers and police providing security have been killed. In response, National Health Services Minister Saira Afzal Tarar said that polio teams in high-risk areas will be accompanied by paramilitary forces in the future.
“The targeted killing of polio workers and security personnel that accompany them is unprecedented,” said Farooq.
“The biggest barrier we face toward achieving our goal of eradicating polio is accessibility,” Farooq said, noting 80 percent of this year’s cases were reported from the security compromised areas of the FATA and in cities like Peshawar and Karachi.
Meanwhile, deep-rooted views against the administration of polio drops continue to hamper the work of vaccinators. “Prior to the CIA’s fake vaccination drive back in 2011, we never faced so many refusals or ban on vaccination drive by the militants,” Farooq said, referencing the CIA’s scheme to obtain DNA from Osama bin Laden’s family by staging a vaccination drive.
“Till the program wins the hearts and minds of the people, it would remain ineffective,” said Bhutta.
Farooq says the government has been somewhat able to confront the issue of refusals. “We are now engaging with the community in the high-risk areas through influential people, especially clerics, whom the community holds in high esteem. These people, in turn, will tell the locals about the dividends of vaccinating their children, in their own language,” she said.
“Pakistan can make the last ditch effort and put the program back on track,” said the WHO’s Elias. “The virus has been cornered now. What is needed is its hot pursuit.”
Bhutta criticizes the abysmally low coverage of routine childhood immunizations against infectious diseases including polio, which averages at a mere 53.8 percent, and even lower in some districts. Unless routine immunizations can be scaled up to a minimum coverage of 80 percent or more and issues like malnutrition, poor hygiene and sanitation addressed seriously, he warns, Pakistan will continue to “play host” to the polio virus.