Pakistan and the Politics of Polio

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Pakistan and the Politics of Polio

After each political transition, polio cases spike. This year, that trend seems to be getting worse.

Pakistan and the Politics of Polio

A health worker gives a polio vaccination to students in Peshawar, Pakistan, April 22, 2019.

Credit: AP Photo/Muhammad Sajjad

ISLAMABAD, PAKISTAN— The last polio case was reported in the Islamic Republic of Iran in 1997. Since then, the country has been free from polio cases and the virus — until wild poliovirus was transmitted from Karachi, Pakistan to the Iranian province of Sistan-Baluchistan. Karachi, a cosmopolitan Pakistani city, is now being called a centrifuge for the virus.

“On 9 May 2019, the Global Polio Laboratory Network (GPLN) notified WHO of the detection of wild poliovirus type 1 (WPV1) from an environmental sewage sample collected on 20 April 2019 in Konarak district, Sistan-Baluchistan province, Islamic Republic of Iran,” a statement from the World Health Organization (WHO) said. “The virus was detected in an environmental sample only, and to date, no associated cases of paralysis have been detected.”

Afghanistan and Pakistan are the only two countries left with polio cases. All other countries have eradicated the virus.

Back in 2013, when Pakistan went for general elections, the next year witnessed a rise in polio-related cases. This year seems to be repeating the trend.

Whenever there has been a political transition in Pakistan, polio-related cases have spiked immediately after. After general elections in 2013, the number of polio cases rose to 306 in 2014 before dropping to 54 in 2015, 20 in 2016, and only eight in 2017. In 2018, another election year, cases again rose to 12. Within the first six months of 2019, 32 cases of polio have been recorded across the country, which also has left a question mark on the performance of newly formed government. Experts fear the number of cases is going to cross 50, at the very least.

“Pakistan, its political transition, and polio cases go in the same direction, an upward direction. Due to the transition, a chaotic environment develops,” says Dr. Rana Safdar, former National Emergency Operations Coordinator of the Polio Eradication Program in Pakistan. “The entire [polio] program goes upside down.”

Before general elections, a caretaker government is formed to conduct the elections and transfer power to the new government. This process takes more than four months. Amid the chaos, bureaucrats and health officials are often transferred to new postings. As a result, the polio program suffers.

“This is what happened in 2018,” Safdar explains. “The shuffle in civil bureaucracy took place. A deputy commissioner [DC], who is in charge of a district and responsible for the polio program, can’t focus on tasks except those that are political in nature. [Everyone] from DCs to secretaries [bureaucrats] gets transferred, this results in mismanagement.”

People are worried about the rise in polio cases. Globally Pakistan has been criticized for its uncommitted attitude toward eradicating the polio virus once and for all. The International Health Regulations Emergency Committee of the WHO recently warned that Pakistan’s polio eradication program is no longer on track.

But Babar Bin Atta, who is the current Prime Minister’s Focal Person on Polio Eradication (PMFP), says that the rise in polio cases is not very serious and that he is devoted to wiping out the disease.

“I will not rest until I clean Pakistan from wild poliovirus,” Babar Bin Atta told The Diplomat.

However, Safdar says that circumstances are very bleak. The issue has to be taken very seriously and tackled immediately.

The Independent Monitoring Board of the WHO’s Global Polio Eradication Initiative is among those with grave concerns. In a confidential report sent to the Pakistani government and seen by The Diplomat, the IMB has damning words for Pakistan’s polio program:

Despite Pakistan’s considerable progress since 2014, when the IMB declared its Polio Program as a “disaster”, it is now clear that there is something seriously wrong with the Program in Pakistan. The virology data show continuing transmission in key reservoirs, including Karachi, Quetta Block, and Peshawar. This has not been fixed. This cannot be dismissed as some sort of glitch. Some would say that the Pakistan Polio Program is fooling itself into thinking that it has made any progress at all since 2017.

Like the experts interviewed for this article, the IMB believes that the recent political transition is having a negative impact. “The Polio Program in Pakistan has been seriously disrupted by recent national elections,” the report says. “The pre-election reassurances given to the IMB that there was political all-party agreement on retaining the national leadership arrangements for polio proved completely unsound.

“The highly effective Prime Minister’s Focal Point for polio eradication has gone. There is currently a leadership vacuum. The new Prime Minister has previously shown great commitment to the Polio Program. He needs to act quickly given the precarious epidemiological situation in Pakistan.”

Many believe that the increase in polio cases is not only due to the political transition. There are more factors at play. Former Director General of Health Services Dr. Munir Ahmed argues that under the new Imran Khan government, the “polio program not only became very slow but also inexperienced people took charge of it. Massive changes occurred at the national and provincial levels in the polio program. This literally has damaged the program.”

Safdar seconds Ahmed and adds, “As the new government took power they came up with new people who have less experience in the field of polio or preventive health.”

As a concrete example of the program’s flagging effectiveness, Safdar cites falling vaccine rates. “Each year we vaccinated around 40 million kids. Some 40,000 used to refuse polio vaccinations.” The number of vaccine refusals, according to Safdar, is now up to 120,000.

Every day some 20,000 newborns open their eyes in Pakistan. The current population of the country is some 210 million. Many term Pakistan a ticking population bomb.

“In this case, routine immunization is very important and for that we have to convince parents to take their newborn babies to basic health units in their respective towns, even without waiting for a door-to-door campaign,” explains Safdar. “But unfortunately, due to propaganda against the polio program many parents are refusing.”

Indeed, false propaganda against the polio vaccine campaign has hit a new level. Many conservative and ultra-religious groups have asked the public not to vaccinate their infants and shared misconceptions about the polio program.

Religious fanatics and so-called scholars have shared materials advocating against the vaccine program. Orya Maqbool, a former bureaucrat who is followed by some conservatives, is one of many who wrote and shared anti-vaccine thoughts. Many Pakistanis are conservative; they follow and revere such scholars and these postings can have an enormous impact.

Atta, the government’s focal person for the polio program, reached out to Facebook and Twitter asking them to take down anti-polio vaccine campaign pages. He succeeded. Facebook agreed to limit videos concerning the anti-polio drive. Hundreds of pages and posts that shared false propaganda against the polio vaccine were taken down, including Orya Maqbool’s. “We also are in contact with WhatsApp about deleting anti-polio related videos,” Atta says.

But deleting some pages on social media can’t actually defeat the wild poliovirus. “It’s a battle which needs to be fought in houses, streets, and towns, not on social media,” believes Safdar.

Safdar and Ahmed both agree on this point. “We can’t eradicate polio by fighting them on social media,” Ahmed says. “There is no other way than community engagement and dialogue with conservative people or groups to end their misconceptions. We can only make Pakistan polio-free if we convince parents, communities, even radical people — all Pakistanis to end their misconceptions about the polio campaign.”

As an example of successful engagement, the late Maulana Sami ul Haq, a renowned Islamic scholar known as the “father of the Taliban” in Pakistan, gave a fatwa, a religious decree, in the favor of the polio campaign. His institute, Jamia Darul Uloom Haqqania, published this decree. Many experts say that it helped to convince people to vaccinate their children.

Both Safdar and Ahmed are seconded by Farhad Jarral, a social media expert and digital consultant. “The strategy of coordinating with Facebook and Twitter to take down the anti-polio campaign’s content is effective and appreciating. But that does not help with the increasing numbers of refusals and WPV [wild poliovirus] cases in Pakistan,” Jarral told The Diplomat.

“…The government is completely ignoring the offline-online connection. The focus right now is to project the polio workers in some of the cold areas in KP and the northern parts of Pakistan, and the hottest areas including Balochistan and Sindh. Meanwhile the community engagement and the reason behind so many refusals have not been focused on.”

Worryingly, the anti-polio campaign propaganda not only raise the number of vaccine refusals, but also prompted violence. Polio workers and police personnel guarding the polio campaigners have been killed.

“The program has become politicized under Babar Bin Atta and [the ruling] Pakistan Tehreek-e-Insaf” or PTI, says Safdar. “It seems that the program is of only for the PTI, not a collective effort. Before it was our ‘one team’ approach that proved to be a game changer. We took all political parties, religious groups and communities on board under one roof. It should be a collective approach.”

“I think that [in pursuit of] becoming the blue-eyed boy in Imran Khan’s eyes, and to get some political gains, Atta has damaged the entire campaign,” an official working with the polio team told The Diplomat, while requesting anonymity.

Jarral likewise believes that “the polio campaign is more focused on promoting the personal gains of Babar Bin Atta.”

Atta denies such claims. “I am doing everything for Pakistan and our upcoming generations,” he says.

“An overall revamp of polio program will be done and we will not rest until we eradicate polio. The UN and its foreign employees, not Pakistani officials, have been dealing with communication or leading it, so there have been communication gaps. We have requested the posting of Pakistani officials, who are working abroad, in leading the communications.

“I don’t have any political agenda or interests, as a focal person of the program I just plan to eradicate the polio virus.”

Atta seems determined to eradicate polio and he further says that he would resign if he fails in the task of making Pakistan polio-free. However, the polio official who requested anonymity contradicts Atta.

He says, “This is a game of a billion dollars. Atta is trying to bring the entire program and communication under the PTI government’s fold. The UN has made this program effective by its direct involvement.

“The focal person is trying for more changes in the program; if he succeeds [in bringing the polio program under the government’s fold] the country will see more cases, more corruption, and damage to the entire polio program.”

Beena Sarwar, a journalist and a documentary maker who has worked on polio issue, told The Diplomat, “Disgruntlement and suspicions about how the government is running the program aside, this issue is too important to fall prey to political differences. The concerned authorities must do everything in their power to bring all stakeholders on board and move forward together. The health and future of our children depends on it.”

Shah Meer Baloch is a journalist based in Pakistan. He has had his work published in New York Times, Deutsche Welle, The National, The Diplomat, Daily Dawn, Firstpost, Herald magazine, and Balochistan Times.