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A PUBLIC HEALTH DISASTER

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.

This article was originally published at: Dawn

The opinions expressed in this article are the author's own and do not necessarily reflect the viewpoint or stance of SDPI.