Despite exponential advancement in medical science in the past hundred years or so, the only two diseases completely eradicated from our planet have been smallpox in 1980, and rinderpest in 2011. The good news is that the world today is very close to achieving a third remarkable success – the total eradication of polio. At least this is what it appeared to be in recent years – until this year, which has seen an alarming resurgence of polio in Pakistan.
Polio, or poliomyelitis in medical jargon, or infantile paralysis, is an infectious disease caused by a virus. While the legs are mainly affected, head, neck and diaphragm muscles may also fall victim. Polio mainly spreads from one person to another through infected faecal matter being ingested, even indirectly. But it also spreads through contaminated food or water containing traces of faeces. There is no cure for polio, but it is preventable through the administration of multiple doses of the polio vaccine.
In 1988, a global effort was launched to eradicate polio, spearheaded by the World Health Organization (WHO), Unicef, and The Rotary Foundation. By 2001, the number of cases worldwide got reduced to 483, from a mind-boggling high of about 350,000 cases in the starting year, 1988. Today polio stands eliminated from all countries of the world except for two - Afghanistan and Pakistan. In Pakistan, from 53 cases in 2015, we came down to 20 in 2016, and to just eight in 2017. But alarmingly, there has been a regression since eight cases in 2017, to 12 in 2018, and in just the first half of this year, to nearly 30 cases.
In recent weeks, there has been substantial commentary by experts and stakeholders on this resurgence and they have advocated counter-measures for this. Most of the points of view have merit, and collectively they urge a thorough, critical review of all aspects of the End Polio Now strategy. Generally speaking, most stakeholders attribute the resurgence to the increasing number of people refusing the administration of polio drops to their children, and to various shortcomings in the vaccine administration procedures.
I believe that the fundamental reason for the increasing refusals is the absence of really effective behaviour change communication. The anti-polio campaign in Pakistan needs to implement an altogether new and professionally devised communications strategy, based on deeply understanding, accepting and answering audiences wants and needs, addressing their apprehensions, fears and reservations – in short, winning them over.
The messaging or content has to be credible, persuasive and touching both the hearts and the minds of the recipients. And it should be in the language each segment of the diverse target audience across the country is most comfortable with. This implies that the communication must be in several regional languages, customized to the specific geographic audiences being targeted, and not necessarily through the national language Urdu, or through English.
What will also be critically important will be the effective delivery of the messaging. This must be through multiple channels – radio, television, print media, social media. So for example if the people of Khyber Pakhtunkhwa and the former tribal areas are being addressed and they mainly listen to FM radio and as a second mainly watch specific TV channels (perhaps regional language TV channels mostly), then this audience needs to be addressed predominantly through FM radio and regional language TV channels.
The messaging outreach should also utilize multiple mediums – print collateral with easy to understand infographics, short videos, talks (in person and over radio), physical presentations for larger community meetings and so forth. Overall, the outreach should be continuous and intensive over the next several months at least. A comprehensive communications strategy can be developed for review by the policy-makers, if so desired.
The holistic objective of the new communication strategy should be to gain the uncompromising trust and buy-in of the target audiences, by really making them understand and believe in the need to end polio once and for all. If India, with a population five or six times that of ours, and faced with a lot of the same challenges that we are facing (illiteracy, misperceptions, poverty, lack of sanitations, etc), can succeed in eliminating polio several years ago already, why can’t we in Pakistan?
For any strategy for eradicating polio to succeed, it is also imperative to address the issues of the polio-workers; the over hundred thousand individuals who are the front-line soldiers in the war against polio, administering the polio vaccine several times each year to tens of millions of children in every nook and corner of Pakistan – lady health workers, teachers, others, even volunteers. Their altruism, humaneness, commitment and personal sacrifices for the cause remain grossly under-recognized. Take these people out of the equation, and in no time polio will once again be a globally prevailing disease, crippling hundreds of thousands of people, if not millions.
Therefore an immediate and objective review of the whole deal with the polio workers is required. The minimum changes to be implemented should include, fixing the monthly salary at a minimum of Rs50,000.00, ensuring salaries are paid on a timely basis, ensuring a working day of maximum eight hours, assuring transportation availability, providing life and personal injury insurance, providing really effective security cover, and arranging thorough training in all aspects of the work required to be done, including truthful, transparent, accurate and timely reporting.
The war against polio will ultimately be won on the frontlines by the foot soldiers, and not in the air-conditioned offices of higher echelon policymakers. So, no matter how much extra it costs, the frontline army of foot soldiers needs to be deeply motivated and inspired, sincerely recognized and appreciated for its critical work, strongly supported through the assured provision of vitally needed support services like transportation and security, and not the least, more than adequately compensated for the work done.
The writer is a communications professional who has been associated with the End Polio Now campaign.
