hcghr

Stamping Out Polio

In Uncategorized on January 15, 2010 at 12:06 am

Vaccines and Postage Stamps in Pakistan

Jessica Villegas, Staff Writer

Receive a letter from Pakistan, and chances are your stamp will feature a touching picture of former Prime Minister Benazir Bhutto immunizing her youngest daughter, Aseefa Bhutto Zardari, with the oral polio vaccine. Pakistan’s President Asif Ali Zardari, Ms. Bhutto’s widower, has requested that this photograph of his late wife be issued as a postage stamp to raise awareness of Pakistan’s polio eradication efforts amidst an alarming resurgence of the crippling disease.[1]

Pakistan is one of four countries worldwide where polio is still endemic, the others being Afghanistan, Nigeria and India. In 2008, Pakistan reported 118 cases of polio, up from 32 in 2007.[2,3] In the first nine months of 2009, health officials reported 62 new cases of the disease.[4]

While there is no cure for polio, eradication efforts focus on the widespread administration of polio vaccines. The Global Polio Eradication Initiative (GPEI) was launched in 1988, but it was not initiated in Pakistan until 1994, with the first two National Immunization Days (NIDs) held that same year.[5] In 2001, a door-to door strategy of administering vaccines was adopted in Pakistan, but its efficiency is now left vulnerable to security threats that arise in the conservative and unstable northwest parts of the country, where the Pakistani army is presently locked in battle with Taliban troops.

In October 2009, polio vaccination efforts in Pakistan received a heavy blow. Four serious security incidents, including an attack on the United Nations World Food Programme offices in the capital Islamabad, left areas of northern Pakistan inaccessible to immunization officers. A polio team in the country’s volatile North West Frontier Province (NWFP) is presently trying to grasp the number of children under five who will be missed during the next round of NIDs due to the current military action against the Taliban.[6] President Zardari’s urgent call for “no child missed” in the October NIDs has been rendered silent.

Conservative areas like the NWFP witness campaigns that equate anti-polio efforts with federal and even American interference. Local clergymen oppose the idea of vaccination, calling it a conspiracy of the West against Muslims to makethem sterile and curtail their population growth.Using mosque loudspeakers and illegal radio stations, these clerics denounce polio vaccination before a population vulnerable to a disabling disease that has already eradicated from most of the world.[7] With fiery anti-vaccination voices and literacy rates hovering below the national average of 48%, these areas pose a serious challenge to health workers.[8]

To highlight the virulence of this opposition, in 2007 health workers in Bannu, near North Waziristan (in the Federally-administered Tribal Area, or FATA, near NWFP) were sent a letter and a 500 Rupee note giving them two choices—to stop the polio immunization of local children or to buy their own coffins.[9]

Health workers in Pakistan retaliated against these anti-vaccination sentiments with a fatwa, a religious opinion concerning Islamic law, endorsing polio vaccination campaigns. Maulana Fazlur Rehman and Qazi Hussain Ahmed, the leaders of Pakistan’s largest religious parties, endorsed this fatwa. Health workers and volunteers now travel with these papers, hoping to dispel fears and myths about polio immunization campaigns.[10]

Intriguingly, Oliver Rosenbauer, a WHO spokesperson for the Global Polio Eradication Initiative, informs HCGHR that, “Refusals due to religious reasons are actually extremely low in Pakistan, well below 1%.” The support from religious leadership garnered by local health workers still does little to combat both the security risks and inaccessibility of Pakistani children, and political intimidation from conservative leaders.

Of the 54 new cases of polio reported before October this year, 34 are in the NWFP and FATA.11 Rosenbauer notes that active surveillance of the poliovirus by WHO experts revealed reservoirs of the virus in these regions, making them priority areas for health workers. The government does not have much authority or control in most of these areas, and so NGOs need to negotiate with local leadership ahead of time to gain access to children.

A lack of government oversight can lead to more mundane problems. Responding to HCGHR’s queries, Aziz Menon, the National Chair of the Rotary International Polio Plus Committee in Pakistan, lists managerial problems as an important reason for the rise in polio cases. The prevalence of “Population movements” between infected populations, unbeknownst to any authority, only complicates matters for health workers.

This is where Bhutto’s stamp might help. Amidst a prolonged struggle between the government and powerful militants, and limited official outreach, creative strategies for reaching families in regions like NWFP might be the best way to raise people’s awareness of the polio problem. There have been complaints that Bhutto’s image might fuel even further anger among conservative clerics due to the former Prime Minister’s anti-Taliban stance.[12,13] Nevertheless, in the absence of a vaccine against opposition rooted in cultural, religious, or political contexts, a simple postage stamp is more likely to make it into the homes of Pakistan’s conflict-ridden, insecure areas before any health worker.

_________________________________________________________________________________________

1 “No child should be missed: Zardari.” Global Polio Eradication Initiative News 13 Oct 2009. <http://www.polioeradication.org/content/general/LatestNews200910.asp#03&gt; (Accessed 16 Oct 2009)
2 “Monthly Situation Reports.” Global Polio Eradication Initiative. 7 Oct 2009. <http://www.polioeradication.org/content/general/current_monthly_sitrep.asp&gt;. (Accessed 16 Oct 2009)
3 PAKISTAN: Record number of polio cases in 2008.” IRIN: A Project of the UN Office for the Coordination of Humanitarian Affairs. 13 Jan 2009. <http://www.irinnews.org/Report.aspx?ReportId=82333&gt;. (Accessed 16 Oct 2009)

4 “Global Case Count.” Global Polio Eradication Initiative < http://www.polioeradication.org/casecount.asp&gt; (Accessed 16 Oct 2009)

5 “The History.” Global Polio Eradication Initiative Background. 26 Sep 2009 <http://www.polioeradication.org/history.asp&gt; (Accessed 16 Oct 2009)
6 “Wild Poliovirus Weekly Update.” Global Polio Eradication Initiative. 14 Oct 2009. <http://www.polioeradication.org/casecount.asp&gt;. (Accessed 16 Oct 2009)
7 Nizza, Mike. “When Polio Reappears in Tribal Pakistan.” New York Times. 17 Jul 2008. <http://thelede.blogs.nytimes.com/2008/07/17/when-polio-reappears-intribal-pakistan/&gt;. (Accessed 16 Oct 2009)

8 “PAKISTAN: New tactics in anti-polio drive as more cases emerge.” IRIN: A Project of the UN Office for the Coordination of Humanitarian Affairs. 18 Aug 2008. <http://www.irinnews.org/Report.aspx?ReportId=79864&gt;. (Accessed 16 Oct 2009)
9 “Jahalat: Polio Vaccination Campaign Facing Threats.” All Things Pakistan. 4 May 2007. <http://pakistaniat.com/2007/05/04/jahalat-polio-vaccination-campaign-facingthreats/&gt;. (Accessed 16 Oct 2009)
10 Walsh, Declan. “Polio cases jump in Pakistan as clerics declare vaccination an American plot.” The Guardian 15 Feb 2007. <http://www.guardian.co.uk/world/2007/feb/15/pakistan.topstories3&gt; (Accessed 16 Oct 2009)
11 “Most polio victims belong to conflict zones” The Dawn 29 Sep 2009. <http://www.dawn.com/wps/wcm/connect/dawn-contentlibrary/dawn/news/pakistan/provinces/07-most-polio-victims-belong-to-conflictzones-ha-07 > (Accessed 16 Oct 2009)
12 “Bhutto blames Taliban, al-Qaida for explosions”. MSNBC.com. 19 Oct 2007. <http://www.msnbc.msn.com/id/21374344/. Retrieved 2008-09-13>. (Accessed 16 Oct 2009)
13 Afzal, Omer and Rai, Mohammad A., “Battling polio in Pakistan: Breaking new ground” Vaccine Sep 2009, Vol. 27 Issue 40, p. 5431

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