Fighting polio in Khyber-Pakhtunkhwa

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The battle – and it is a battle – to eradicate polio in Pakistan has been long, bitter and bloody. Most of the country is now polio-free but cases do still occur, and there are parts of the country where resistance to polio vaccination creates a pool of unvaccinated people especially children that are a vector for the disease.

In Khyber-Pakhtunkhwa there is a reported rise in parents refusing the administration of polio drops to children with 13,000 such in the last year, the majority of them in the city of Peshawar with 10,319 refusals, a deeply worrying figure. Those running the EPI programme say that they will be giving ‘special attention’ to such parents.

As if the above were not of sufficient concern the government has warned that it is going to take action against the staff of UN agencies that are responsible for the elimination of the polio virus from the Peshawar sewage system. The responsibility for the campaign is held by the WHO and UNICEF and both are noted as falling short of expectation. A meeting held on 2nd December was told by the PM focal person for polio Baber bin Attar that the Independent Monitoring board (IMB) lays emphasis on the elimination of the virus and not only on a head-count of cases.

There has been a large recruitment campaign by the UN agencies that have hired 3,000 female community health and 250 Union Council polio officers. It now transpires that there was no performance criteria attached to the posts, absenteeism is rife and despite a substantial workforce, there are still positive polio samples from water in the Peshawar sewer system. The Peshawar deputy commissioner lamented that the absence of performance criteria meant that he could not take action against those absent from or negligent of their duties. He has ordered a cut in the honorariums paid to union council chairpersons responsible for polio eradication in the hope this may spur them into activity.

Further bad news was that more than 10,000 children remain unvaccinated in every anti-polio drive due to the absence of community health workers. There are reports of fake finger marking and four UN polio workers have been relieved of their posts in Peshawar due to poor performance.

The picture that is before us is one of incompetence, maladministration, poor agency coordination and downright and inexcusable negligence. There is any number of guilty parties in this black scenario and none of those involved emerges with credit. Polio is a curse that Pakistan has had within its capacity to eradicate for many years and has failed to do so. Much of the country is polio-free and we are close to herd immunity, but it requires constant diligence if the disease is not to return in places where it no longer occurs. Polio vaccination has to become the norm for all children under five everywhere.

That polio persists in K-P is in large part down to failure on the part of those whose job it is to eradicate it. The lack of an effective public relations campaign that creates a narrative which countervails those that promote the wild conspiracy theories that underpin much of the vaccination refusals is particularly invidious. Both the means and the money is there which could see polio gone and gone forever.  This is fixable. We watch closely in the hope of positive developments.

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