Polio in Pakistan- The overshadowed emergency

Ebola and polio are the only two diseases currently considered global public health emergencies by the World Health Organisation (WHO). The world’s attention is on the growing threat of Ebola, and the global community’s woefully slow response. On the other hand, it seems the world has largely forgotten the hundreds of thousands of children who have died in Pakistan, from what most would consider a preventable disease.

In 1955 a vaccine created by Jonas Salk promised the end to the crippling, debilitating illness called Poliomyelitis. Or so we thought. Almost 60 years later, whilst a massive international effort to eradicate polio has been undertaken, the disease still remains endemic in three countries; Nigeria, Afghanistan and Pakistan.

Pakistan represents over 80% of the global disease burden of Polio, and the recent upsurge threatens to spread not only throughout the country, but across borders too. With over 200 cases this year alone, Sona Bari, a spokeswoman for polio eradication at the WHO says the country is “really at a tipping point.” There are numerous reasons for the state Pakistan now finds itself in, one of the most discussed among commentators, being the motives of Taliban and other militant leaders in certain areas of the country.

In 2011 the CIA controversially targeted a vaccination programme in Pakistan, testing DNA samples from people in and around Osama Bin Laden’s compound in Abbottabad, to confirm his presence in the area. Health care workers were used for the mission, and as a result a savage militant revenge campaign has been unleashed in certain parts of the country. The Taliban response to the situation has been called “paranoid” by some, but with drones flying overhead for the past decade, and healthcare practitioners turning into spies, their response of killing over 50 public health workers since 2011, whilst being ethically condemnable, is not entirely surprising. America’s foreign policy in the region, for many years, has contributed to a growing anti-west sentiment, and the CIA’s decision to use public health as a medium for espionage has certainly added fuel to the fire.

International politics definitely plays a role, but it is not the only reason polio still exists in Pakistan. The majority of confirmed polio cases identified in Punjab, Sindh and Khyber Pakhtunkhwa states in 2013, were from zones considered to be low-violence areas.  This fact contradicts the opinion of militancy alone as an obstruction to polio eradication in Pakistan. Whilst the Americans must be held partially accountable for the clamp-down on vaccination programmes in certain areas, and the deaths of many innocent lives, the Pakistani government must also take responsibility. Polio vaccination programmes are poorly implemented in many places, and there is a failure to control or even slightly influence attitudes towards vaccinations, in many areas of the country.

Professor of Paediatrics and Child Health at the Aga Khan University Hospital (AKUH) in Karachi, Anita Zaidi claims that “Malnutrition among children in our country is a significant factor in the problems with the anti-polio campaign. Co-existing diseases can affect the efficacy of vaccination, for instance if a child is suffering from severe diarrhoea there is a high chance that the polio drops will have little or no impact. Infectious disease and malnutrition are key in damaging a child’s health in Pakistan. With the government only spending 2.2% of GDP on healthcare, $28 per capita, Pakistan ranks 188 out of 192 countries with regard to government health expenditure. In the long term, more pressure needs to be applied to those making decisions in Pakistan, to increase this budget, if they are ever to deal with, and recover from the Polio emergency. Public health schemes need not only to be expanded into less accessible, rural areas, but the quality of the programmes must also be improved.

It is imperative that the international community provide aid wherever possible, not just to prevent the spread of disease to their own country, but to put an end to the hundreds of thousands of children needlessly dying in Pakistan. Once polio is eradicated, the world can celebrate the delivery of a major global success, and move on to addressing the health care needs of the future. Economic modelling has found that the eradication of polio would save at least US$ 40–50 billion over the next 20 years, mostly in low-income countries. Not only can these funds be re-injected into other areas of medicine and healthcare, but most importantly, countless children will be saved from paralysis and an incredibly premature death.

Vageesh Jain,

Global Healthcare Editor

The Spectrum

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