Dangerous casualty

Pakistan’s polio eradication campaign, which managed to come to to grips with deep-seated prejudices regarding the polio vaccine, has again fallen victim. This time, it’s the country’s on-off relationship with the United States, courtesy Washington’s drone policy and the use of a public health programme by the Central Intelligence Agency (CIA) to zero in on al-Qaeda leader Osama bin Laden that is to blame.

As a result of a ban imposed by the Taliban on the campaign, well over three lakh children in the tribal agencies of North and South Waziristan besides Bara tehsil in the Khyber agency could not be immunised in the just concluded three-day National Immunisation Days programme.

Setbacks

If that was not bad enough, the past week saw several attacks on health workers who are a part of the campaign in Islamabad and Karachi which culminated in the death of a doctor in a shooting incident in the commercial capital on Friday. The doctor — a Union Council Polio Worker — was shot dead in the area where the immunisation programme had been suspended earlier this week after a World Health Organisation (WHO) staff member and an international consultant were shot at during a visit to one of the vaccination camps.

Together, these events have struck a body blow to the polio programme at a time when the vigorous campaign had begun showing results. As against 58 confirmed cases from 24 districts between January and June 2011, only 22 polio cases were reported from 13 districts across the country in the first six months of this year.

Drone attacks

Reports from the tribal areas suggest that the government’s efforts at working with the community to get the ban lifted have failed. A tribal jirga held in Miramshah — the main town of North Waziristan — endorsed the polio vaccination ban as long as drone attacks continued in the region. The ban had been imposed by the Taliban in mid-June when it announced that “after consultation with the Taliban Shura, servant of Mujahideen in North Waziristan Agency Hafiz Gul Bahadur has decided that there will be a ban on polio campaign as long as drone strikes are not stopped.”

The Taliban also view such campaigns as a means by the U.S. to infiltrate their areas. Referring to Shakeel Afridi — the doctor who helped the Central Intelligence Agency (CIA) confirm bin Laden’s presence in Abbottabad by getting his family’s DNA samples through a health programme — the Taliban argue that the polio campaign is a front for the U.S. to spy on them. Health workers in the tribal agencies say they are questioned by the community on the need to vaccinate their children if they are only to be killed in drone attacks. “That rhetoric is powerful in those remote areas,” said an official at the Prime Minister’s Monitoring and Coordination Cell for Polio Eradication which is hopeful of working around this ban through an “opportunistic and flexible campaign” with health workers accessing children where and when they can, although this is easier said than done.

Since accessing these areas has always been a problem, first due to prejudices and now the ban, the federal government has recently evolved a transit strategy aimed at firewalling the tribal agencies which account for the maximum number of cases. Half of this year’s 22 cases came from the Federally Administered Tribal Agencies (FATA). Pashtuns — the dominant ethnic group of FATA and Khyber-Pukhtoonkhwa (formerly North West Frontier Province) — accounted for 77 per cent of the 198 cases of polio reported in Pakistan in 2011.

Global ranking

This was a decadal high that set alarm bells ringing in a country that had brought down the incidence of polio to 30 in 2005. In fact, Pakistan today has double the number of cases of polio than Afghanistan and ranks second among the four countries which reported polio this year; the other two being Nigeria and Chad.

Primarily, the spurt in cases is the result of the growing hold of terrorists and fundamentalists in Pakistan’s Pashtun-dominated north-western areas. The Swat Taliban banned the vaccine and the exodus from the valley following military operations saw refugees at high-risk transport the virus elsewhere. This got replicated when military operations in FATA triggered another round of internal displacement.

Vaccination points

As part of the firewalling of FATA strategy, 45 polio vaccination points have been set up at entry and exit points to the seven agencies and all children in the five-to-15 age-group transiting through any of these points are vaccinated. Besides, 22 cross-border vaccination points have been set up along the Pakistan-Afghanistan border. These again firewall FATA.

To deal with the prejudices and misconceptions associated with the vaccine, the government has roped in clerics and sought to drive home the point that even the Haj is out-of-bounds for those having polio. “District khateebs” and imams of mosques have been made part of the District and Union Council Polio Eradication Committees. They are encouraged to use the Friday sermon to address prejudices and misconceptions.

Given the growing inclination to link Pakistan with the Islam of the Arab world — seen as more pure when compared to the way the religion evolved in the sub-continent before the Zia years — the government has been using dignitaries from the Gulf to send across the message. Last week, the government got the Bahrain Ambassador to attend a vaccination camp and call for a “Muslim Ummah free of the scourge of polio.”

Also, the government has plans to invite the Imam-e-Kaba to Pakistan and during the visit request him to make a plea to all religious leaders — from all schools of thought — to play a proactive role in spreading the message against polio. After all, without a polio vaccination certificate, a Pakistani — however devout — cannot perform the Haj, Pakistan-Saudi Arabian friendship notwithstanding.