Pakistan’s polio drive ‘a disaster’

'Pakistan’s polio programme is a disaster. It continues to flounder hopelessly, as its virus flourishes,' according to the Independent Monitoring Board , which advises agencies fighting polio.

A Pakistani boy carries his sibling to receive the polio vaccine from vaccinators at a slum in Karachi. Akhtar Soomro / Reuters

KARACHI // Taliban militants have long been the scourge of Pakistan’s polio vaccination campaign, attacking aid workers and the police who protect them as they distribute doses to children.

But experts say there is another reason for the sharp spike in cases of the crippling disease in Pakistan this year – government mismanagement.

“Pakistan’s polio programme is a disaster. It continues to flounder hopelessly, as its virus flourishes,” the Independent Monitoring Board (IMB), which advises agencies fighting polio, will say in a report to be released this week.

The prime minister's polio cell was disbanded during 2013 elections, the new government delayed reconstituting it, and in recent months the prime minister has been consumed with protests in the capital that have only just ended.

“Eradicating polio is not rocket science,” said Elias Durry, head of the World Health Organisation polio campaign in Pakistan.

“If we could have three to five months to have really good campaigns, then we could get rid of this disease,” he said.

“We have been doing half-baked campaigns in high risk areas.”

Polio was meant be a thing of the past. A global campaign came tantalisingly close to wiping out the disease altogether.

Now polio, which can kill or paralyse a child in hours, is endemic only in Pakistan, Afghanistan and Nigeria.

So far this year, Pakistan has had 217 polio cases, a 14-year high accounting for 85 per cent of instances around the world.

The disease spreads easily from person to person, and Pakistan has already exported the virus to Syria, China, Israel and Egypt. Experts say complacency is not an option and the government has called the situation an “emergency”.

Yet as the latest vaccination campaign started this week in Karachi, vaccination workers said they had not received stipends from the provincial government for months.

Some have dropped out of the campaign in Karachi, a teeming city of 18 million people where the disease is entrenched.

As teams prepared to venture out on vaccination missions into some of Karachi’s most dangerous streets, police deployed to protect them showed up late.

Vaccinators must wait, which means they miss children. Sometimes only a third of children in an area are vaccinated, the WHO said, and low coverage fuels new outbreaks.

Pakistani prime minister Nawaz Sharif took six months to appoint an official responsible for polio, and the government approved a funding plan only last month.

“We had a loss of about nine to 10 months, which is a very big setback,” Mr Ali said.

Ayesha Farooq, the prime minister’s appointee on polio, admitted there were problems.

Most new cases were in areas where security was poor so children had not been vaccinated, she said, and denied that Mr Sharif was not taking the issue seriously.

Emergency operations centres, meant to be operational by July, will not be ready until the end of November, she said. The IMB report said the delay “speaks volumes about the inertia of the programme in Pakistan”.

For frontline polio workers, late pay is less worrying than lack of protection. Sixty-four people have been killed in attacks on polio teams and their security escorts since 2012, when the Taliban banned vaccinations.

Their targets are women like 19-year-old medical student Asma Nizam, who received a death threat for taking part in the programme.

“A man came on a motorbike and said, ‘if you want to save your life, you should go from here’,” she said.

The next day, militants killed five of her colleagues.

Last Monday, police sent to protect Ms Nizam were three hours late.

Pakistan’s police are thinly spread, especially in crime-ridden Karachi where only 26,000 police watch over the city. Some are seconded as bodyguards for politicians.

“I have seen six police taking a VIP’s teenager to the salon but they cannot spare any officers to protect the poor children of Pakistan,” one health official burst out in exasperation.

Karachi police spokesman Atiq Shaikh said the force was severely understaffed.

A further hurdle is caution among families offered the treatment. Some believe Taliban propaganda that says vaccinations are a Western plot to sterilise children.

Aiding polio’s spread has been this year’s military offensive in the tribal region of North Waziristan, which drove nearly a million people out of the conflict zone.

The mass movement allowed workers to vaccinate children previously unreachable. But families also moved to areas where vaccination coverage was patchy, allowing polio to reestablish itself in cities where it had been eradicated, experts say.

Children may need the oral vaccine up to 10 times for it to be effective. Many Pakistani children are malnourished or have diarrhoea so the vaccine is not absorbed.

The unlucky ones may end up like two-year-old Rafia. Her legs were partially paralysed after contracting polio this summer.

“She was vaccinated whenever they came,” said her father Ghulam Isaq. He massaged her tiny toes as a group of polio vaccinators looked on.

“We need help even if we are poor,” Mr Isaq said. “We are Pakistanis too.”

* Reuters