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PAKISTAN: Fatal Polio Thrives on Conflict Along Porous Border

Ashfaq Yusufzai

PESHAWAR, Feb 19 2009 (IPS) - The battle to eradicate polio in Pakistan has become more complicated.

The government has pinned responsibility on the World Health Organisation (WHO) for the sudden spread of the P3 virus in northwestern Pakistan and the tribal areas bordering Afghanistan since 2008.

"The WHO stopped the P3 vaccination causing a rise in cases in 2008," says Dr Mohammad Ali Chauhan, who is in charge of the polio eradication campaign in the North West Frontier Province (NWFP). "Thirty three of the 52 cases of polio (in the province and Federally Administered Tribal Areas – FATA) were of the P3 virus last year."

Since January, four new cases have been reported from Charsadda and other parts of the NWFP. Last week, a special campaign against P3 was launched in the border districts and in parts of the densely populated Punjab province.

Pakistan’s porous border with Afghanistan has been blamed for the continuing rise in polio cases. Years of conflict in Afghanistan has meant that it remains among four endemic countries that have failed to eradicate the acute viral disease that attacks the nerve cells of the brain stem and spinal cord. The others are Pakistan, India and Nigeria.

In early-February, ministers of health from Pakistan and Afghanistan chaired a cross-border coordination meeting to consider the operational challenges in tackling the transmission of polio in high-transit and cross-border areas. Twelve of the 33 children who tested positive for P3 in 2008 were Afghan refugees.

Between Feb. 9 and 11, house-to-house supplementary immunisation activities (SIAs) were carried out in six districts of North Punjab province and central NWFP, targetting more than six million children.

The next round of national immunisations planned over two days, from Mar. 3 to 4, has been postponed by at least one week, and will use trivalent OPV (oral polio vaccine) that immunises against P3 and P1, the most dangerous strain of the virus.

According to the Global Polio Eradication Initiative, a total of 1,528 cases were reported in 2008 from the four endemic countries, and 147 from non-endemic countries (all in Africa).

Last November, Pakistan’s Ministry of Health set up a new inter-ministerial committee for polio eradication efforts.

Prof Abdul Hameed, president of The Pakistan Pediatric Association (PPA), says the polio campaign is flawed. "The government and WHO have not involved pediatricians due to which the campaign has not been successful," he told IPS.

Urging the government to accept the PPA’s offer of help this year, Hameed says: "Had the affected children been given enough doses of trivalent OPV instead of monovalent OPV-1, they could have been protected against the poliovirus type-3."

The NWFP government has requested the UN to set up more vaccination points to immunise Afghan children crossing into Pakistan. Currently there are nine vaccination stations along the 2,400-km border.

But Dr Abdul Jabbar who heads the WHO’s Polio Eradication Initiative in Peshawar said in an interview with IPS that the use of OPV worldwide was recommended by a technical advisory group. All children are administered trivalent OPV doses for P1 and P3 virus. And for more effectiveness, monovalent OPV-1, was given for children under 5 years against the P1 virus.

Since 2001, Pakistan has spent an estimated one billion dollars annually on polio eradication efforts. The campaign has failed to penetrate remote areas, particularly in the Federally Administered Tribal Areas adjoining the NWFP, in the wake of opposition from Islamist radicals that the vaccine is a U.S. ploy to make the population infertile.

Pakistan’s northern villages have become recruiting grounds for pro-Taliban fighters ever since the U.S. stormed into Afghanistan in September 2001 to oust the Taliban regime. Anti-U.S. militancy has engulfed the tribal areas and districts in the NWFP like Swat, which until two years ago was a popular tourist destination.

A ceasefire in Swat this week may reopen the district to government health workers. The previous ceasefire in May last year, between the provincial government and the outlawed Tehrik-i-Taliban, had led to the resumption of the anti-polio campaign in the district after a break of a year.

But that ceasefire was shortlived, and on Jul. 28, on the first day of the second round of immunisations, volunteers were roughed up and vaccines broken in Swat.

"We hope the ceasfire will enable us to immunise children against polio everywhere in Swat," says Dr Irfan Ali, a Swat-based polio official. Talking to IPS over the phone from Mingora, the district headquarters, he said there were parts of the district where volunteers had not been allowed to administer the oral polio vaccine for at least a year and a half.

"We need an aggressive campaign to be able to reach more than 400,000 children," he adds.

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