By Ayesha Raza Farooq, PM's Focal Person on Polio Eradication - Published in The News
Saturday, October 24, 2015 - If history is any guide, we are a resilient nation, having tackled the most testing of circumstances – whether battered by natural calamities including the worst kind of floods, the most devastating earthquakes or political upheavals like the one in 1971, and the frequent adventures of dictators. On each occasion the nation rose from a state of hopelessness and despair, and continued its march in the hope for a better tomorrow.
Protection from disease and disability is the right of every Pakistani citizen. Our constitution guarantees the right to life as a fundamental right and the state is duty bound to provide safeguards and an enabling environment that allows an individual to lead a secure and healthful life. Protection from diseases that cause death and disability is, therefore, an obligation of the state.
Polio is a disease that causes permanent irreversible disability amongst children. The world – having discovered that polio can be eradicated like smallpox – initiated the global campaign against the disease in 1988. Pakistan joined the effort in 1994.
From a situation where the country was reporting around 30,000 cases annually to cases in double figures in the late 2000s, Pakistan has made progress in this long and arduous journey. However, the security paradigm in the region and a wave of militant activity in parts of the country, coupled with negative propaganda against the anti-polio drive, meant that the disease one again reared its head. The present government was faced with a raging epidemic of the disease in conflict-prone areas of the country.
Just like we had a plan to defeat terrorism, address the energy crisis and improve the economy, we definitely had the plan, the resolve and determination to the stem the tide of rising polio cases in the country. Prime Minister Nawaz Sharif led the initiative from the front, as head of the Polio Task Force, bringing all provinces together in the fight against polio.
National and provincial emergency operation centres were established across the country to better monitor and oversee the polio effort. Zero tolerance for inefficiency was introduced as improved governance was the cornerstone of the government’s strategy in stopping poliovirus transmission.
The security situation was the most challenging in polio eradication efforts. Our government’s unwavering resolve against terrorism and decisive action in the troubled areas have had a salutary effect on polio eradication. A reign of fear prevented both health workers and families from reaching out to each other. It is most unfortunate that children had to suffer in this senseless spate of violence. With the success of Operation Zarb-e-Azb, and the support provided by the armed forces in implementation of the campaign, that challenge is being effectively addressed.
We have converted adversity into opportunity and managed to reach eligible children in all agencies of Fata and across the country. The UAE-Pakistan Army collaborative effort in Fata and the adjoining areas of Khyber Pakhtunkhwa has been most effective. As part of special strategies to exploit every opportunity to immunise children against polio and other diseases, all children of the Temporarily Displaced Populations returning to their homes were also vaccinated.
A major breakthrough has been the overwhelming support of the religious clergy – representing all schools of thought. They have rallied behind the cause calling upon the faithful to fulfil their obligation towards their children as enshrined in the Holy Quran.
As a result of locally appropriate and innovative communication and advocacy strategies, refusal to polio vaccination has seen a sharp decline and today stands at an all-time low.
Our valiant health workers have shown exemplary courage in carrying out their task undeterred in the face of the most challenging circumstances. We need to improve the working conditions of these frontline workers and institute a reward system to recognise their effort.
Innovation and improvisation remain at the heart of our effort to wipe out polio. Administration of the injectable polio vaccine in tandem with oral polio vaccine in high-risk areas, community protected vaccination and health camps are reflective of this approach.
Pakistan has been facing a peculiar situation where organized and targeted attacks against vaccination teams are rampant. Killings and kidnappings of doctors, paramedics, vaccinators and volunteers associated with the Polio Eradication Program were taking place between 2002 and 2014. However, violence against health workers administrating vaccines reached a crescendo in July 2012 when targeted attacks began in different cities of the country.
In the period between July 2012 and February 2015, 80 polio workers and those protecting them have been killed whereas 54 received serious injuries. Such brazen attacks against health workers finds no precedent anywhere in the world.
With concerted efforts, there has been an overall 85 percent drop in cases this year with the geographic distribution of cases becoming more limited. Additionally, we have witnessed the proportion of positive environmental samples fall from 34 percent to 19 percent.
Our programme’s single most important breakthrough is access to hitherto inaccessible areas and making insecure areas safe for vaccination operations. Increasing access to children in previously insecure areas is helping us significantly on the ‘road to zero’.
The strategic and paradigm shift in the programme was backed up by a systematic process to develop detailed implementation plans at all levels.
Cognizant of the need for support of the civil society, a robust and effective network has been established under the National Child Health Council with key civil society organisations, opinion leaders – activists, intellectuals and writers – contributing to positive positioning of the programme.
Out-of-the-box strategies like community protected vaccination in security compromised areas have been scaled up with door-to-door vaccination campaigns in difficult to reach areas in Balochistan, Fata, KP and Karachi. With the support of the armed forces, access to children was achieved in most insecure areas of Fata with the first ‘door-to-door’ campaigns in Khyber since 2009 and NWA/SWA since 2012.
On the occasion of World Polio Day, I would like to thank the public health managers, vaccine experts, logisticians and epidemiologists who plan for vaccination, who make sure our vaccine is of the best quality and who search out communities and children to ensure we deliver this life-saving service to them.
Thank you to the lab technicians and genetic scientists who test samples and tell us where the virus is hiding. Gratitude to our donors, who finance this ambitious goal and have never wavered in their dedication. Thank you to local and religious leaders who teach and advocate the importance of vaccination.
A special tribute on this day to parents who demand the service of vaccination, to all political parties that have come together over this common goal and done their utmost to ensure children receive vaccination in their constituencies.
But most of all, gratitude is due to the hundreds of women and men who go door to door to protect the children of Pakistan. They go to to the remotest corners of our country and the high-rises buildings of our populous cities to make sure no child is missed. They often brave danger, and long hard days of work.
We are closing in on the poliovirus. The virus has found sanctuary in our country, but we will not give it refuge any longer. As polio has been defeated in every country except here and in Afghanistan, the world is standing ready to help us. My commitment to the dedicated workers, the families and the local leaders who have brought us this far is that I will stand by you until the job is done, securing the political will and international solidarity you need.
The international community is with us. Pakistan is not alone in this struggle. Let us look back today and cherish the success achieved by the world so far.
A global movement has brought cases down 99.9 percent since 1988 and, since then, more than 2.5 billion children have been vaccinated against this paralysing disease. Thanks to widespread vaccination campaigns in hundreds of countries, a disease that once paralysed 1,000 children each day is now almost history.
The lessons learned from the global polio programme have created a lasting legacy to protect future generations from polio and other preventable diseases. We have the knowledge, resources and expertise to end polio for good. It is time now to capitalise on what we have learned – and finish what we started.
The writer is the Prime Minister’s Focal Person for Polio Eradication.