Pakistan’s Polio Challenge: A Crippling Fear

Pakistan's Khyber Pakhtunkhwa and Balochistan provinces are prone to a large outbreak of polio if they do not reform their immunization drives.

Posted on 03/15/15
By Imtiaz Gul and Dr. Masood Jogezai | Via The Friday Times
 CHAMAN: A health worker gives polio vaccine drops to a child going to Afghanistan in this border town on Monday.—INP CHAMAN: A health worker gives polio vaccine drops to a child going to Afghanistan in this border town on Monday. (Photo by INP, via Dawn)
CHAMAN: A health worker gives polio vaccine drops to a child going to Afghanistan in this border town on Monday. (Photo by INP, via Dawn)

The story of the two-year-old Hanifa from Balochistan’s Pashtun-dominated Killa Abdulla district is shocking and disturbing. A year ago, her father Abdus Salam turned back polio vaccine workers from his doorstep. In February this year, doctors diagnosed the little girl with the polio virus. Because of an ignorant decision by her father, Hanifa will suffer for the rest of her life. Her parents are now running around frantically to find a cure for their daughter’s illness, but chances of extricating and salvaging her limbs from the deadly virus are distant.


There were 25 reported cases of polio in Balochistan last year. Of them, 13 were in Killa Abdullah. At least 11 cases resulted from parents’ refusal to administer anti-polio immunization drops. Similar refusals in the Khyber Pakhtunkhwa province led to the arrest of over 700 parents in the first two months of this year. Nearly all of these reluctant parents consider the polio vaccine a western conspiracy to sterilize their children. They believe it will cause impotency and promote immoral behavior in their children. They have been told by clerics and religious militants that the polio vaccine contains monkey, donkey and lion meat and brains.


Such propaganda gained considerable currency after it was reported that the CIA used Pakistani doctor Shakeel Afridi and paramedics employed by Save the Children to find and kill Osama bin Laden under the cover of an anti-polio campaign. Militants have since campaigned violently against polio vaccination.


UNICEF says as many as 71,131 caregivers refused vaccination last year, with over 250 polio virus cases across Pakistan, compared to 63 a year ago. The field staff also encounters stiff resistance from parents and caretakers, who refuse to cooperate with mobile teams.


Balochistan had made stunning progress from 73 cases in 2011 to nearly zero in 2013, until last year when it registered 25 infections. A similar rise has also been seen in Khyber Pakhtunkhwa, despite a strategy for which the provincial government won the appreciation of the global philanthropist Bill Gates.


Balochistan lost about ten polio vaccine workers to terrorism in 2014. All the killings were claimed by various factions of Taliban militants. The number of polio workers and accompanying guards killed since 2012 is more than 55.


Seen in a larger context, the bureaucracy has failed in crafting a narrative to counter the militant propaganda against polio vaccination. The experience of the field staff reveals that officials often draw consolation if a new reported polio case has an Afghan origin. Rough estimates tell us that about 50 percent of the inhabitants in Chaman and Killa Abdulla are from Afghanistan. Besides, several thousand people cross the Friendship Gate at Chaman both ways daily, with the possibility of many of them carrying the polio virus.


The officials do not realize that the polio virus does not distinguish between national boundaries. The World Health Organization, for instance, once treated the Kandahar and Quetta region as one epidemiological block. But regardless of who imports the polio virus, there is little doubt that poor governance, a lack of political will, volatile security conditions, corruption and insufficient financial resource are the main causes of the recurrence of polio virus predominantly in the Pashtun regions of Pakistan.


Outreach and poor service delivery are among the major problems for the anti-polio campaign. A majority of the nearly 200,000 vaccinators are young volunteers with limited skills, commitment and doing work with carelessness. Post-campaign third-party evaluations in 2014 and 2015 reveal that the majority of the children under five years of age missed polio drops because vaccinators failed to reach them.


Another major problem is the criminal indifference of the government. In Balochistan, our political leaders should be leading vaccination campaigns at the district level, but are hardly ever visible in the areas when required. Similarly, tardy response to the raging challenge by top health department and administration officials also undermines outreach to distant areas. In many cases, media and officials report, vaccinators can neither maintain the critical cold-chain for the vaccines nor have enough mobility protection (vehicles, fuel, security) to carry out the job effectively.


Mismanagement, oversight and accountability also undermine the anti-polio drive with severe consequences for the target populations. At the cost of jeopardizing the future of young children, officials save financial resources for their own pockets, according to another complaint.


These shortcomings are compounded by an omnipresent hostile and insecure environment induced by militant groups and their religio-political supporters, particularly in Pashtun areas where Afghan and Pakistani Taliban melt into populations but keep a watch on all those who dare to challenge their narrative on vaccination or the justification for armed resistance. They roam about all over Killa Abdullah, field staff from the area observes. But they operate even in cities such as Quetta, the scene of attacks on polio workers, four of whom were killed in broad daylight, followed by kidnapping and ruthless killing of polio workers along with levies personnel in Zhob in February. The Taliban claimed responsibility.


Effective polio eradication requires fixed continuous support centers such as civil dispensaries and basic health units, which are almost nonfunctional in many districts of Balochistan and Khyber Pakhtunkhwa. Unless authorities in the two provinces rise to the challenge and fix the management issues surrounding the anti-polio drive, we all run the risk of a huge outbreak of polio in the high transmission season, which will begin in May.


Imtiaz Gul is the executive director of the Center for Research and Security Studies, Islamabad. Dr Masood Jogezai is the Technical Focal Person (Balochistan) on Polio for the Bill & Melinda Gates Foundation

This article first appeared in The Friday Times. Click here to go to the original.

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