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October 13, 2014

A crippled Pakistan

The crisis in Pakistan’s fight against polio is that of a weak state which does not have the will, reach or capacity to control the public health narrative.
26 years after the World Health Organization started its Global Polio Eradication Initiative and for only the second time since the health norms were established in 2005, WHO declared that the rapid spread of the wild polio virus would constitute a public health emergency of international concern. The change of status for polio from a disease that was close to universal eradication to one that was infecting across borders at an unprecedented rate, was a huge setback for the organisation and for the people working to eliminate the virus. Of the 10 countries that still harbor the virus, three had been marked as endemic and of the three, Pakistan today poses the greatest threat to the eradication of the virus.
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From less than 150 in 2010 to 200 and counting in 2014, Pakistan’s situation poses a threat not just to its own citizens, but to the region in its entirety. Pakistan announced its 206th case of polio for 2014, the highest in 14 years. The viral strain from the country has also been found in sewers as far as Israel, Syria and Palestine– all countries that had successfully eliminated the disease. To date 80 percent of global cases according to WHO are said to originate in Pakistan and it holds the dubious distinction of being one of three countries exporting polio.
The crisis in Pakistan’s fight against polio is not against accessibility or sanitation alone, but that of a weak state which does not have the will, reach or capacity to control the public health narrative. It is of misinformation, violent repression of “un-Islamic practices” and incompetence at multiple levels of the government to control the spread of the disease. Both the federal government and the provincial governments have not given any indication that they understand the gravity of the situation or have shown persistence in tackling the disease.
The death of more than 60 polio workers in the last few years, along with low volunteer turnout, inadequate pay and falling security standards remains a huge challenge. Security or the lack thereof, has also become a crutch on which provincial leaders lean on when questioned. In typical bureaucratic fashion, responsibility for security moves from the provincial level to the Prime minister’s polio cell each denying the charges faster than the other. The lack of storage facilities, inadequate access to the western border regions and mounting challenges in ensuring the kids remain vaccinated is becoming an issue too. Many of the infected children according to the polio eradication site are ones who had been vaccinated with expired vaccines. Most of the kids end up without the vaccine because of bureaucratic hurdles and corruption within the morass called the health industry. The lack of education, awareness about the disease feeds into the very popular notion of vaccines being seen as a western conspiracy to sterilise Muslims.
Each of these factors that have led to the dramatic rise of polio in the country can be boiled down to one of two issues, a state that has been co-opted by the military complex to focus on a narrow body of issues that deprioritise matters of health and safety of its citizens. Where the state opted out, religious outfits, aided indirectly by the government and with the blessings of the military have stepped in. Radical Islamic movements have established private schools, health clinics, and aid centers that often serve as a front for religious instruction. They have managed to successfully impose their definition of Islam and Muslim on society. Part of the teaching at these institutions includes spreading misinformation about western medicine, and using religion as an excuse to instill an unhealthy fear about vaccinations and their side effects. The increase in the polio numbers, the number of children succumbing to this paralysing disease has been the result of misinformation spread by these people who preach religion as a defense against medicines, and the failure of the state to use its resources effectively to counter this narrative. The state today, does not have the wherewithal to ensure that its citizens get the necessary vaccines and to ensure that preventable diseases like polio are checked. The radical movements working at cross purposes towards the state have, through the use of threat, violence, misguided information and ignorance ensured that Pakistan remains the most dangerous and largest haven for polio
The Zarb-e-azb operation that was said to be a standoff between Pakistan and the militants who terrorise its borders has so far displaced more than 2 million people. Almost half of the IDP’s are said to be children who have never been vaccinated. The risk that these children pose both to themselves and the people around them is enormous. The highly contagious nature of the disease has ensured the spread of the virus from the frontier regions to provinces like Balochistan that had managed to bring the number of its affected population down to single digits.
What Pakistan does to ensure availability and administration of the vaccine will be watched keenly in the coming days. The longer it goes without taking concrete steps to check the disease, the harder it will become for itself and the regions around it, to completely eradicate polio. The country needs to act now. 206 can never be an acceptable number, 26 years after health organizations stepped up to rid the disease.
The contagious nature of the disease also means that Pakistan poses a security threat to its neighbours who have managed to successfully eradicate the disease. WHO has demanded that Pakistan issue cards certifying travelers have been vaccinated against polio. With fake certificate rackets becoming popular, and illegal migration and surreptitious border crossing remaining an issue, certificates cannot be depended upon to ensure that the virus doesn’t cross the border.
My piece in January this year brought up the case for polio to be seen as national security threat in India. The government of India should take the threat of polio carriers infiltrating the country seriously. India has only recently been declared to be polio free. We cannot afford to let up and slacken in our efforts to ensure that the country remains polio free.
Photo: Gates Foundation

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