Eradicating polio

In a report published by Al-Jazeera (Oct 7, 2013) “Pakistan — one of only three countries where polio is endemic — reported nearly 200 confirmed cases of the disease in 2011, the most for any country that year. Pakistan was able to bring that number down through a vaccination program that is supported by the U.N., but threats of violence could reverse its progress. Polio, which can cause irreversible paralysis within hours of infection, is spreading rapidly throughout Pakistan.” We are not talking of mere ‘threats’ of violence here. We are talking of incidents of brutally killing polio workers. About 75 percent of Pakistan’s polio cases can be traced back to certain areas, primarily FATA, the Federally Administered Tribal Areas, and neighboring Khyber Pakhtunkhwa. Quetta, in Baluchistan, is also difficult to enter, says Pakistan’s point person for polio, Shahnaz Wazir Ali (npr: ‘How Taliban are Thwarting the War on Polio’ by Jackie Northam on October 17th 2012).
According to Reuters on 20th December 2012, the Pakistani Clerics called for protests against polio workers killings. The report states that Tahir Ashrafi, who heads the moderate Pakistan Ulema Council, said that 24,000 mosques associated with his organization would preach against the killings of health workers during Friday prayers.
But is condemnation by itself enough?
It is extremely sad to note that besides Nigeria and Afghanistan, Pakistan is the third state that is still struggling with polio cases. Whereas according to a local newspaper (Jan 14, 2014) India has successfully completed three years of polio eradication from her lands. Around 2009, India had nearly half of the world’s polio cases, shares the report. United Nations Foundation states reasons for this achievement and includes; ‘strong leadership and political will at every level of government, dedicated, trained health workers and volunteers, public-private collaboration and financial resources and commitments from government and public/private organizations.‘ (Kathy Calvin March 29, 2012)
Although the Taliban are creating roadblocks for polio health workers all over Pakistan, in particular, this issue has assumed grave dimensions in Khyber Pakhtunkhwa and also the Federally Administered Tribal Areas (FATA). As per an IPS report of 2014, “Taliban militants have killed 17 people in polio-related incidents in the province from December 2012 to December 2013, and continue to block vaccination.” According to CBS News, “The number of polio cases in Pakistan jumped from 58 in 2012 to 91 in 2013. Of the polio cases recorded last year, 65 were located in the remote tribal regions. …The WHO and the government regularly test samples of the sewage water in Peshawar as well as other major cities across the country. During the last six months, they detected the highly contagious polio virus in all the samples collected in Peshawar.” (January 17, 2014)
The question is why are the Taliban opposing the polio vaccination campaign? Can the government do something to turn the situation around? If yes, what? To address the cause we must first know the reason. The first is lack of education and related socio-cultural circumstances. A few days ago, a woman, who as a young girl had worked as a maid for me many years ago, came for a visit. In tow were two of her younger kids. The elder son has been taken by her brother who is a cleric in a mosque for being educated in a madrassa. I was told that he was initially placed in a regular school and was doing very well, bagging the first position, no less. However, the cleric brother told the sister that ‘English educational system is bad for their children who are much better off at madrassas.’ This view was further reinforced by the area’s landlord at Jalalpur Bhatian where she lives. At least, so far as English medium education goes for the surfs. Never mind the fact that his own sons have returned from the US after getting an education. A fact never questioned by these poor people, even in their own minds!! This proved to be the capping view so to speak. The result was the younger daughter has not been placed in any educational institution at all. Being a girl, further acts to her disadvantage. The third off spring is a toddler and too young anyways. How does the government change this attitude? A door-to-door campaign for education? Running an advertisement on TV and radio to promote education?
The second is a deep seated conspiracy theory that is exploited by Taliban. For lack of education in most cases, people fall for it more often than not. The anti-polio vaccination is largely seen as a western conspiracy, a plot aimed to inject Muslims with mysterious fluids to render them infertile. This infertility according to the conspiracy theory will lead to cutting down in numbers of Muslims at inception. I do believe many, including within the Taliban ranks themselves may well believe in this to be true.
The third reason is perceived using of Shakeel Afridi to gather information of the whereabouts of Osama Bin Laden. Dr Shakil Afridi was accused of obtaining DNA samples of Osama Bin Laden through a phony vaccination campaign that helped the American spy agency hunt down Bin Laden in May 2011. The people are afraid. They do not know who the individuals employed by WHO may be. Are they genuinely trying to help eradicate polio? Are they fake; snooping and gathering information on them? A huge trust deficit has developed on this front.
The fact remains, this issue needs to be immediately addressed. Besides the fact that the disease itself is deadly, according to a local newspaper report, “The Health Department has been warned by donors and monitoring agencies to strictly monitor its polio immunisation campaigns or face serious consequences including travel restrictions and tough visa policies.” (Published January 4, 2014) How do we go about the job of administering vaccination while protecting the lives of these selfless workers? Will going house to house in line of duty be safe enough? Can so many be provided personal security on one-to-one basis spread all over the country? Does this mean we shelve the anti-polio scheme? Leave our children to be crippled? Can there be a middle way? A way whereby both objectives can be met?
Here is one suggestion: instead of going door to door, jeopardizing their lives and making security arrangements near impossible - polio camps can be set up in local mosques. Each locality has one. This stands true for all over Pakistan Announcements for the camp being set up in the courtyard of the mosque can be made five times a day at least a few days prior to setting up the camps regularly. This action will work positively at two levels. First, with the strength of the mosque supporting the camps for anti-polio drive, confidence of the people; mostly uneducated will stand restored and second; with the workers going to and staying in one specified place, their security will be relatively easy. On the flip side, there is however, always a good chance that people who do not wish to have the children vaccinated simply do not show up and the health workers cannot confirm how many were actually not vaccinated. Can the services of local pharmacies, doctors, hakeems and medicine men by providing exact prescribed dosage to them? WHO may like to explore this option. This suggestion is made in light of the comment posted on WHO official site, “Where community involvement in the eradication programme has been low, OPV coverage has remained low, leading to failure to eradicate polio.”
Some out-of-the-box thinking is required here, a more creative approach towards addressing the issue in face of stumbling barriers. Can Pakistan do it?

The writer is a lawyer, academic and political analyst. She has authored a book titled A Comparative Analysis of Media & Media Laws in Pakistan.

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