As 2017 draws to a close, it is worth highlighting a quiet success story underlying the headlines about Pakistan. This is a country on the verge of eliminating a foe that poses a critical threat not just within national borders but also the region. The dramatic drop in polio cases over the past three years – down by a whopping 99 percent, from 306 cases in 2014 to just 8 in 2017 so far – shows what political will, commitment, coordination and consistency can achieve.
The progress against polio in Pakistan “is a hard fought, hard earned gain, substantiated by solid evidence,” says Dr Hamid Jafari, principal deputy director for the Center for Global Health at the Centers for Disease Control & Prevention (CDC). “This is not the time to be sceptical.” He should know. Heading the polio eradication team in India on behalf of the World Health Organisation (WHO) from 2007-2012, he helped India become polio-free, one step closer to the region becoming polio-free.
“There are lessons to be learnt from India,” adds Rod Curtis of the Unicef’s Polio Eradication Unit who is present at my meeting with Dr Jafari in Atlanta. The first three months of the year in India when no cases appeared were full of anxiety, he recalls. The virus could have popped up any time. “We are very fortunate to have learnt the lesson from India – that we’re not done until we’re really done. And we all desperately want to be done.”
It is a matter of time before polio joins smallpox in extinction. The campaign’s success over the past decades is evident in the 16 million individuals around the world who can walk because they were vaccinated. But until the wild poliovirus is wiped out, children remain at risk. Pakistan, Afghanistan, and Nigeria, the only three polio-endemic countries in the world, are nearing success. There is suspense as the year ends with Nigeria recording zero cases in 2017 so far. In 2016, new cases cropped up just as Nigeria geared up to celebrate two years of being polio-free.
To be considered polio-free, a country must maintain high immunisation rates and high-quality surveillance and have no cases of polio for at least three years. A region is certified as having eradicated polio only when all its countries meet these criteria. “If we fail, the poliovirus will return, kill and paralyse”, noted Bill Gates in his keynote speech at the Rotary International Convention in Atlanta in June.
“We now need all hands on deck”, advocates Dr Jafari. He wants the Pakistani diaspora to be involved proactively, “with tongue, brain, and deed. Whatever your constituency back home is – family, friends, colleagues in cities and villages – we all need to get down to [the] basics and ensure that every child gets vaccinated and every case of floppy paralysis reported and investigated”.
Cornered, the wild poliovirus finds sanctuary and crops up in harder-to-reach places and populations. This “particularly treacherous phase” makes it essential to detect and respond to new cases fast; “It has to be an emergency response to deliver the final blow”, says Dr Jafari. At this stage, with so much at stake, “any union council or district that reports a polio case should be praised and rewarded, not penalised”. Pakistan’s polio programme enjoys broad political support, with political parties across the board committed to eradicating the virus. Political upheavals notwithstanding, the programme continues full throttle.
Senator Ayesha Raza Farooq, the prime minister’s focal person on polio eradication, is fully cognizant of the challenges. “We encourage unearthing issues, rather than brushing things under the carpet”. The programme continuously assesses and evaluates accountability mechanisms “to reward the good performers and penalise those involved in fudging or misreporting”. They take environmental samples, focusing on 53 strategically selected sites, working closely with provincial, district and union council teams. We must, says Senator Farooq, “catch the virus wherever it’s present. So that we really mean zero when we say we are zero”. The fight against polio has wider implications. Polio vaccinations, Dr Jafari observes, “are the ultimate in equity; you have to reach and serve everyone”.
“It is also about eradicating poverty”, as the European Union’s Commissioner for International Cooperation and Development Neven Mimica said at the Rotary Convention. Thirdly, to eradicate polio, countries and communities must collaborate within a country and the region, as Bill Gates stressed. Encouragingly, Pakistan and Afghanistan, sharing a common poliovirus transmission zone, are working together against polio, rising above political differences.
The Bill & Melinda Gates Foundation has added momentum – and dollars – to the polio campaign spearheaded by Rotary International, along with the WHO, the CDC, and Unicef. Their Global Polio Eradication Initiative (GPEI), the world’s largest public-private partnership, works with national governments and millions of volunteers. The GPEI has raised $14 billion international investment towards a polio-free world. But this is about more than money. “It’s the passion, commitment and energy” of those driven by the vision of a polio-free future, as Dr Tedros, the new Director General of WHO noted. “Health for all and all for health”. Highlighting the work of Pakistan’s polio workers, Gates said the campaign is a “testament to the kindness, compassion and spirit of helping others.”
The programme’s template may serve as a prototype to tackle other life-threatening health issues and vaccine-preventable deaths – measles, diarrhoea, pneumonia, and other scourges, like malaria and TB. Nigeria applied the lessons learnt from its polio eradication programme to fighting the deadly Ebola outbreak.
Adapting the experiences of local planning, supervision, commitment and accountability at all levels may also impact the critical area of education, especially for girls. At the Rotary Convention panel on human trafficking, actor Ashton Kutcher suggested using the polio programme’s inspiration to end human trafficking. The possibilities are endless. Another lesson is the importance of regular samples and testing. There are 125 environmental surveillance sites in Afghanistan, Nigeria, Pakistan, said Gates.
A third essential lesson is the importance of mapping. In Nigeria, only after the country had been properly mapped, was it discovered how many villages had been left out. This lent fresh impetus to the polio campaign. India’s success in polio eradication and Nigeria’s near success owes much to engagement with religious and community leaders – a fourth important lesson that Pakistan and Afghanistan are also applying. As Pakistan reaches closer to eliminating polio and contributing to a worldwide eradication of this deadly disease, its polio programme needs widespread support. The bottom line is the need to reach and vaccinate every child to wipe out polio, not just from the remaining three polio-endemic countries, but from the world.
The writer is a journalist, editor and journalism teacher.
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