Polio must be stopped in Pakistan

By Deepak Kapur & Aziz Memon

As the new year dawns, our respective neighboring states, India and Pakistan, both are in the news because of their efforts to eradicate the crippling childhood virus, poliomyelitis but due to completely opposite circumstances.

India, once projected by many experts to linger as polio’s last stronghold, now has every hope of marking its third full year with no new cases on January 12. Once that milestone is reached, it will set the stage for a national celebration a month or so later, when the World Health Organization is expected to certify WHO’s entire South-East Asia Region to be polio-free. 

Unfortunately, the anti-polio campaign in Pakistan, which is in a different WHO region, is garnering international coverage for the wrong reasons as more than 30 health workers or their security escorts have been killed trying to reach children with the oral polio vaccine. 

The escalation of violence keeps the Pakistani children at risk of contracting this incurable, disabling – but completely vaccine-preventable – disease. As of this writing, Pakistan had recorded 75 new cases of polio this year, up from 58 for all of 2012. Most of the infected children live within the Federally Administered Tribal Areas, notably North and South Waziristan, where the vaccination activities were banned.

And the concern now is that the virus will spread back to other areas of Pakistan where it had previously been stopped, as well as to other countries. 

Indeed, this is happening right now in several previously polio-free countries, such as Syria, where WHO has determined through genetic sequencing that a recent outbreak was caused by a polio strain originating in Pakistan. 

The spread of polio in Pakistan also poses a threat to neighboring India’s hard-earned success, which is exactly why anyone entering India from Pakistan after January 30 will be required to show proof of vaccination. 

It is clear that remaining three polio-endemic countries, Afghanistan, Pakistan and Nigeria – especially the latter two – constitute the reservoir where this opportunistic virus thrives and from which it can spread. As of mid-December, new polio cases in non-endemic countries in 2013 outnumbered the cases in the endemic countries 224 to 136.

At stake is the incredible progress achieved by the Global Polio Eradication Initiative, launched in 1988 by Rotary International, WHO, UNICEF, and the U.S. Centers for Disease Control and Prevention and now also supported by the Bill & Melinda Gates Foundation. 

Since 1988, the world has spent more than $10 billion on polio eradication, and the return on that investment has been a reduction in polio cases of more than 99 percent, from about 350,000 cases a year to only 223 in 2012, the lowest annual total ever. If we don’t finish the job and stop polio in the endemic countries, we risk losing all of the ground we’ve gained and jeopardizing the health and lives of millions of children. 

The outbreaks in the non-endemic countries this year are proof positive that the risk is real. Fortunately, India’s success in stopping the transmission of polio provides practical lessons already being put to use in Pakistan. India’s 116,000 Rotary clubs members contributed immensely to the nation’s effort against polio, especially in raising awareness and maximizing public participation in national polio immunization days, which reach more than 172 million children under the age of five years.

This included engaging and working closely with Islamic leaders, ulemmas, and scholars in the predominantly Muslim communities of northern India to obtain their support to help quell any parental misconceptions or misgivings about the vaccination program. 

The eradication volunteers among Pakistan’s 3,500 Rotary members likewise are working hand-in-glove with local leaders to secure their buy-in. As a way to avoid entering communities where the risk is deemed too high for vaccination teams, Rotary has set up mobile health clinics at key transit points, such as toll plazas and military checkpoints near the Pakistan-Afghanistan border, enabling thousands of children to receive the vaccine as families enter and exit the country. 

Rotary also established permanent immunization centers to improve routine vaccination and organized health camps in high-risk districts, an approach that proved effective in India. Rotary also recently provided 5,000 copies of a “speaking” story book about polio vaccination – with audio in the Urdu and Pushto languages-as an advocacy tool for social mobilizers/health workers at Pakistan’s Rotary Resource Centers.

It is through persistence, perseverance, and patience that the war against polio will be won in Pakistan. India proved polio can be beaten under the most challenging conditions. 

But it was not easy, and it clearly will not be easy in Pakistan. We must find a way to end the violence. We must reach every last child with the polio vaccine in Pakistan and in the other endemic countries and we will. 

The Global Polio Eradication Initiative’s commitment to the world’s children demands no less. 

**Deepak Kapur chairs Rotary’s National PolioPlus Committee for India and Aziz Memon chairs Rotary’s National PolioPlus Committee for Pakistan.