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Tue July 29, 2014
Goats and Soda

The Hidden Costs Of Fighting Polio In Pakistan

Originally published on Tue July 29, 2014 11:06 pm

Pakistan is currently at the center of the global effort to eradicate polio. Although the country has reported only about a hundred cases this year, that's more cases than in all other nations combined.

Eliminating the paralyzing disease is a major logistical operation in Pakistan. More than 200,000 vaccinators fan out across the country, several times a year, to inoculate millions of children. The government also deploys tens of thousands of armed security forces to guard the workers.

All this is happening while Pakistan is fighting against the Taliban — and that militant group continues to threaten polio vaccinators and parents who immunize their children.

The polio campaign is costing Pakistani lives, national pride and precious health resources. Some health leaders are starting to question whether the focus on polio is worth it.

"All the immunization workers have been redirected into the polio campaign, which has resulted in another disaster: Our routine immunization has gone down to as low as 30 percent or less," says Dr. Raza Jamal, of the National Institute of Child Health in Karachi. "So that has resulted in epidemics of measles, diphtheria, cases of pertussis — which we had stopped seeing for a long time."

Jamal supports the polio eradication effort. But, he says, it has become a national obsession and has taken a huge toll on Pakistan's already overstretched health system.

Polio is only one of many challenges facing the poor country. People lack access to jobs, sanitation, decent housing, clean water and electricity. Criminal gangs terrorize the slums of Karachi. Pakistan has a major terrorism problem.

Last month, militants in suicide vests fought a five-hour gunbattle with security forces at the Karachi airport, which left 38 people dead. On the same day, 22 Shiite pilgrims were attacked and killed near the Iranian border.

Amid all this, Western health officials have pushed polio to the front of the country's national agenda.

Mazhar Nisar coordinates anti-polio campaigns for the Pakistani Ministry of Health, but even he thinks the constant drumbeat on polio can be a problem. "There is a serious fatigue factor in the parents," he says. "There is a serious fatigue factor among the providers."

Coordinating the mass immunization drives all across the country is a major logistical operation for the health department. And parents have started to question why the government is directing so much attention to this one disease, Nisar says.

"They [parents] said, 'When we go to the hospital, we don't get the medicines. We don't get the proper treatment. My child is dying of diarrhea. My child has measles. And yet every four or six weeks, you come with the polio vaccine,' " he says.

But being one of the last nations on Earth with polio — even if it's just a hundred cases — is an embarrassment for the government.

"There are people at the highest level [of the government] who've told me they start their day with polio, they end their day with polio, as if this is the only priority," says Zulfiqar Bhutta, a professor of pediatrics at the Aga Khan University in Karachi. Bhutta has worked on polio for decades.

Polio eradication is very important, he says. But it's unclear how long Pakistan can stay focused on mass immunization drives. "What we need to go and try to do is something a bit more holistic," he says, "rather than trying to focus on a single intervention and a single program that bears very little relevance to the lives and livelihoods of people."

Pakistan should work to improve its basic health services, Bhutta says, so kids get immunized for polio along with everything else; and sanitation should be upgraded so the polio virus can't contaminate drinking water.

But projects like those take even more time — and more resources — than the current barrage of polio immunization campaigns.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

ARI SHAPIRO, HOST:

Pakistan is now at the center of a global effort to eradicate polio. While the country's only had about 100 cases this year, there is now more polio in Pakistan than the rest of the world combined. The drive to eliminate the paralyzing disease is a major logistical operation. And it's happening while the country is fighting a vicious insurgency against the Taliban. The polio campaign is costing Pakistani lives, national pride and precious health resources. NPR's Jason Beaubien recently visited Karachi, the country's largest and most chaotic city and filed this report.

JASON BEAUBIEN, BYLINE: To get into the main Children's Hospital in Karachi you have to pass a phalanx of motorcycle-taxi drivers, guard with an AK-47 and a massive metal traffic boom - set up to deter potential terrorist attacks. And then pass the polio-women, teams of vaccinators in black burqas and polio-free Pakistan baseball caps. These female vaccinators are at the front gate, they're in the hallways and in the main waiting room searching for children under the age of five to immunize. If a child's finger isn't covered in ink to show a recent polio inoculation the women squeeze two drops of the vaccine into the child's mouth. Doctor Raza Jamal runs the hospital from a busy office on the second floor.

RAZA JAMAL: This is the largest, second-largest children's hospital in the country so all the cases that are from the region mostly can refer to us.

BEAUBIEN: Last year that was just four polio cases. Doctor Jamal supports the polio eradication effort but he says it's become a national obsession. And he adds that it's taking a huge toll on Pakistan's already over-stretched health system.

JAMAL: All the immunization workers have been redirected into the polio campaign which has resulted in other disaster and our routine immunization rates have gone down to as low as 30 percent or less. So that has resulted in epidemics of measles, cases of diphtheria, cases of pertussis which we have stopped seeing for a long time.

BEAUBIEN: During nationwide polio campaigns some 200,000 vaccinators fan out across the country to inoculate children and these days the government has had to deploy thousands of armed security forces to guard them. Two years ago, the Taliban started killing polio vaccinators. The militants were irate over the CIA setting up a fake hepatitis vaccination campaign in the country to spy on Osama bin Laden. Since then the Taliban and has gunned down more than 60 polio workers.

UNIDENTIFIED MAN 1: Clearly it is not just a medical issue anymore and it's a huge political problem.

BEAUBIEN: And polio is one of many significant challenges facing the country. There's a huge security problem in Pakistan. Last month there was a five-hour gun battle at the Karachi airport between militants in suicide vests and security forces.

UNIDENTIFIED MAN 2: (Foreign language spoken).

BEAUBIEN: The attack was broadcast live on local TV, left 38 people dead and shut down international air travel from the country's largest airport. People here lack access to jobs, sanitation, decent housing, electricity. Criminal gangs terrorize the slums of Karachi. This is life in chaotic Pakistan. And on top of all this, Western health officials have pushed polio to the front of the country's national agenda and Pakistan keeps plugging away at the disease.

(SOUNDBITE OF TRAIN)

BEAUBIEN: Polio workers vaccinate kids at bus stations, at the airport and here aboard a stifling hot train car in the Karachi railway station. Two vaccinators shove their way through the economy class cabins. Just like at the hospital they snatch up children, squeeze their cheeks together, drop the vaccine into their mouths, mark their little fingers and, with in a few seconds, move on. Mazhar Nisar from the Pakistan Ministry of Health says, the constant drumbeat on polio can be a problem.

MAZHAR NISAR: There is a serious fatigue factor in the parents. There is a serious fatigue factor amongst the providers.

BEAUBIEN: Coordinating the mass immunization drives all across the country - the major logistical operation. And Nisar says, parents have started to question why there's so much attention on this one disease.

NISAR: They said, you know, when we go to the hospital we don't get the medicines and we don't get proper treatment and my child is dying of diarrhea, my child has measles. So every 4 or 6 weeks you come with the polio vaccine.

BEAUBIEN: This is in part because Pakistan is under intense international pressure to wipe out the disease. Last month the country got hit with new World Health Organization travel requirements, forcing all Pakistanis to show proof of polio immunization before they can leave the country. Meanwhile, in another blow to national pride, the WHO declared Pakistan's perpetual rival India polio-free earlier this year. Being one of the last nations with polio, even if it's just a few dozen cases, has become an embarrassment for the government.

ZULFIQAR BHUTTA: There are people at the highest level who have told me that they start their day with polio, they end their day with polio. As if this is the only priority.

BEAUBIEN: Zulfiqar Bhutta professor of pediatrics at the Aga Khan University in Karachi, has worked on polio for decades. He says, it's unclear how long Pakistan can stay focused on mass polio immunization drives.

BHUTTA: What we need to go and try and do is something a little bit more holistic, rather than just be singularly focused on a single intervention and a single program that bears there's very little relevance to the lives and livelihoods of people.

BEAUBIEN: By holistic, he means improving the basic health services so kids get immunized for polio along with everything else. Upgrading sanitation so the virus can't contaminate drinking water. What Bhutta's talking about is nation building, development which will take even more time and money than the current barrage of polio immunization campaigns. Jason Beaubien, NPR News.

SHAPIRO: Tomorrow on Morning Edition, we'll hear from parents in Pakistan. A team of pollsters from Harvard and UNICEF went door-to-door asking for parent's views on this controversial effort to wipe out polio.

AUDIE CORNISH, HOST:

The U.S. says Russia has violated a landmark nuclear treaty that helped put an end to the Cold War. The Obama administration says that in 2011 Russia tested a band missle in violation of the treaty. President Obama wrote to Vladimir Putin about the issue directly. Russian officials say they've looked into the allegations and consider the matter closed. The Intermediate Range Nuclear Forces Treaty was signed by the U.S. and Russia in 1987 and it called for the destruction of both countries ground launch missiles. At the time, President Reagan remarked that in terms of compliance both nations would find wisdom in an old Russian Maxim.

(SOUNDBITE OF PRESS CONFERENCE)

PRESIDENT RONALD REAGAN: Doveryai, no proveryai - trust, but verify. Transcript provided by NPR, Copyright NPR.

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