This is a rare opportunity for the Pakistani government, along with its international partners, to seize upon the damaging effects of the travel restrictions and take advantage of the medical personnel and resources that are now suddenly essential, and will reportedly be made available, to drive forward the polio vaccination campaign. In recent years efforts have been hampered by threats from militants, natural disasters, conspiracy theories and a lack of proper public health information.
Polio has been crippling lives in Pakistan for decades but until 2006-07 the disease was actually on the decline. Unlike its neighbour, India, which managed to eliminate endemic cases of polio in 2012, in Pakistan cases are now on the rise from 58 in 2012 to 91 in 2013. Cameroon and Syria have also been labelled as ‘states currently exporting the wild polio virus’ but Pakistan has come under the spotlight because the country currently accounts for a fifth of the 417 cases that were reported globally.
Pakistan’s neighbours, China and India in particular, have taken precautions against the spread of polio into their borders from Pakistan. China tightened its border controls when cases of polio were found in areas close to its western border with Pakistan and India now requires all Pakistani citizens applying for visas to show proof of polio vaccination.
The travel restriction imposed by the WHO will hopefully compel the federal and provincial governments to re-examine the current mechanisms for immunization and stemming the spread of the debilitating disease. Although there will be a reassessment in three months, according to the WHO guidelines, in the interim there is an urgent need for mass mobilization of the polio vaccine. Proposals to setup vaccination counters at entry and exit ports both at the federal and provincial level require coordination that would be challenging for any country, in addition to the difficulties managing a fairly porous border with neighbouring Afghanistan.
With most cases occurring in the Federally Administered Tribal Areas (FATA) where polio workers have been systematically targeted and killed by militants, there is still a major challenge in reaching the affected and those who are vulnerable to the disease, particularly children under five, as they have limited, intermittent at best, access to the vaccine.
However, the cases are not confined to conflict areas on the borders but have spread to one of the largest cities in the world, Karachi, where the environment is ripe for the spread of polio, with poor sanitation, over-population and lack of public health information. In early 2014, three polio workers were killed in Karachi; this was followed shortly by the first identified case of polio in the city. The provincial government of Punjab has already taken precautionary measures by announcing polio checks at their provincial border to prevent the spread of the disease from other provinces within Pakistan.
One of the main obstacles cited by those working on the polio campaign in Pakistan is the refusal of parents to vaccinate their children. Many cite the resistance by parents as a deleterious by-product of the US intelligence gathering effort to locate Osama bin Laden which reportedly used a fake vaccination campaign to obtain DNA samples of those within the compound in Abbottabad. In June 2012 the Taliban issued a fatwa in North Waziristan against the polio vaccination.
However, the conspiracy theories began long before the raid on Osama bin Laden as rumours spread after the conflict began that these vaccines were produced in the US and being administered to sterilize Muslim males. The propensity for refusal was typically higher in Pashtun communities but of late this has spread into native Sindhi families as well. Although misconceptions around the polio vaccine have declined slightly with some religious leaders supporting the vaccination efforts, it is still a widespread problem in conflict areas of Khyber-Pakhtunkhwa and FATA.
Unfortunately, it is not simply terrorism and the narratives that swirl around in a conflict zone such as Pakistan that has contributed to these outcomes but perennial crises in the country that consecutive governments have fallen short of addressing: the breakdown of law and order, monitoring the porous border with Afghanistan, poor provision of public goods and services and lack of education.
Given the task of public health workers to administer polio vaccines has now become life-threatening (since July 2012 at least 22 polio workers have been killed) far more public support, awareness and resources are required to ensure the spread of polio in Pakistan is arrested. Closer coordination between the federal government and provincial governments in Pakistan will be essential to secure polio vaccination centres and health workers alongside a concerted public information campaign. In the long-run, public health and medical facilities in Pakistan require far more public funding than the current allocation of 2.5 per cent of GDP (2011), the lowest in South Asia.
As the scramble to immunize the minority of citizens who are able to travel abroad gets underway, Pakistanis now have one more obstacle to negotiate and one more negative narrative to reverse on the global stage.
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