May 9, 2013 Liz Borkowski, MPH 4Comment

Earlier this week, a UN official told AFP that a child in North Waziristan, Pakistan had contracted polio — the first reported case since tribesman in North Waziristan stopped authorities from conducted a vaccination campaign in June last year. AFP explains:

The Taliban alleged that the campaign was a cover for espionage.

Efforts to tackle the highly infectious disease have been hampered over the years by local suspicion about vaccines being a plot to sterilise Muslims, particularly in Pakistan’s conservative and poorly educated northwest.

“We are worried because this new case comes as an example of a bigger impending outbreak of disease in the region,” the WHO official said.

As we’ve noted before, it’s not entirely unreasonable for Pakistanis to think a vaccination campaign might be cover for espionage, because the CIA ran a fake vaccination campaign in Abbottabad, Pakistan in an attempt to get DNA samples showing that members of Osama bin Laden’s family were living there. After nine polio vaccinators were killed in Pakistan in December, deans of schools of public health wrote to President Obama denouncing the CIA’s ruse and stating:

International public health work builds peace and is one of the most constructive means by which our past, present, and future public health students can pursue a life of fulfillment and service. Please do not allow that outlet of common good to be closed to them because of political and/or security interests that ignore the type of unintended negative public health impacts we are witnessing in Pakistan.

Pakistan is one of only three countries where the polio virus still circulates (Afghanistan and Nigeria are the others). Global eradication of the disease would be a public health triumph, and could save as much as $2 billion a year. Last month, an international group of scientists released a statement declaring their “conviction that the eradication of polio is an urgent and achievable global health priority” and calling on the global community to implement the Global Polio Eradication Initiative’s Eradication and Endgame Strategic Plan. At the Global Vaccine Summit held in Abu Dhabi two weeks ago, global leaders pledged financial and political support to the plan and its goal of a lasting polio-free world by 2018.

The new polio case in Pakistan underscores the urgency of the situation, and offers a reminder that new approaches may be necessary now that the CIA’s actions have weakened trust in existing vaccination efforts. In the latest issue of the Lancet, Qanta A Ahmed, Sania Nishtar, and Ziad A Memish urge that the Muslim world assume a more active role in the effort to eliminate polio in Pakistan, with Saudi Arabia taking leadership. They write::

Saudi Arabia and its health authorities are uniquely placed to bring about change in Pakistan for two reasons. First, as the site of Mecca and Medina and host to the Hajj, Saudi Arabia wields enormous influence in Muslim Pakistan. Second, Saudi Arabia has experience of introducing new public health recommendations and strengthening public health outreach by legitimising new public health measures with both formal Islamic authority, in the form of fatwas, and informally, through public opinion.

Saudi theocrats and public health officials are experienced in effective public health messaging in the diverse Muslim public space. … Pakistan’s Taliban views vaccination programmes as not being Islamic and a western innovation to be repudiated, at the peril of the murder of health workers and the inexorable rise of poliomyelitis. Saudi Arabia’s clerics have shown the opposite view through their willing and engaged acceptance of diverse forms of advanced medicine — e.g., the use of alcohol-based hand hygiene agents, and use of porcine medicinal products if no alternative is available.

The authors point out that it’s in Saudi Arabia’s interest to help eradicate polio in Pakistan, because nearly 200,000 Pakistanis travel to Saudi Arabia annually for the Hajj pilgrimage. (Their piece notes that Saudi Arabia has public-health measures in place to prevent pilgrims bringing polio into the country, including requiring vaccination for visa issuance to pilgrims coming from countries where poliovirus is actively circulating.)

Whatever roles individual countries play, it’s crucial that the global community act quickly and decisively to eradicate polio before it can gain a foothold again. And the US intelligence community needs to refrain from imperiling major public health achievements that save millions of lives worldwide, because health is a key component of security.

4 thoughts on “Pakistan sees first polio case since vaccination campaign disrupted

  1. Because the people living in rural areas believe its against their religion. It takes time to bring a collective change.

  2. Pakistan’s government is certainly very involved in the effort, but needs assistance. Vaccination campaigns are complex and resource-intensive — they usually involve teams health workers going house-to-house to administer vaccines, which must be kept refrigerated (an aspect that adds to logistical challenges). And in Pakistan, now the vaccination teams need to have security teams accompanying them, too. If the global health community had waited for all countries to fund their own vaccination campaigns instead of providing assistance, poliovirus would still be circulating around the globe.

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