The World Health Organization (WHO) has put a restriction on all travellers from Pakistan to carry a polio vaccination certificate. After the initial confusion on whether this was a restriction or recommendation, the government has now announced that this international recommendation will be put into effect on all travellers from the country from June 1, 2014.
The WHO restriction came in the wake of evidence that Pakistan has become the largest global source of polio infections. Pakistan is among the three countries that have received this directive -- the other two being Syria and Cameroon. Together the three countries are said to have exported the virus recently.
According to reports, the prime minister has taken some administrative measures internally, after meeting with the National Coordinator for Polio Eradication Ayesha Raza Farooq. He has decided to seek help of the army to regulate the movement of people from Fata to settled districts only after polio drops have been administered to them.
At the moment, only three countries in the world -- Pakistan, Afghanistan and Nigeria -- are polio endemic, putting the rest of the world at risk. The World Health Organisation’s (WHO) travel restriction is the first of its kind because of polio in the three countries. Syria and Cameroon too are facing restrictions for polio outbreak. The current rise of polio in Syria is said to be because of Pakistan, while Nigeria imported that from Cameroon.
Only this year, the number of polio cases in Pakistan has gone up to 62 till mid May, with a majority of them from North Waziristan while the rest belonging to Khyber Pakhtunkhwa and Karachi. The spread of polio in Pakistan has been a big worry for the past few years. The number of polio cases in 2013 was 93. There has been a gradual rise in polio cases in Pakistan since 2007.
"Pakistan was the first country to face travel restriction because of failure to eradicate polio. Pakistan will have serious social and economic implications because of these restrictions. We will stand isolated in the world," says Dr Tariq Bhutta, Chairman Pakistan’s National Immunisation Technical Advisory Group and member of two WHO regions on polio eradication certification commission.
The WHO had been warning Pakistan for the past two years but our governments did not take it seriously, he says. "A country like Somalia has controlled polio virus but we have failed."
The virus strain of polio found in the country has affected many countries over the past two years, becoming a serious threat to the rest of the world. Pakistan is said to have transmitted polio virus to Middle East, Central Asia, and China. According to reports, China had to spend US$45 million to control that virus while the Middle East has spent several million dollars so far.
According to WHO findings, Pakistani polio virus has been found in Tajikistan, China, Palestine, Israel, Syria, Egypt and Iraq. It is turning into an epidemic in Syria and Iraq while it has been controlled in other countries because of high immunisation rate. It is also said to have travelled from Pakistan to Afghanistan because of the porous border, though some Pakistani authorities believe that it is Afghanistan that is exporting it to Pakistan.
The problem was compounded by the killing of Osama bin Laden on May 2, 2011 followed by the arrest of Dr Shakil Afridi, a Pakistani doctor who allegedly helped CIA through a spy vaccination campaign for Hepatitis. Prior to this incident, the Taliban were only opposing the administering of polio drops to children but since December 2012 they have started killing the polio workers.
As many as 40 polio workers and security officials have been killed during anti-polio campaigns in the past several months.
Pakistan’s health ministry and WHO have, in a joint statement, announced that all Pakistani travellers will be required to carry a valid polio vaccination certificate from June 1, 2014.
A template for the required vaccination certificate has been prepared. According to the health ministry, people travelling out of Pakistan can get vaccinated against polio from major public hospitals in cities as well as from District Health Offices, airports, seaports and cross-border checkpoints of neighbouring countries. The polio certificate issued to any one will be valid for one year.
The Minister of State for National Health Services, Saira Afzal Tarar, says the government would try to address the concerns of the WHO so that by the next assessment which is scheduled to be reviewed after three months the condition improves.
"We don’t take such matters of health seriously. Security concern and accessibility are two major reasons for this spread," Dr Bhutta says. He maintains Taliban added to this crisis barring polio workers in tribal areas in 2012.
He says among reasons of failure to eradicate polio, security is one. Pakistan has not provided vaccine to every child despite having sufficient dozes because Taliban have banned the entry of polio workers in many areas.
Rahimullah Yusfzai, a senior journalist based in KP, believes that accessibility due to lack of security is the main reason why tribal areas and parts of KP have become major polio reservoirs. He says vaccinators are under threat and banned from entering areas like North Waziristan. "I don’t think we cannot achieve hundred per cent target in the current situation but we have to do maximum. Such restrictions are aimed at putting more pressure on Pakistan to evolve a comprehensive strategy to eradicate this disease."
For those who travel frequently from Pakistan, it is an embarrassing situation after the allegations of exporting drugs and terrorism.
The Punjab and Sindh governments have prepared plans for setting up special counters for polio drops administration at district level and give free certification, which will be valid for one year.
"We have been put in an awkward situation," says Tahir Hussain, a Lahore based regular international traveller. He hopes that there would be a transparent procedure for this certification. He fears there can also be a problem if people start getting fake certificates, alarming the embassies to come up with their own system to make sure the procedure is transparent.
According to the reports of Ministry of National Health Services, despite all the efforts, the December 2013 reports claim that more than 47,099 children failed to get polio drops in Pakistan because their parents refused vaccination. The real issue is Pakistan is to access its every child for vaccination. A few years ago, polio vaccination was put under the prime minister’s office for greater oversight but that too did not help.
Dr Bhutta says, "A neighbouring country like Iran’s routine immunisation coverage is above 95 per cent and India has become polio-free. In Pakistan, routine immunisation coverage is 55 per cent, and less in many areas like Balochistan."
Recently, wild polio virus has been found in sewerage in environmental sampling in the heavily populated cities of Lahore and Karachi. "It might take years to improve the situation," says Dr Bhutta.
Dr Altaf Bosan, national focal person of prime minister’s polio cell tells TNS that all the affected areas in the country are somehow conflict zones including Karachi were an operation is going on. "The new strategy includes negotiations with those refusing or resisting vaccination, effective coordination from national to local level with greater role for the provinces."
He says strict accountability mechanism would be evolved in districts where the vaccination ratio will be low to make sure a quality campaign. "If we make effective and serious efforts to targeting polio reservoir zones, we can overcome the endemic situation in a year," Bosan hopes.