A
NUMBER of months have now passed since the apparently coordinated attacks in
Karachi and Peshawar which left five health workers and volunteers dead.
The
deceased — mostly young women — were working on a national campaign for the
eradication of polio, coordinated by provincial and federal governments.
As
a response to the attacks, the governments of Sindh and Khyber Pakhtunkhwa
suspended the campaign for a short period, while the United Nations removed
some of its field personnel until they could receive guarantees of better
security.
Extra
protection was then offered by the various provincial governments to polio
workers in order that they may return to the field and continue to administer
the vaccine. Understandably, a number of lady health workers announced their
reluctance to continue due to fear for their safety. Some of the police were
also attacked subsequently.
Public
response was initially slow to emerge. As the full scale of the attacks became
apparent and the number of victims increased, outrage grew. Opinion-makers in
the media grappled with this tragedy and most of the ire was aimed at the
failure of the government at protecting the polio workers.
It
was unclear which government — provincial or federal — was being held
responsible. Regardless, with tens of thousands of health workers and
volunteers involved in each campaign, providing security for all of them would
be a massive challenge.
While
the debate continued, relevant stakeholders in the eradication campaign got
together and realised that the very tool being used to promote polio
eradication (the national polio drives) was helping militants target them.
It
was decided that instead of pre-announced national polio days, sets of
districts would be targeted more quietly in a staggered way. This would reduce
the media attention on the drives. While this would damage the outreach and
awareness component of the anti-polio campaign it would at least reduce the
chances of attacks on campaign workers.
Well,
it did not work. Polio workers continued to be targeted, one at a time. The
entire sorry mess represents a major public health disaster in the country and
is a perfect metaphor for our societal failure at combating extremism.
Consider.
Polio
is a highly infectious viral disease. It invades the nervous system and can
leave the infected individual paralysed for life. In extreme cases, the
paralysis can affect the lung muscles leaving the individual incapable of
breathing. There is no cure. The most vulnerable are children below the age of
five. You would not wish this terrible affliction on your enemies.
Polio
epidemics have been known of since the late 19th century. Vaccines have existed
since the 1950s. The most famous of these is the Oral Polio Vaccine (OPV)
developed by Albert Sabin, an American virologist.
To
this day, the OPV is the most effective method of immunising large populations.
It is effective because of the simplicity of delivery (just a couple of drops
delivered orally two or three times over a few months; a trained volunteer can
administer the vaccine without need for medical expertise) and its low cost
(one vaccination is estimated to cost, on average, less than 14 cents; the
equivalent of Rs14).
Mass
immunisation leads to the added benefit of herd immunity. This means that
everyone is safer when more and more children are immunised. The unfortunate
corollary, however, is that even if you are immunised, you are still at risk if
there are non-immunised pockets in the population.
A
concerted international campaign for polio eradication began in 1988 using the
OPV. In that year there were 350,000 reported cases of polio in 125 countries
where the disease was prevalent. Over the last few years the number of reported
cases of polio has fluctuated around 1,000 per year. The Global Polio
Eradication Initiative has succeeded in reducing the number of
polio cases by 99 per cent, worldwide.
In
2013 there are still three countries left where polio is endemic, which is to
say that the proportion of the population susceptible to infection is
relatively stable, but persistent. These three countries are Afghanistan,
Nigeria and Pakistan. Of those who have recently eradicated polio, Congo and
Chad are countries much poorer than ours while India has six times more people.
In
Pakistan, an activity which is relatively low-cost in per capita terms, has
clear significant benefits for our children and society at large and requires
no complicated transfer of technology or highly trained individuals, has become
the victim of mass murdering fanatics, and we seem powerless to stop them.
The
results of these attacks and the lowering of inoculation rates will have a
severe adverse impact on our ability to defeat polio.
This has happened before.
For
years the number of cases reported has been declining in Pakistan until 2007
when resurgence in the number of cases was noted. Some years later, a jirga in
Fata announced that polio vaccinations for infants in their area would be
banned until Nato and US forces stopped drone strikes against militants in
their area. Could a more senseless thing be said?
The
inevitable happened. Polio cases in Pakistan increased. At the same time,
China, a country which had been polio-free for a decade, reported cases of
polio in its Western provinces. The outbreak was caused by a polio virus strain
spreading from Pakistan.
Another
case was reported recently as far as Egypt with the reinfection said to have
originated in Pakistan. Our lack of resolve in the matter has not only placed
our own children (even those who have received the vaccine) at risk but we are
a risk to other countries.
Medical
science, dedicated health professionals and international cooperation have
removed one infectious disease affecting humans from the planet: small pox.
Polio eradication is tantalisingly close. We are standing in the way.
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