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 But experts say there is another reason for the sharp spike in cases
of the crippling disease in Pakistan this year - government
mismanagement.
"Pakistan’s polio programme is a disaster. It continues to flounder
hopelessly, as its virus flourishes," the Independent Monitoring
Board, which advises agencies fighting polio, will say in a report
to be released this week.
The prime minister's polio cell was disbanded during 2013 elections,
the new government delayed reconstituting it, and in recent months
the prime minister has been consumed with protests in the capital
that have only just ended.
"It's frustrating. Eradicating polio is not rocket science," said
Elias Durry, head of the World Health Organization (WHO) polio
campaign in Pakistan.
"If we could have three to five months to have really good
campaigns, then we could get rid of this disease," he said. "We have
been doing half-baked campaigns in high risk areas."
Polio was meant be a thing of the past. A global campaign came
tantalisingly close to wiping out the disease altogether.
Now polio, which can kill or paralyse a child in hours, is endemic
only in Pakistan, Afghanistan and Nigeria. So far this year,
Pakistan has had 217 polio cases, a 14-year high accounting for 85
percent of instances around the world.
The disease spreads easily from person to person, and Pakistan has
already exported the virus to Syria, China, Israel and Egypt.
Experts say complacency is not an option and the government has
called the situation an "emergency".
Yet as the latest vaccination campaign kicked off this week in the
broiling, garbage-strewn alleys of Pakistan's biggest city, Karachi,
vaccination workers said they had not received stipends from the
provincial government for months.
Some have dropped out of the campaign in Karachi, a teeming city of
18 million people where the disease is entrenched.
As teams prepared to venture out on vaccination missions into some
of Karachi's most dangerous streets, police deployed to protect them
showed up late.
Vaccinators must wait, meaning they miss children. Sometimes only a
third of children in an area are vaccinated, the WHO said, and low
coverage fuels new outbreaks.
TAKING RESPONSIBILITY
Pakistani Prime Minister Nawaz Sharif took six months to appoint an
official responsible for polio, and the government approved a
funding plan only last month.
That meant provinces did not pay workers their stipends of $2.50 a
day on time, said Shahnaz Wazir Ali, a polio adviser to Sindh
province in the south where Karachi is located.
"We had a loss of about nine to 10 months, which is a very big
setback," Ali said.
Ayesha Farooq, the prime minister's appointee on polio, admitted
there were problems, but said that payment arrears were down to
provincial, not central government.
Most new cases were in areas where security was poor so children had
not been vaccinated, she said, and denied that Sharif was not taking
the issue seriously.
"We have got to take responsibility for our weaknesses," Farooq told
Reuters. "The quality of campaigns is something we will be paying
close attention to."
Emergency Operations Centres, which were meant to be operational by
July, will not be ready until the end of November, she said. The IMB
report said the delay "speaks volumes about the inertia of the
programme in Pakistan".
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POLICE PROTECTION
For frontline polio workers, late pay is less worrying than lack of
protection. Sixty-four people have been killed in attacks on polio
teams and their security escorts since 2012, when the Taliban banned
vaccinations in areas they controlled.
Their targets are women like 19-year-old medical student Asma Nizam,
who received a death threat for taking part in the program.
"A man came on a motorbike and said, 'if you want to save your life,
you should go from here'," she said.
The next day, militants killed five of her colleagues.
As she prepared to visit Karachi slums on a vaccination mission last
Monday, police sent to protect Nizam were three hours late.
Pakistan's police are thinly spread, especially in crime-ridden
Karachi where only 26,000 police watch over the huge city. Some are
seconded as bodyguards for politicians.
"I have seen six police taking a VIP's teenager to the salon but
they cannot spare any officers to protect the poor children of
Pakistan," one health official burst out in exasperation.
Karachi police spokesman Atiq Shaikh said the force was severely
understaffed.
"Polio campaigns take 2,000 officers. But we always provide them
with security even though we have some time constraints," he said.
A further hurdle is caution among families offered the treatment.
Some believe Taliban propaganda that says vaccinations are a Western
plot to sterilise children.
Aiding polio's spread has been this year's military offensive in the
tribal region of North Waziristan, which drove nearly a million
people out of the conflict zone.
The mass movement allowed workers to vaccinate children previously
unreachable. But families also moved to areas where vaccination
coverage was patchy, allowing polio to reestablish itself in cities
where it had been eradicated, experts say.
Children may need the oral vaccine up to 10 times for it to be
effective. Many Pakistani children are malnourished or have
diarrhoea so the vaccine is not absorbed.
The unlucky ones may end up like Rafia, a chubby two-year-old with
kohl-rimmed eyes. Her legs were partially paralysed after
contracting polio this summer.
"She was vaccinated whenever they came," said her father Ghulam Isaq,
a shopkeeper. He massaged her tiny toes as a group of black-robed
polio vaccinators looked on, only their eyes visible above black
niqabs covering their faces.
"We need help even if we are poor," Isaq said. "We are Pakistanis
too."
(Editing by Mike Collett-White and Maria Golovnina)
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