Pakistan close to polio victory
OUTSIDE her small, mud-walled house in western Pakistan, Gul Saima is cajoling her 3-year-old son to take a few steps. He cries as he struggles to lift his right leg and arm, both stiff and unyielding.
Overhead is a banner featuring a photo of a smiling boy on crutches. Saima, 38, is illiterate and cannot read the words printed in Urdu: “Don’t let your child’s dreams go to waste”. But the connection between the smiling boy and her son, Sayyad Karam, is painfully clear: Both have the paralysis that often follows a polio infection.
Authorities hung the banners throughout the area for a polio awareness campaign – and apparently put one on Saima’s house in an attempt to show officials, many of whom have visited since Sayyad was diagnosed with polio last month – that they are committed to it.
Sayyad’s diagnosis was a significant event. So far, his is the only new polio case of the year in Pakistan – a historic low, according to official figures in a country where eradication efforts have been foiled by ignorance, mistrust and militant attacks on vaccination teams.
Pakistan has come agonisingly close to declaring victory over polio. Each of the last three years, nongovernmental organisations involved in fighting it have optimistically declared it the virus’ final year, seeking support from international donors and local officials as they embark on the daunting task of vaccinating every child 5 and under in the country.
But polio has persisted here and in Afghanistan, where increasing instability has left both countries at risk, the finish line just beyond reach.
Sayyad’s diagnosis prompted an emergency vaccination campaign in Dukki, the small coal-mining town in Pakistan’s western province of Baluchistan where the family lives.
About 35 miles from Saima’s home, Saif ur-Rehman, the commissioner of Loralai, the district that includes Dukki, is checking in with some of the vaccination teams after the emergencycampaign’sfirstday. The teams report their results to Rehman, and he responds with strident calls for greater efforts.
“This is a scar on our community,” he tells them, adding if polio were to appear “anywhere else in the world, I don’t care. But this is our town, our community. It’s here and it’s here now.”
He makes a pointed comparison with India, Pakistan’s neighbour and main rival, which eradicated polio in 2014. The meeting goes into the evening, even though almost everyone has been up since dawn, preparing and deploying the vaccination teams that go door to door under police escort.
After the meeting, Rehman explains his urgency. “We don’t hide anything. The worst thing you can do in this scenario is try to paint a rosy picture.”
He is all too aware of the vulnerability of Baluchistan, Pakistan’s biggest province: It consistently ranks last in the country on progress markers like literacy, infant mortality and terrorism. Of the eight new polio cases in Pakistan last year, three were in Baluchistan.
“We know the issues we’re facing,” Rehman says. “It just presents an opportunity for us to get stronger.”
His positivity reflects a new optimism about the polio eradication campaign after years of setbacks. In 2014, 306 new cases were reported, the most in 15 years and over three times as many as the year before.
And since 2012, militants have killed over 70 anti-polio workers and police officers protecting them, attacks that began after the Pakistani Taliban accused vaccinators of being spies. The situation worsened after the United States was found to have recruited a Pakistani doctor to help find Osama bin Laden under the guise of carrying out a vaccination campaign.
“Back then, everyone felt like efforts were in vain,” says Dr Rana Safdar, the national coordinator of the Emergency Operation Center for Polio Eradication. “If things kept going the same way, we knew we were going to get the same results.”
Since 2015, Safdar has overseen virtually every aspect of Pakistan’s battle against polio. In his office in Islamabad, the capital, he sits among a war room’s assortment of maps and weekly reports from across the country. Local bureaucracies, the World Health Organiza- tion, the Bill & Melinda Gates Foundation, Uniced – all report to and coordinate with Safdar’s office under a federal program similar to India’s.
“People needed to have some trust in the federal government to reach a solution,” he says.
But given the rampant corruption and sometimes deadly political rivalries within that government, trust is hard to come by. And many of the impoverished families that vaccinators seek out have never met a representative of the state.
Their suspicion is compounded by rumours that the polio vaccine causes impotence, death and, ironically, paralysis. Refusals are common, and some families will hide their children from vaccinators, or even attack them.
“They’ve chased us with sticks before,” says Saida Baloch, a cheerful 27-year-old leading an emergency vaccination team on its rounds in Dukki.
Baloch, who has worked as a vaccinator in Dukki since 2014, is well aware of the risks she and her team face. Attacks have been rare the past two years, but in January a motherdaughter vaccination team was shot and killed in Quetta, about 100 miles west of Dukki.
Despite the deaths, much of Pakistan’s recent success in battling polio can be attributed to the country’s improving security. Michel Zaffran, director of polio eradication for the World Health Organization, says a bigger threat lies across the border in hard-to-reach places in Afghanistan.
“As long as we have the virus on either side of the border, we have a risk,” he says.
“It’s a sneaky virus. It continues to hide in pockets where the vaccine isn’t reaching it.”