The polio story

By Zubeida Mustafa

PAKISTAN has failed to educate its children. It is now failing to protect them from communicable diseases like poliomyelitis, an untreatable crippling disease caused by a virus.

Preventive vaccines have however been developed and large regions of the world have been declared polio-free. It is, therefore, a pity that Pakistan is losing its war against polio. A spate of stories in the print media lately point to this tragedy. This is not at all surprising, given our criminal neglect of the health sector.

What is the polio story? When Pakistan launched itself on the long road to polio eradication in 1994, it showed remarkable success. It set up an effective surveillance cell and national immunisation days were undertaken.

The number of polio cases in the country fell from 1,155 in 1997 to just 28 in 2005. Then came the crunch. The war on terror in Fata made many areas inaccessible to the vaccinating teams and migration of populations from war-torn areas became a regular phenomenon. Polio made a comeback and in 2011 the Geneva-based Global Polio Eradication Initiative (GPEI) recorded 198 cases in Pakistan, the highest in any country for the second consecutive year. In 2010, the polio toll in Pakistan was 144. The country has now been dubbed a polio danger zone.

We thus have a giant share of the world total of polio cases of 647. There is unprecedented international interest in Pakistan’s polio policy today. Even one case here means a child anywhere remains vulnerable, so globalised has the world become. This argument has been vindicated by our recent ‘success’ in exporting the virus to China which recorded 18 cases of polio with the strain of the virus being traced to Pakistan.

Multiple factors are responsible for this failure. Broadly speaking, the high level of poverty and the near-collapse of Pakistan’s health delivery structure have made polio eradication an enormous challenge. So far as the specifics are concerned, the immunisation strategy is said to be flawless but not its implementation.

Ten to 12 national and sub-national immunisation days are held annually. Funds have been no problem either as foreign donors have been generous. There is no shortage of manpower — if anything there are too many cooks spoiling the broth.

What can be faulted is the implementation process that fails to cover every region of the country. Notwithstanding the loud claims made, serious doubts have been expressed by insiders about the coverage. The fact is that not every child under five receives the polio vaccine. This lapse is due to the prevailing insecurity that prompts parents not to open their doors to strangers. Others are influenced by the propaganda of clerics who discourage parents from cooperating.

It is not clear why a more democratic approach is not adopted. It is important that the local social mobilisers and trusted community leaders are taken into confidence and asked to facilitate access of vaccinators to their neighbourhoods. Dr Samrina Hashmi, president of the Pakistan Medical Association (Sindh), points out that the cooperation of GPs and the mohalla physicians who are the backbone of community health, could transform the polio immunisation drive.

The GPEI’s report also speaks of the health workers not being motivated enough, lacking ownership of the programme and there being issues of governance in the wake of the 18th Amendment. One source even spoke of ‘ghost’ vaccinators who draw hefty allowances but don’t exist. Conversely, efficient and committed individuals can make a difference.

There is the case of the health secretary in Punjab, who kept the EDOs on their toes and the province reported not a single polio case that year. Then he was transferred and you can guess what the results were after his departure.

These are problems of governance that can be handled if the political will exists. More difficult to resolve are the problems related to health, migration and poverty. Many paediatricians have pointed out that it is now an established fact that undernourished and weak children fail to derive immunity against polio from the vaccine they are administered.

Dr Hasina Shahani, the secretary general of the Pakistan Paediatrics Association (Sindh), says this is one reason why many children contract the disease in spite of receiving multiple doses. If they are suffering from diarrhoea or are debilitated, immunity may not develop. In Pakistan, 40 per cent of children are underweight and 50 per cent have stunted growth.

Dr Shahani also points to high mobility in the population especially from Khyber Pakhtunkhwa and Fata. Most of the cases recently recorded have been in Pakhtun children — even in Karachi — indicating the challenge faced in the war-torn regions which do not receive coverage. Families migrating from there infect new areas. The size of the infected population is actually larger — only one per cent show the symptoms and are diagnosed only when paralysis sets in — but others are carriers and can transmit the disease.

The problem can be solved by introducing greater accountability and transparency in the campaign. Let every EDO be responsible and answerable for his own district. Those whose districts remain polio-free for a year should be honoured.

A strategy must be developed of targeting the area where a case is detected with a follow-up mop-up campaign. The Expanded Immunisation Programme, which had reached impressive coverage a decade or two ago, is said to be on the decline. It should also be spruced up. Above all, we need peace. We now know that war and polio go together in Pakistan.

Source: Dawn

9 thoughts on “The polio story”

  1. Apropos to you article in DAWN on Polio,please watch the recent episode of Khari Baat Luqman Kay saath.

    Expired vaccines are being administerd in Punjab which is a deadly crime and will spike up polio cases exponentially.
    After export of virus to China, Pakstan iteslf may be quarantined effective 2013 for a mop up campaign with all its implications

  2. Failure is not because problem with FATA or trible area because cases r being repoted in Karachi ,Hyderabad and other parts of the Sind.2.U had suggested that EDO should b held responsible but how EDO can b held responsible when he gets posting after paying huge ammouut. If Pakistan will b Polio or Malaria free than who will pay for the petrol of the Minster ,secratary and EDO ? at preset in Sind all vehicles are getting petrol from these projects so Polio or Malaria is not problem for Pakistan but blessing for health departments.

  3. @ Mustafa!

    A social-cum-health problem has been dealt in a best way.
    But the pity is that POLIO is problem of too many countries and why your findings remains limited to Pakistan.
    Further your opening sentence is totally wrong which says as " Pakistan has failed to educate its children". How we should expect a children or kid to know about POLIO and should take preventive measures as soon he/she lands into mother's lap.

    Yes Polio now (thanks to Doctors and Scientists) is under control of humans provided right action is taken at appropriate time(s).

    It is very much apparent that India is very much ahead on this count not as compared to Pakistan but other many countries also.

    Parents should not wait for the health worker or POLIO day or POLIO mela etc. but must act at their own to give a healthy and sturdy life to their kids.

    Internet application can help parents greatly and easily to know about POLIO, vaccination and when when to administer.

    Please keep on writing on social-cum-health based topics….

    Greetings…

  4. This is indeed unsettling to see children die of polio in Pakistan. But then the responsibility cannot be fixed on the state of the government. We all, especially the parents, should also shoulder the responsibility of this collective failure. Why don't parents ensure their children get the polio drops, and why are those poor workers entrusted with the task of giving polio drops to the infants not given due respect when they come to our doorsteps? This is just one of the many malaises that has beset the collective conscience of society, desensitising the public to wake up to any imminent danger that is bound to cripple our young generation in any imaginable way.

  5. You have almost covered all the aspects of this sorry state of affairs. The sad part is that there is such lethargy in both the parents and the health providers and the population is so big. It seems a hopeless situation.

  6. what a sad story! when we compare ourselves with india in nuclear race and armaments – why not on eradication of communicable diseases like polio where they have done a commendable job compared to us

    i think the 'privatisation' of polio vaccine supply (stopping) from traditional UNICEF suppliers to market suppliers was a big mistake. the credit goes to musharraf regime for deregulation of the health department. while his government should be held responsible for this terrible decision, the present day PPP – ANP government cannot be absolved for their criminal neglect of the health department as well. they deserve a jail term for this criminal neglect of public health issue

    for the first time in many years we did not get any polio vaccinator at our doorstep since more than one year. despite the fact that i am from the health department and teach in the medical college and have made many many complaints with the PEI officials at the provincial level., i am told the financial matters like refusal for doing the vaccinator job for a measly rs 200 per day (when a labourer is getting rs 400 or more) is the real problem here. its surprizing really when the provincial government is paying huge amounts in health advertisements for the polio drive cant get their house in order and pay the right amount to the right vaccinators who can do the job. finally, the bombshell: i do not live in any inaccessable mountainside of FATA – but right in the center of hyatabad township and a kilometer away from hyatabad medical complex where the EPI is situated!

    now what?

  7. The latest news is that WHO knock India off polio list as India is now a polio free country. Read this news at http://www.hindustantimes.com/India-news/NewDelhi….

    It is due to strong combination of efforts put in by Govt., Doctors, General Admn and public. People and Govt of Pak should take advantage of this achievement. Presently Govt to Govt relations are not forwarding on negative side if not on positive side. People to people (not all but few) hatred is being spread if we read the various comments put through media.

    Once a child is attacked by POLIO then it the parents who suffered through out the life. And if this child happens to be girl then this worry of parents shoot up. Prevention is better than Cure. The parents must run from pillar to post to administer POLIO drops and other vaccination for their kids.

  8. Read the news at http://tribune.com.pk/story/344591/un-who-can-ban

    It is the high time to take result-oriented action.

    Apart from the POLIO patient and his/her parents now the healthy person may also suffer if WHO ban Pakistanis from traveling to other countries.

    Hope the WAKE UP call given by Ms Zubeida is well understood and the kids are protected from POLIO and must enjoy an active life of his/her own.

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