Eradicating Polio

Prime Minister Narendra Modi at his SAARC appearance late last year had suggested that India would be willing to support and help countries in the Indian subcontinent where Polio still remains a threat. He said

“We offer the five-in-one vaccine for the children of South Asia. We will support monitoring and surveillance of polio-free countries, and provide vaccines where it might reappear.”

While the gesture includes monitoring for polio free countries like Nepal, Sri Lanka and Bhutan, the intended target would be Pakistan and Afghanistan where polio still remains endemic and exportable.

The two countries have fought an uphill battle for the last 5 years to eradicate Polio. The resurgence of Polio in Pakistan has been especially high, with over 300 reported cases in 2014 alone. Pakistan’s polio strain have also been found as far as Syria, Israel and Egypt, countries where polio had been eradicated before.

India’s gesture to help the countries reduce and eventually eradicate polio is pragmatic and much required at this point. While the idea to rid the subcontinent of polio is important, it is more critical for India to protect its borders and ensure that polio from Pakistan doesn’t cross over. Increased monitoring of people traveling across the India-Pakistan border have been established by the government alongside compulsory vaccination for travelers. These measures might however fail, in the event of unauthorized border crossing or through waterways. It would be devastating if there is another outbreak of Polio in India. The persistence shown by the government and private organizations in ensuring kids remain vaccinated has been fantastic. It cannot afford to be derailed by neighbours being lax in their monitoring of the situation

Pakistan’s effort to eradicate Polio has run into a gamut of problems including security concerns, a large number of IDP coming from Waziristan and Khyber-Pakhtunkhwa region, suspicion about the vaccine and a strong religious majority that forbid the vaccine for various reasons. With more than 60 workers and security guarding the workers killed since 2012, security and ease of accessibility to administer the vaccine remains Pakistan’s biggest hurdle. With a police force stretched to its limits, the workers understand the challenge

“For all our teams to have officers at one time we would need more than 5,000 officers — more like 7,000. It is just not possible to get that with the law and order situation in Karachi,”.

The law enforcement and the ministry have tried to work around the issue by targeting areas with higher prevalence of Polio. IDP’s fleeing the Zarb-e-Azb operation in the north-west have been instrumental in spreading the virus too. One of the strongest forces in play against the vaccination are the religious beliefs that see the vaccine as an American conspiracy against Muslims, or as antifertility drugs or as something that their religion prohibits.

India too faced issues of reach and opposition to the vaccine from various quarters. The fight against polio was won by focussing on two important things, technology to reach moving population and using local leaders to emphasise the safety and security that the polio vaccine could offer. A report in Guardian on how India’s success can help Pakistan and Afghanistan pointed out that

India had leveraged sophisticated global positioning technology to map the movements of the mobile and migrant population to successfully reach children consistently missed by previous vaccination campaigns.

Community and religious leaders were used effectively to spread the message about vaccination.

In cities like Ghaziabad, announcements by local imams in mosques actively encourage congregations to immunise their children, persuading parents to accept the polio vaccine where they otherwise may have resisted.

Both the Pakistani and Afghan governments have taken steps ensure more kids are vaccinated. Polio workers, in spite of threats and shootings have been persistent in their efforts to vaccinate kids. Both the countries can learn from the Indian experience, and use the lessons learnt here to effectively combat the disease. It is an uphill task. Both Afghanistan and Pakistan face a lot of hurdles in dealing with the disease. The Afghan government has sent a team to India to monitor operations and learn from the system here.

Pakistan has not made any effort to move forward with the offer so far. With the Bill and Melinda Gates foundation offering to finance operations, support from the UN and other international agencies and, India’s assistance in technical and logistical areas, Pakistan has everything it needs to fight the disease. The ball is now in its court.