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PAKISTAN: Political Scandals Rock the Polio Eradication Boat

LAHORE, Feb 15 2012 (IPS) - A knock on her front door throws Beenish, a 28-year-old housewife from Lahore, into a fix: should she allow the female volunteer vaccinators to administer the oral polio vaccine (OPV) to her two-year-old son, or not?

The decision has not always been this hard. Last year, Beenish had no qualms about hosting the service providers in her home to perform the simple procedure.

But now she is gripped with anxiety about the potentially harmful nature of the vaccine.

Her fears are not unfounded.

Lahore, the capital of Pakistan’s populous Punjab province, is still reeling from the deaths of over 125 people who suffered an adverse reaction to Isotab, distributed by the government-run Punjab Institute of Cardiology (PIC) to a large number of cardiac patients.

Subsequent laboratory tests revealed that each tablet contained the antimalarial substance Pyrimethamine in quantities over 14 times the recommended weekly dose for malaria patients.

“I can’t afford to trust these people (with) my child’s life. The government’s inefficiency and the harms associated with free medicine are (dangerous) to us all,” Beenish told IPS.

The tragedy over the cardiac patients ignited severe criticism of the government from various corners of society.

The absence of a sufficient drug regulatory mechanism at the provincial level has also been dragged into the spotlight as a major health concern.

Obstacles to the eradication campaign

Outright distrust in the public health system has taken a crippling toll on the anti-polio initiative, especially in Punjab.

The United Nations Children’s Fund (UNICEF) estimates that roughly 700,000 children in the province already miss immunisation drives for various reasons. With fears of contamination now proliferating, and scores of households resisting the vaccination, medical experts fear this number will now rise.

Pakistan is one of just four countries in the world where the wild poliovirus is still circulating freely; the other three are India, Nigeria and Afghanistan.

Of the 326 polio cases reported in these countries in 2011, only one was detected in India, 52 in Nigeria, 76 in Afghanistan, and an alarming 197 in Pakistan.

According to UNICEF, “The annual incidence of polio in Pakistan, which was estimated to be more than 20,000 cases annually in the early 1990s, had decreased to around thirty cases in 2005. Just a few years ago Pakistan was on the verge of polio eradication. It seemed that we had made it.”

But a resurgence of infection rates has turned the country into a site of global concern, as it is now responsible for well over 60 percent of polio cases worldwide.

Global polio watchdogs recently found that the particular strain of poliovirus endemic to Pakistan has traveled to other countries and caused outbreaks in China and Afghanistan.

While UNICEF, the World Health Organisation (WHO) and federal and provincial governments have been urging mass media to minimise negative coverage of anti-polio drives, a recent political scandal involving the United States’ Central Intelligence Agency (CIA) appears to have undone several years’ worth of efforts in that regard.

Towards the end of Jan. 2011, U.S. defence secretary Leon Panetta urged Pakistan to release a doctor named Shakil Afridi who was under arrest on charges of treason.

At the behest of CIA officials, Afridi reportedly launched a fake polio vaccination campaign in Abbottabad last year, using it as a front to gather DNA samples from people thought to be relatives of the elusive Osama Bin Laden. This elaborate scheme would later contribute to the frenetic manhunt for and subsequent assassination of the Al Qaeda leader.

“(Before this) happened, one could brush aside negative perceptions about the polio vaccine, terming them baseless and ‘agenda-driven’, but not this time,” Fazal Shah, a development sector professional based in the northern district of Mardan, told IPS.

“How can anybody deny something confirmed by the U.S. itself, including in its own media?” he asked.

Religious leaders and tribal elders who had hitherto been highly successful in generating public support for the polio vaccine – by breaking myths about the vaccine being life-threatening, made of haram (forbidden) ingredients or causing infertility among both male and female recipients – found their efforts seriously hampered by Afridi’s hoax vaccination drive.

In fact, as news of the CIA’s scheme filtered into thousands of households across Pakistan via sensational newspaper and TV reports, Pakistan’s entire polio eradication campaign began to suffer a major setback.

In an effort to form a joint front against the barrage of negative media coverage, individuals and groups working to exterminate the poliovirus have identified key partners in the fight and are approaching the media together, hoping for strength in numbers.

The timing of such a united front is crucial as the polio vaccine is currently being distributed in the Federally Administered Tribal Areas (FATA) and, for the first time in the past three years, in the lower part of Orakzai Agency – areas that had, for years, been inaccessible due to rampant militancy and military confrontations between rebels and state armed forces.

In a statement drafted exclusively for IPS, UNICEF claimed, “Pakistani journalists, being the major pillar of (this) nation, have both a moral and professional responsibility to ensure that polio eradication is set on top of the public agenda.”

“Balanced coverage, accurate reporting, due verification of facts, critical analysis of rumors, segregation of individual opinion from expert knowledge (and) avoiding unnecessary sensationalism are of the utmost importance in reporting about polio,” it added. “Recently, the media has contributed to numerous unwarranted speculations about the alleged side effects of the polio vaccine. The oral polio vaccine used in Pakistan is potent, safe, and efficacious; it is exactly the same vaccine that brought the number of polio cases down to just over 30 in 2007,” the statement concluded.

Mueen Ahmed, a Lahore-based investigative reporter with Pakistan’s premier Geo TV, agrees headlines like “Polio Vaccine Claims Child’s Life” should be carried only if autopsy reports confirm the claim.

However, he says the media cannot be stopped from calling a spade a spade.

“If the government engages untrained vaccinators for less than five dollars a day and stores vaccines out in the open, how can the media remain silent?” he asked.

Mueen believes the disease cannot be treated without simultaneously bringing about a complete paradigm shift.

“The day people all over the country start chasing vaccinators, rather than (vice versa), we will achieve our goal,” he said, adding the media could be instrumental in bringing about such a fundamental change in public thinking. Azhar Mahmood Bhatti, director of the Punjab’s Expanded Programme on Immunisation (EPI), went a step further to suggest that legislation be implemented along with responsible media coverage.

“Laws should be (on the books) to make immunisation mandatory, and birth certificates should be issued to children only on verification of their polio vaccination cards,” he told IPS.