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Great trepidations


Published in The News International on December 29, 2012:

The brutal assassination of nine grass-roots level health workers in Pakistan, who were involved in a door-to-door immunisation campaign in an attempt to secure children from the crippling disease of polio, adds an unprecedentedly grave dimension to the ongoing carnage in Pakistan.

Pakistan’s parliament was quick in passing a unanimous resolution and there was widespread condemnation of the killings from all factions of the society – and rightly so. These incidents have deep-seated implications for the global drive to eliminate an infectious disease for a second time from the planet.

Additionally, they illustrate the nature of polarisation, mistrust and extremism that has crept into the Pakistani society, posing challenges on many fronts – beyond public health.

This tragedy comes at a time when the Independent Monitoring Board of the Global Polio Eradication Initiative had, in its November 2012 report, issued a positive note about Pakistan with regard to its efforts to curb polio.

Pakistan’s polio programme reduced cases by more than 60 percent since last year (from 154 to 64), indicating that things could turn around after the multidimensional negative trends in 2011, where environmental surveillance indicated geographically widespread transmission and domestic numbers of new polio cases kept soaring.

During the year 2011, Pakistan was also held responsible for the virus spreading beyond its borders, causing an outbreak in neighbouring western China. Additionally, it was declared the only remaining reservoir of a rare wild poliovirus type, posing a risk for reseeding Asia.

The recent wave of killings is a huge setback, placing the 2012 gains at risk. These killings have also added another level of challenges to the existing multidimensional problems for vaccination, including problems of geographical inaccessibility due to the armed insurgency in large parts of the country; refusal to vaccinate on the mistaken notion that it is forbidden by religion; population movements across the vast and porous Pak-Afghan border; abysmal state of water and sanitation; the perception that immunisation is part of a covert operation; and the 2011 commercial-interest driven smear campaign against GAVI which, despite the government’s rebuttals, helped strengthen misplaced fears about vaccination.

In fact, polio in Pakistan today is not just a public health issue, but an illustration of the problems inherent within the state and society. Pakistan’s polio eradication drive has also taken the brunt of the country’s governance challenges.

Institutionalised collusion, geared to systematic pillage at the health systems’ level and absence of an accountability law make it very difficult to insulate polio from overall inefficiencies and malpractices which plague public sector functioning. Compounding these is the 18th Amendment-led abolition of Pakistan’s Ministry of Health and the lack of readiness of some provinces.

These challenges were already overwhelming for polio eradication efforts but the recent wave of killings adds another unprecedented complexity – polio vaccination risks becoming one of the epitomes of anti-western sentiment in Pakistan. If that happens, the global gains in polio eradication could be at risk.

Much has transpired between the 1988 World Health Assembly (WHA) Resolution, which called for eradication of polio by 2012, and global events around polio eradication in 2012. During which investment of more than US$8 billion, 20 million workers and implementation in 125 countries characterises the scale of the eradication effort.

With the May 2012 WHA Resolution, labelling polio as an emergency, WHO’s Global Polio Emergency Action Plan 2012-2013, and the Endgame Strategic Plan 2013-2018 now framed, the end is in sight. But as long as a single child remains infected, children around the world are at risk.

Pakistan now has a three-fold responsibility: addressing systemic polio eradication impediments; getting vaccination back on track with appropriate security cover for more than 90,000 vaccinators; and reaching out to the masses with the right information to allay mistrust.

At a minimum this would demand the will to prioritise action, the intent and ability of political factions to work collaboratively, and the ongoing injection of resources.

The writer is the founding present of the NGO think tank, Heartfile. Email: sania@ heartfile.org

December 29th, 2012
Sania Nishtar,
Health Systems,Governance,
Publication Type:
Op-ed columns,