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Ending Pakistan's Polio Crisis

By Zeeshan Salahuddin

Pakistan remains one of the last three polio endemic countries in the world. There is no known cure for polio, which invades the central nervous system, and can paralyze limbs in a matter of days. However, a vaccination immunizes children against it permanently. These vaccinations have been conducted on a national scale in most countries around the world, and the virus has been effectively eradicated in most of the world. The success of the anti-polio campaign around the world can be ascertained from the fact that in 1988, when the Global Polio Eradication Initiative (GPEI) was launched around the world, 1,000 children were afflicted with polio daily, in 125 countries. Since then, this number has decreased globally by 99.9%, with 406 cases reported in 2013. 

In 2014, nearly 89% of all cases reported in endemic countries, and approximately 76% of all cases reported worldwide have been reported from Pakistan, 39 to be exact. The progress against polio in Pakistan has been nothing short of remarkable, but there are three factors that have gravely affected the campaign against polio in recent years.

First, conspiracy theorists in Pakistan have segments of the population convinced that the vaccine is either a western ploy for rendering our youth infertile, or a cover for espionage. Unfortunately, incidents like Dr. Shakeel Afridi embedding himself in the local polio vaccination team to positively identify Osama bin Ladin in the city of Abbottabad lend considerable credence to this argument. Second, since June 2012, there has been a ban on the vaccinations in the tribal belt of the Federally Administered Tribal Areas, especially in North Waziristan. This region has not seen a polio campaign in almost two years and accounts for most of the polio cases reported in 2014.

Third, polio workers have been targeted and gunned down in virtually every corner of Pakistan, especially the cities of Karachi in the province of Sindh, and Peshawar in province of Khyber Pukhtunkhwa (KP). Since December 2012, 56 polio workers, or security officials entrusted with protecting them, have been killed (mostly by unidentified assailants on motorbikes).

These factors, especially the killings, were severely affecting the confidence for polio workers, and people like the World Health Organization's (WHO) global chief for polio eradication, Dr. Elias Durry. There was almost no campaign in Pakistan without incident. If the campaign was without incident, it had to be staggered over several days, sometimes weeks, to allow for proper security. Sometimes, the target area had to be reduced for similar reasons. All of this led to one painful truth: in the problem districts of Pakistan, the polio campaign was causing little to no dent in the circulation of the virus.

At this point, Pakistan stood at risk of being the only polio endemic country in the world in the coming years. Virus strains in Egypt and Israel had been traced back to Pakistan, and the severity of this situation could still lead to international traveling restrictions on Pakistanis to curb the spread of the virus to non-endemic countries.Effectively, Pakistan's inability to eradicate polio puts the polio eradication efforts at risk worldwide, and has become a global focal point for shame in the international community. 

However, in the beginning of February, 2014, Dr. Durry's team tried something bold and unorthodox. First, they teamed up with the local provincial government, which pledged it's full and unflinching support for an incident-free and efficient campaign in Peshawar, a city recently declared the largest polio reservoir in the world by the WHO. Second, the vaccinations were not staggered, but completed in a single day, with local law enforcement agencies cordoning off areas, banning motorcycles from roaming in the vicinity, and making large areas secure for the vaccinators, instead of accompanying them door-to-door. Finally, the vaccinations were clubbed with a range of activities, such as free medical camps, routine vaccinations, and workshops on preventative measures against diseases such as dengue and malaria. 



"Peshawar changed the trajectory of polio eradication in Pakistan and how we saw things", says Dr. Durry. The combination worked, the campaign was exceptionally successful. In ten consecutive weeks, polio eradication campaigns have been conducted in a single day and  vaccinated more children than the campaigns in 2013. No one was attacked, because the law enforcement agencies updated their tactics and provided adequate security, and the confidence of the polio workers went up every week. This model is now being replicated in three additional districts in the KP, as well as 24 high-risk areas in Karachi.

Once again, hope is alive.

"I am 100% sure that the campaigns in the KP and Karachi will produce results," says Dr. Durry. "All that is left is getting access to children in FATA that couldn't be immunized in the last two years. It will take time, but with this kind of commitment from the government, we can see unparalleled results."

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Zeeshan Salahuddin is a journalist based in Pakistan.   [Photos courtesy of UNICEF, Ground Report, and rferl.org]  

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