Eradicating polio

A longside the war-torn, cash-strapped and poverty-stricken Afghanistan, Pakistan has the global ignominy of being one of the last remaining regions with wild poliovirus cases. The incidence of polio, which can cripple the nervous system and cause permanent paralysis in severe cases must be dealt with as a national emergency to safeguard the current and future generations. The decision to launch the three-day polio eradication drive by the Shehbaz Sharif government will be a test case on the efficacy of the virus’ eradication. The task of immunising 44 million children under the age of five must be completed in letter and spirit.

The nationwide campaign is Pakistan’s first for the year 2023 and targets 150 districts across the country. Prime Minister Shehbaz Sharif, who is facing great domestic political pressure at home, inaugurated the campaign and expressed conviction that all the provincial governments along with the federal capital will continue to collaborate to eradicate this debilitating disease. It is critical for Pakistani politicians to create enough room and support such an initiative despite differences over models of governance and strategies that were implemented previously. The debate should centre on whether the current campaign will prove to be effective, and the discourse should also solely be about polio victims.

Politics aside, there is little doubt that the resurgence of the virus is a cause for global concern. The World Health Organisation (WHO) and stakeholders have expressed caution over the incidence of the virus, limited to a few countries including Pakistan. While PM Shehbaz can tout the fact that during his brother Nawaz Sharif’s tenure, who is currently an absconder as per the Supreme Court (SC), the few cases of polio were completely eradicated, its mere presence constitutes a problem for the country. Hence, it is imperative to not play politics over the issue and ensue targeted, focused strategies for the betterment of the public at large.

Interestingly, in 2021, Pakistan only witnessed one new case of polio. This raised hopes that the debilitating disease had finally been eradicated due to the joint efforts of the authorities. However, that number rose to an alarming 20 in 2022, the same year when much of the country was inundated by floods. The linkage between the flood’s situation and the incidence of polio however, is still unclear as all 20 cases were reported in the northern province of Khyber Pakhtunkhwa (KP). At least 17 of them were found in Waziristan while the other three were in Lakki Marwat.

For the country to officially be recognised as polio-free by the international community, Pakistan must demonstrate an absence of wild transmission for at least three consecutive years. This standard or benchmark has been laid out by the Global Polio Eradication Initiative led by the WHO itself. According to the National Emergency Operations Centre, Pakistan’s efforts to eradicate the disease were hampered by the flooding situation which took a huge toll on the availability of health workers, administrators of the vaccine and universal availability.

With the flood situation having slowly subsided, the polio eradication programme aims to utilise more than 350,000 health workers who would be performing tasks such as administering vitamin-A supplements along with polio drops. The challenge however, is far deeper. The deeply conservative nature of the tribal belt and the resistance from religious fanatics and extremist groups who view such campaign drives as ‘Western conspiracies’ remains a cultural impediment. Hence, there is a need to initiate polio awareness campaigns in far-flung areas to ensure maximum impact and results. The staggering fact is that more than 100 people have been killed across the country over the past decade while administering vaccines. An attack in Dera Ismail Khan, in which four policemen were injured during an anti-polio campaign in January, underlines the problem.

There is, of course, the looming possibility that polio eradication efforts will continue to be stalled as flood rehabilitation drives must be operationalized to make the best use of international aid. There is little doubt that 33 million people have been affected across the country while 1,700 others have been killed due to the worst flooding in Pakistan’s history. Many Pakistanis, including children, have died from waterborne diseases that stem from stagnant floodwaters. Balancing priorities and proper policy planning amid little resources will be the main challenge for this government.

The political cost of not being able to successfully complete the campaign is also significant. With 2023 being the election year, and the Punjab Assembly standing dissolved and political impasses characterising Pakistan’s troubled landscape, the ability of the PDM government to back its promises with action will define its electoral success, which hinges heavily on constituent politics. Their predecessors, the PTI government gained widespread praise for the successful implementation of health cards as evidence of their commitment to a welfare state.

Fragile health systems and conflicts also have a direct impact on the incidence of disease and the well-being of societies. Pakistan will need to ensure that significant funding is directed at upgrading hospitals particularly in tribal/rural areas for maximum effectiveness. Combating the scourge of terrorism and militancy will also ensure that the security situation improves for citizens. According to Hamid Jafari, the director of polio eradication for the WHO’s Mediterranean region, countries which are conflict-torn are prone to exporting the virus, which complicates global health efforts.

The truth is that the success of Pakistan’s anti-polio profile rests with the latest 2023 campaign. Failure is not an option.

The writer is an Assistant Research Associate at IPRI