ISLAMABAD: A high level delegation led by Global Alliance for Vaccines and Immunization, Chief Executive Officer, Dr Seth Berkeley and World Health Organization, Regional Director, Dr Ala Alwan met the National Health Services Minister Saira Afzal Tarar here on Thursday.
Ministry of National Health, Secretary, Muhammad Ayub Sheikh was also present on the occasion. The high level delegation included global and regional leaderships of Bill and Melinda Gates Foundation, UNICEF, USAID, UK Department for International Development (DFID), World Bank, and Saudi Arabia, Islamic Development Bank.
The Minister on the occasion shared that third party evaluation of the polio program has been initiated. The same monitoring mechanism will be instituted for routine EPI, she said. Lady Health Workers were being trained to deliver all EPI vaccines which will give a major boost to routine EPI coverage as there are over 100,000 lady health workers with access into homes and trust of the communities, said the Minister. She pledged that soon the international partners would see a sea change in the situation in terms of health indications.
GAVI Chief Executive Officer Dr Berkeley informed the minister that Pakistan was the world’s largest recipient of support from Global Alliance for Vaccines and Immunisation as the organization has committed 825 million US dollars support to strengthen immunization services and health systems in Pakistan. The support will be available for the next five years period till the year 2020. He emphasized that strengthening routine immunisation for children was critical to saving lives and an integral part of the strategy to eradicate polio. He pointed out that 2.7 million children in Pakistan were not being accessed by vaccine against nine preventable diseases for which efforts are required to effect a change in the situation.
WHO, Regional Director, Dr Ala Alwan pointing to the seriousness of the issue said there was need to address issues of staffing, capacity, financing and management in delivery of immunisation services. Bill Gates Foundation Global Development President, Dr Chris Elias said his foundation was pleased to support Pakistan’s polio eradication effort. He urged to do efforts for achieving MDG 4, which aimed at reducing child mortality by two thirds by 2015. He further added that increasing routine vaccination coverage would significantly contribute to decreasing infant and child deaths and achieving MDG4. He said the establishment of emergency operation centers for polio eradication at the federal and provincial levels with effective monitoring and coordination capacities impressed him.
Speaking on the occasion UNICEF’s Deputy Executive Director Dr Geeta Rao Gupta reiterated her organization support to protecting the health of children and mothers in Pakistan. “The need to improve routine immunization coverage in Pakistan cannot be over emphasized,” said Geeta. National Health Services, Secretary, Muhammad Ayub Sheikh said we are mindful of the challenges and have taken the right course to achieving our targets. The roles of the federation and provinces were being defined in the context of the post devolution scenario and strengthening sustainability of immunization services, he said. The speakers further said that they realise the challenges Pakistan faces regarding immunisation and are determined to make 2015 a turning point for the country in terms of immunising all children, especially those living in marginalized communities and hard to reach areas. The fact that nearly 400,000 children under the age of five die in Pakistan every year from diseases, which can be prevented through vaccine is simply not acceptable. These precious lives can and must be saved. They stressed the need for taking more innovative steps to improve Expanded Program on Immunisation (EPI) to routine immunisation as well as recruitment and training of qualified EPI personnel coupled with improved reporting systems.
TIME magazine online “What it Will Take To End Polio” Oct 2, 2014
What it Will Take to End Polio
Franklin Roosevelt never knew the Pakistani babies battling polio today, but he knew their pain. The world is fighting to end that suffering forever
You can still see the ramps and rails at Franklin Roosevelt’s house on East 65th Street in Manhattan—even though they’ve been gone for decades. They’re easily visible in the pictures that decorate the home. They’re visible, too, in the popular iconography of Roosevelt, who was photographed standing countless times after being paralyzed by polio in 1921, but always with a hand on a railing, an arm on an aide, a cane in his grip—and ramps and rails at the ready.
The six-story Roosevelt house, where the family lived from 1908 until their move to the White House in 1933, is now owned—and was restored—by New York’s Hunter College. These days it’s a place of learning and policy conferences. But it is also a place of historical serendipity.
“When the house was built, it was one of the first private residences in New York that had its own elevators,” Hunter president Jennifer Raab told me as we toured the building this morning. Those became indispensable once FDR became paralyzed, and it was in that house that his kitchen cabinet thus gathered in the four months between his election in 1932 and his inauguration 1933. “The New Deal was born here,” Raab says.
For FDR, there were abundant compensations for polio. As Ken Burns’ documentary The Roosevelts makes clear, the disease deepened and grounded him. It made him a champion of children with polio—an effort that led to the March of Dimes and the later Salk and Sabin vaccines—and for that matter a champion of all people who suffered hardship. It was polio that gave Roosevelt a fuller temperament—and in turn gave the nation a fuller Roosevelt.
There are no such compensations for the handful of children around the world who still contract the crippling disease. On the same morning I was making my visit to the Roosevelt house, word came out of Pakistan that the country is on target to top 200 polio cases in 2014, its biggest caseload since 2000. Pakistan is one of only three countries in the world where polio remains endemic—the other two are Afghanistan and Nigeria, with 10 and six cases respectively so far this year—and it’s the only one in which the caseloads are moving in the wrong direction.
As recently as 2005, Pakistan’s case count was down to just 28, helping to push polio to the brink of eradication. That same year, however, religious leaders in northern Nigeria declared a boycott of the vaccine, claiming that it contained HIV and was intended to sterilize Muslim girls. This led to a wildfire spread of the Nigerian strain that stretched as far southeast as Indonesia.
But Nigeria got its house in order, and the hot zone now—a more challenging one—has shifted to Pakistan, particularly in the tribal areas in the north and in the mega-city of Karachi. Some of the problem is simply the crowded, unhygienic conditions in Karachi. But the bigger piece is the fighting in the tribal regions, which have made vaccinations difficult or impossible. That’s been exacerbated by Taliban gunmen, who have shot and killed 59 polio field workers and police officers trying to protect them since 2012.
“It’s a very sad thing,” Aziz Memon, head of Rotary International’s PolioPlus team, told TIME by phone from Pakistan today. “We’re trying to get vaccinators on the ground and into the field despite the ban. And now rains and flooding that have broken 100-year-old records are creating more problems.”
Rotary, which has been the point-organization for the eradication of polio for more than 25 years, is being assisted by the Gates Foundation, Save the Children and multiple other international groups, all working to push back against the Taliban blockade. Vaccinators routinely wait at bus stops around Pakistan, climbing aboard and looking for kids who have no vaccination records and administering the drops on the spot. Refugee camps in the war torn tribal regions provide another way of standing between the virus and the babies.
“When the virus is contained like this it’s a good opportunity to step in and control it,” says Memon. “We can also take advantage of the low-transmission season, which starts soon.”
The effort to snuff out polio altogether is more than merely the moral thing, it’s also the practical thing. Bill Gates repeatedly stresses that $1 billion spent per year over the next few years can save $50 billion of the next 20 years, money that would otherwise be spent treating polio and constantly fighting the brushfire war of vaccinating against outbreaks. Eliminate the disease for good and those costs go with it. What’s more, the delivery networks that are put in place to do the job can be easily repurposed to fight other diseases.
None of this long-range thinking makes a lick of difference to the 187 Pakistani children—or the 10 Afghanis or six Nigerians—who forever lost the use of their legs this year. They are paralyzed, as they will be for life. For them, there is no offsetting wealth, no townhouse with an elevator, no path to global greatness. There is only the disease—a pain FDR recognized and fought to fix. In Pakistan, that same fight is being waged today.
Polio remains endemic in Pakistan as health workers battle anti-vaccine prejudice and threat to life by armed groups.
Uzma Islam, right, says she tries to address the concerns of those who refuse the vaccine [Asad Hashim/Al Jazeera]
Karachi, Pakistan - Sitting at his worktable in a ramshackle hut in one of Karachi’s poorest districts, Muhammad Aslam makes clothes for a living. The 17-year-old never went to school, but has been a tailor since he was 12, making about $20 a month from sewing men’s shalwar kurtas - a traditional dress.
“I can walk on it, but it hurts. My leg is wasted away from the knee down,” he says, steadying his left knee with his hand as he leads me through the dusty, labyrinthine streets to his home.
Aslam is one of hundreds of people in Pakistan who suffer from polio, a crippling virus that attacks the body’s central nervous system.
In the last 25 years worldwide polio cases have dropped by 99 percent, but the highly contagious disease, which is passed on through infected water and food contaminated with the faeces of an infected person and thrives in areas with poor sanitation and incomplete vaccination efforts, remains endemic in Pakistan, Afghanistan, and Nigeria.
It is an alarming uptick from the 93 cases reported in total last year, and the 58 cases in 2012, as Pakistan’s efforts to control the disease appeared to finally be bearing fruit.
While the lack of uniform hygiene standards is one reason for the disease’s spread, health workers told Al Jazeera that the biggest issue in Pakistan is opposition to vaccination by parents – often with the “justification” that the vaccine is part of a conspiracy to sterilise Muslims, as advocated by the Pakistani Taliban – and subsequent attacks on polio vaccination workers.
While the majority of Pakistan’s polio cases are found in the tribal areas, where the government writ is tenuous and the Pakistani Taliban hold sway over large areas, that ideology has been exported to other parts of the country, too, creating reservoirs where the disease can spread across geographical boundaries.
Nowhere is the threat more visible than in Karachi, Pakistan’s largest city, and one where a complex mix of ethnic, political and religious conflicts has resulted in a city where violence itself is endemic.
‘Creating fear by killings’
“[The Taliban] have been living in some areas, engaging in criminal activities and killing polio vaccinators,” says Aziz Memon, chairman of Pakistan’s national Polio Plus committee, referring to the Karachi areas of Sohrab Goth, Baldia, Landhi, and Bin Qasim, where even police officials told Al Jazeera they often feared to tread.
“Now if you start killing people, then [vaccinators] will not be able to go there. When they are not able to go there, it will become a polio reservoir.”
Aslam, 17, says that he does not let his disabled leg affect his daily work as a tailor [Asad Hashim/Al Jazeera]
This perception was only strengthened by the CIA’s use of Dr Shakil Afridi during a similar immunisation drive in Abbottabad to ascertain the location of Osama bin Laden, polio workers say, citing arguments made by those who refuse to take the vaccine.The threats from Karachi-based groups allied with the Pakistani Taliban is based on a perception that the polio vaccination drops administered to children are meant to harm them as part of “a foreign conspiracy”.
“No one used to care about the conspiracy theories before Dr Shakil Afridi, but now people have started caring. And they have started creating fear by killing vaccinators,” says Memon.
Since July 2012, 58 people have been killed in attacks on polio vaccination teams in Pakistan, including at least 24 health workers, according to data compiled by UNICEF. In the latest attack, on September 10, in the tribal area of Bajaur, a paramilitary soldier who was providing security to a team was killed by a group of masked gunmen.
“We take our lives in our hands when we work in these areas, the danger is very high,” says Mashook Ali, 20, a polio vaccinator who works in the Quaid-e-Azam Colony area of Karachi. “But we do this for the children, so that they are saved from the virus.”
Vaccination teams in Karachi are often deployed with security cover from the police. On Monday, a four-day polio vaccination drive in Karachi kicked off amid tight security. But vaccinators said that the police protection was often more superficial than meaningful.
“We have seen incidents where vaccinators have been fired upon, especially in Pashtun areas, where we work, so we do feel afraid,” says Saddam Hussain, 18, another vaccinator. “But we do this work for the betterment of Pakistan. We have made an oath to eliminate polio from Pakistan.”
‘Militants are like kings’
Reports of polio cases in Karachi coincide with the areas of influence of the Taliban, according to police officials with whom Al Jazeera spoke. It is in these areas that environmental samples consistently test positive for the virus, too, according to the WHO data.
Karachi is the only Pakistani city, other than Peshawar, where such environmental tests consistently bring up positive results for polio, according to the data.
Sheraz Aslam, a coordinator for polio vaccination efforts in Karachi, says: “There are areas where you cannot go at all. If they want vaccinations there, they have to come outside their area, to us.”
Waqar Gill, 19, an area coordinator for vaccination efforts in an area under threat, said that the vaccinators are more concerned about refusals, however, than the threat of attack.
“Those who refuse say that the vaccine reduces male potency, or that it is a US conspiracy. Some even say it is made from the urine of foreigners,” said Hussain.
Gill added that there were also concerns about short-term ill-effects as a result of the vaccinations, which immunise children by giving them a very small dose of the infection.
Those who refuse say that the vaccine reduces male potency, or that it is a US conspiracy. Some even say it is made from the urine of foreigners.
- Saddam Hussain, 18, a polio vaccinator
“From North Waziristan, when these terrorists went to Syria, they move with their families,” he said, pointing to the detection of a Pakistani strain of polio in Syria last year. “Until you do not achieve total elimination, the whole world is unsafe. Because the virus is just a flight away.”The lack of immunisation coverage, combined with the influence of the Taliban and the constant flow of migrants into the city has turned Karachi into a reservoir for the disease, says Memon, which is of major concern in terms of worldwide polio eradication efforts.
While country-wide coverage rates for Pakistan’s polio immunisation drives are relatively high, they remain far from perfect, with an average of 11 percent of children being missed in vaccination drives, either due to security reasons or refusals, according to the WHO. In Karachi, that number stands at 21 percent.
“If the community is willing to hold a dialogue with you, then you can ask them, and perhaps even convince them [to allow vaccinations],” says Azfar Ali, the country manager for PolioPlus. “But in certain areas of Karachi, like Sohrab Goth, you can’t even talk about it. Militants are like kings there.”
Aslam, the tailor, lives in an area where there are a large number of migrants from the South Waziristan tribal area, and, consequently, a large number of refusals.
“I feel like if I had gotten the drops, then today I would be able to walk, I’d be able to play. I feel like I am less than these other kids,” he says.
“This disease ruins a person’s life. The people who don’t give their children these drops, they must be idiots.”
Follow Asad Hashim on Twitter: @AsadHashim