Awareness, communication gap behind new polio cases in Pakistani tribal areas

A child is being administered polio drops in the newly merged tribal districts. A three-day anti-polio drive has kicked off across the newly merged tribal districts. (Photo courtesy: Emergency Operation Center, KP)

A three-day polio drive is currently underway across the tribal areas and will conclude on Wednesday. (Photo courtesy: Emergency Operation Center, KP)

• Parental refusal to vaccinate also part of the problem
• Three-day polio drive ongoing in tribal regions

PESHAWAR: Government officials and relatives said a lack of awareness and coordination and a communication gap among officials were responsible for the two latest cases of polio found in Khyber Pakhtunkhwa’s remote Bajaur area earlier this month. 
Pakistan’s tribal regions, including Bajaur, were only last year merged into the political and legal mainstream of the country. Access to health care in these areas has been patchy, if not absent, for decades. 
Earlier this month, the National Institute of Health found two new cases of the polio virus in a three-year-old boy Abdul Rehman and a six-and-a-half-year-old girl Nabila. Both belong to Jaba Manzai, a dusty village in the Bajaur tribal district.
A three-day polio drive is currently underway across the tribal areas and will conclude on Wednesday.
“Every confirmed polio case from Bajaur is proof in itself that a [coordination and communication] gap exists and there is need for improving the quality of campaign,” said Kamran Ahmed Afridi, a coordinator at the local Emergency Operation Center. 
He said task teams and syndicates had already been notified and would identify gaps and propose counter strategies. 
Pakistan is one of only three countries in the world, along with Afghanistan and Nigeria, that suffers endemic polio, a childhood virus that can cause paralysis or death.
Efforts to eradicate the disease have been undermined by government mismanagement as well as opposition from militants who see immunization as a foreign ploy to sterilize Muslim children and consider polio workers to be Western spies.
In just one attack in 2015, a suicide bomber killed 15 people outside a vaccination center in the southwestern city of Quetta. 
Wazir Khan Safi, a surgeon in Bajaur, said parental refusal to vaccinate was also behind the latest cases of polio. 
“We have reports that there are four children in that particular home [where the two new cases were found] and their parents avoided administering polio drops to three of their kids,” Safi said, adding that the family had reprimanded and mistreated polio workers in the past.
In Pakistan, suspicion of immunization drives was compounded by the hunt for Al-Qaeda leader Osama bin Laden, the mastermind of the 2001 attacks on the United States. A Pakistani doctor, Shakeel Afridi, has been accused of using a fake vaccination campaign to collect DNA samples that the US Central Intelligence Agency is believed to have used to track down bin Laden.
Bin Laden was killed in a covert raid by US special forces in 2011 in the Pakistani town of Abbottabad, where he had been hiding. 
Sultan Ibrahim, the father of the girl recently diagnosed with polio, said his daughter’s left leg was paralyzed.
“I never refused vaccination but at the same time I had no idea about the importance of anti-polio vaccination or drops,” he said, tearfully. “Sometimes, polio teams were not punctual in carrying out the campaign.”
“I am now ready to go every length to recover my daughter’s health,” he added. 
About the ongoing three-day polio drive, Muhammad Usman Mehsud, the top administrator of Bajaur, said strict directives had been issued to district administration and health department officials to depute polio teams at security check posts, entry and exit points of main towns and bus stands to vaccinate every child under the age of five.
“Any delinquency on the part of any officer will be dealt with sternly,” he said.
According to Afridi at the Emergency Operation Center, a total of 4,120 teams comprising 3,803 mobile teams, 227 fixed and 90 transit mobile teams had been assigned to vaccinate a total of 884,771 children below the age of five years across the tribal areas. 
Last year, the WHO said the polio situation had stagnated in Pakistan, with eight cases reported until November 2018, the same number as was reported for the whole of 2017. 
“We are facing acute shortage of female polio workers.” said Mehsud, “who can play a highly significant role of going inside every home to make sure that no child is left unvaccinated.”