Drop by Drop,a polio battle

As it tackles rumours,distrust of the US and Taliban threats in its fight against the disease,Pak has on its side individual acts of courage,monetary benefits and,above all,a desire to not be left behind by India

Written by New York Times | Karachi | Published: July 23, 2013 5:38 am

DONALD G McNEIL JR

Usman,who limps on a leg bowed by the polio he caught as a child,made sure that his first three children were protected from the disease,but he turned away vaccinators when his youngest was born. He was furious that the CIA,in its hunt for Osama bin Laden,had staged a fake vaccination campaign,and infuriated by US drone strikes. He had come to see the war on polio,the longest,most expensive disease-eradication effort in history,as a Western plot.

In January,his 2-year-old son,Musharaf,became the first child worldwide to be crippled by polio this year.

“I know now I made a mistake,” says Usman,32. “But you abused a humanitarian mission for a military purpose.”

Anger like his over US foreign policy has led to a disastrous setback for the global effort against polio. In December,nine vaccinators were shot dead here,and two Taliban commanders banned vaccination in their areas. Since then,there have been isolated killings—of an activist,a police officer and vaccinators.

The war on polio,which costs $1 billion a year and is expected to take at least five more years,hangs in the balance. When it began 25 years ago,350,000 people a year were paralysed. Last year,fewer than 250 were,and only three countries—Afghanistan,Nigeria and Pakistan—have never halted its spread at any point.

Pakistan’s government has taken steps to ensure the killings don’t halt their efforts. Vaccinators’ pay has been raised to $5 (approximately 500 Pakistani rupees) a day in dangerous areas,police and army escorts have been increased and control rooms created.

But the real urgency to finish the job began earlier,for a very different reason. Two years ago,India eliminated polio. “Nothing wounded our pride as much as that,” says Dr Zulfiqar A Bhutta,a vaccine expert at Aga Khan University’s medical school.

Bill Gates,who is the campaign’s largest private donor and calls beating the disease “the big thing I spend the majority of my time on”,said Pakistan’s desire to not be further humiliated “is our biggest asset”.

After India’s success and hints from the WHO that it might issue travel warnings,Pakistan’s government went on an emergency footing. A Cabinet-level “polio cell” was created. Vaccinators’ routine pay was doubled. More than 1,000 “mobilisers” were hired to counter the rumours that the vaccine contained pork,birth control hormones or HIV. Mullahs were courted to endorse vaccination. They issued 24 fatwas. Perhaps,most important,local command was given to deputy commissioners,with police powers.

Now Pakistan is closer than ever. There have been only 21 cases so far this year. A few years ago,39 substrains of the polio virus circulated; now only two do. About 300,000 children live in areas too dangerous for vaccinators,but almost all the sewage samples from those areas are clear of the virus.

Ultimately,though,success will depend on more than political will and the rivalry with India. In the wake of the killings,it will rely most of all on individual acts of courage,like those by imams who pose for pictures as they vaccinate children. Or by Usman,who appeared with Musharaf in a fundraising video.

Or by volunteers,like the women of the Bibi family. Two of them,Madiha,18,and Fahmida,46,were gunned down in December. Not only are their relatives still vaccinating,Madiha’s 15-year-old sister also volunteered for her spot.

The isolation and poverty of the Pashtun tribe underlie its resistance to the vaccine. Many Pashtun neighbourhoods receive few government services,but get shiny new billboards trumpeting the polio fight paid for by Western donors.

“People tell us,‘We need schools,we need roads,we need housing,and all you bring our children is polio,polio,polio’,” says Madiha,a veiled Gadap vaccinator.

It was in the middle of last year that it became known that the CIA had paid a local doctor to try get DNA samples from children inside an Abbottabad compound to prove they were related to bin Laden. Even though the doctor,who is now serving a 33-year sentence,was offering a hepatitis vaccine,anger turned against polio drops.

Leaders of the polio eradication effort could not have been more frustrated. They were already fighting new rumours that vaccinators were helping set drone targets because they mark homes with chalk so follow-up teams can find them. “It was a huge,stupid mistake,” Bhutta says.

Local opposition has forced the adoption of new ground tactics. Dr Qazi Jan Muhammad,the former deputy commissioner of Karachi East,calls it “a mix of carrots and sticks”.

Whole apartment buildings were missed,he discovered,because Pashtun watchmen were shooing vaccinators away. He had traffic circles blocked so teams could approach each car,and he led some teams himself holding fistfuls of rupees. “I saw a girl,about 11,carrying her 2-year-old sister,” he says. “I gave her a 10-rupee note and said ‘Will you allow me to give drops to your sister?’ She told all the children,and I vaccinated 400 kids for only 4,000 rupees.”

Rotary sponsors a tactic used to reach children from areas too dangerous for home visits: “transit point” vaccinating. At an army tollbooth on the highway into Karachi,as soldiers stop each bus to search for guns,Rotary vaccinators hop aboard. On a typical day,they reach 800 children. Yes,team leader Ghulam Jilani admits,the soldiers’ presence is intimidating. Also,he adds brightly: “We scare them a little.”

Among hundreds of men wearing turbans at Karachi’s train station,Muhammad Arshad stands out in his blue baseball cap with Rotary’s yellow gearwheel. Threading his way through the crowd,he picks out children younger than 5. After the December killings,he worried briefly,Arshad says. “But then I thought: This is good work,God will protect me.” NYT

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