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 The country is one of only three in the world where polio is
endemic, along with neighboring Afghanistan and Nigeria, but
vaccination campaigns have cut the disease sharply, with only a
dozen cases last year compared with 306 in 2014 and more than
350,000 in 1988, according to Pakistani health officials.
However, there has been a worrying jump this year, with 41 cases
recorded, 33 of them in the northwestern region of Khyber
Pakhtunkhwa, where many people resent what they see as intrusive and
coercive vaccination campaigns often involving repeated rounds of
visits, officials say.
Just as alarming for health services, environmental sampling has
shown the presence of the virus in areas across the country, a clear
sign of gaps in vaccination, which must cover the entire population
to be effective.
Hopes that transmission of the disease could be ended this year have
been abandoned.
"We need to take the bull by the horns and accept there are
problems," said Babar Atta, Prime Minister Imran Khan's point person
on polio eradication.
As well as the difficulty in reaching very remote areas and keeping
track of people moving through big cities like Karachi, there have
been problems in collecting reliable data, exacerbated by resistance
to efforts to force vaccination.
Efforts to eradicate the disease have for years been undermined by
opposition from some Islamists, who say immunization is a foreign
ploy to sterilize Muslim children or a cover for Western spies.
Local officials say parents suspicious of mass immunization
campaigns have been getting hold of special markers, used by health
workers to put a colored spot on the little fingers of children who
have been vaccinated.
"They themselves would mark the fingers of their children, in case
of any official visit to countercheck the vaccinated children," one
official associated with an international organization told Reuters
in the northwestern city of Peshawar.
Officials estimate that so-called fake finger marking, sometimes in
collusion with health workers, is hiding the true scale of refusal
rates - and thus gaps in vaccination.
In some areas, as many as 8% of families may be refusing or avoiding
vaccination, a level which would mean the disease is not eradicated.
A senior official of the Health Department in Khyber Pakhtunkhwa
said the exact data had been deliberately hidden by local health
authorities nervous of being blamed for failing to ensure full
coverage. "And the result of hiding figures had led us to face an
epidemic-like situation today," he said.
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RESISTANCE
Polio, a disease transmitted through sewage which can cause
crippling paralysis particularly in young children, is incurable and
remains a threat to human health as long as it has not been
eradicated. Immunization campaigns have succeeded in most countries
and have come close in Pakistan, but persistent problems remain.
International observers have been watching the situation with alarm
for some time. In October, the Independent Monitoring Board, which
oversees the global polio eradication effort, wrote in its annual
report that there was "something seriously wrong with the program in
Pakistan".
In April, fueled by rumors on social media that children were being
poisoned by the vaccinations, mobs rioted in Khyber Pakhtunkhwa and
at least three polio workers were killed.
Even without violence, many people consider polio a "U.S. disease".
Facing more immediate threats such as a lack of clean water, many do
not see why their families should be disturbed by what they consider
intrusive foreign-sponsored campaigns.
Health workers, whose closeness to the communities they work in is
vital in building trust, face difficult choices in remote areas
where kinship and local power structures can often place them under
severe pressure not to report cases of non-compliance.
According to many officials, the stubborn hostility to the campaigns
and the high levels of avoidance underline the problems with heavy
handed repeat visits by health workers and police going after
families that refuse vaccination.
"Why are the marker pens in the shops? Because parents want to buy
them. They are sick and tired of repeated vaccinations," said Babar
Atta.
Officials are now looking at more targeted approaches to areas where
there are problems overcoming resistance to vaccination involving
more persuasion and education.
Oliver Rosenbauer, a spokesman for the World Health Organization,
said resistance to vaccination was hampering the eradication effort
although other factors, including the movement of people in Pakistan
and across the border with Afghanistan were potentially more
important.
He said officials were analyzing the series of problems confronting
the program to build a new approach.
"What is very clear to everyone is that if things keep going the way
they're going, we're not going to eradicate polio in Pakistan," he
said.
"We can keep a lid on it but that's not the aim. The aim is to
eradicate it."
(Editing by Robert Birsel)
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