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HEALTH-PAKISTAN: Porous Afghan Border Thwarts Anti-Polio Drive

Zofeen Ebrahim

KARACHI, Feb 21 2007 (IPS) - Pakistan has intensified efforts to eradicate the polio virus with a new vaccination drive that targets 12 high-risk districts in southern Sindh province where three new cases were reported recently, bringing the total number of polio incidents countrywide to four since the start of the year.

The door-to-door anti-polio campaign from Feb. 20 to 22 is part of the Health Ministry’s Expanded Programme on Immunisation (EPI). Pakistan’s Polio Eradication Initiative (PEI) was launched in 1994 in collaboration with the Global Polio Eradication Initiative (GPI) which was begun six years before.

But despite a gargantuan effort by an army of some 60,000 frontline health workers in Pakistan, who go from house to house to administer two polio drops to some 6.5 million under-five children on every national immunisation day (NID), the coverage has only been some 96 percent.

A lack of political will and the indifference of parents have hampered efforts to achieve the global target of complete eradication. Pakistan remains among four countries in the world still battling to eliminate the virus. The others are Afghanistan, India and Nigeria.

GPI, a partnership between the World Health Organisation (WHO), the UN Children’s Fund (UNICEF), Rotary International and the US-based Centers for Disease Control, wanted to wipe out the debilitating disease by 2005. That was not to be. Nineteen years and 65 campaigns later children are still falling victims to the crippling virus.

“Our efforts need to be supported by the provincial and district governments,” said Dr Salma Kausar Ali, project director of EPI in Sindh province.

Last year, the federal health ministry reported 39 polio cases of which 15 were found in the North West Frontier Province (NWFP). Immunisation teams reported they were unable to reach 66 inaccessible areas, some of which are along the volatile Afghan border. The local population has stiffly resisted the campaign with allegations that the polio vaccine has been imported from the United States which as a close ally of Israel is regarded as an “enemy” of Muslims.

Now there are renewed fears of an outbreak of polio in the NWFP with the reporting of 12 ‘hot’ cases – children suspected of contracting the virus – since January. One of the reasons for the high prevalence rate here is the undemarcated Pakistan-Afghanistan border. There is close interaction between families on both sides of the border.

While Dr Ali ruled out fears of an outbreak in Sindh, she warned that unless the wild polio virus was wiped out from Afghanistan and the border provinces of NWFP and Balochistan, a complete eradication in Pakistan was an exercise in futility.

“The three cases in the last two months belonged to the nomadic population and not from the indigenous Sindhi population,” Dr Ali explained. “The genetic analysis of the virus, showed its origin to be from Kandahar, in Afghanistan, where wild polio virus is still found. Short of stopping people from entering Sindh, we cannot stop the virus from spreading.”

One effective method to control the mobility of the virus has been the setting up of 26 EPI centres at all entry points – bus-stands, sea-port, airports etc û so that no child who enters or goes away from the province has not been immunised since January. So far 11,000 vulnerable children have been administered the polio drops.

Pakistan’s immunisation programme has also been bolstered by the replacement of the ageing equipment needed to maintain the cold chain for the vaccination. Moreover, the logistical nightmare that teams have complained about in the past has also been resolved by providing better transport while the daily allowance for the field teams has been revised.

With campaign fatigue setting in, and diminishing resources, health experts have been frustrated. Dr Mubina Agboatwala who has been running the polio clinic at Karachi’s government-run Civil Hospital said: “Perhaps we need to re-strategise and glamourise the campaign and rope in everyone. The campaign needs to be injected with a renewed vigour to bring it to a close.”

Dr Abdul Wahid Bhurt, the WHO’s provincial operations officer, is more optimistic. “I think we are going about the right, tried and tested way. This is exactly how other countries eradicated the disease. At this point, at the last leg, there were bound to be hiccups and the end was never foreseen to be without problems. I also think the media can now take on a more proactive role and bring the campaign to its logical end,” he appealed.

“People have a short memory and need to be reminded to take the children to routine immunisation centres if they missed out on NIDs,” he said. “They need to be reminded of the consequences of not getting their children immunised. They should be so informed and empowered that if for some reason the vaccine is not available, or the team has not reached their areas, they should be able to demand its availability immediately.”

It appears that the media has been missing all these years from the communication strategy chalked out by the PEI. While there has been some public advertising before and on immunisation days, there has been no attempt to sustain the awareness raising process. Instead of roping in the media, the authorities have relied on their own resources to publicise the polio eradication programme.

“I think the important role media could have played has been overlooked all these years,” conceded Dr Ali. “Yet it’s not too late, for it is the one medium that can reach even the remotest of places.”

However, financial resources for a media campaign are not available. Dr Bhurt acknowledged that their hands are tied when it comes to spending on advertisements. “But perhaps the media can think of it as national interest and run a sustained and rigorous public service campaign for the larger public good,” he reckoned.

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