Pakistan’s Polio Tipping Point

ISLAMABAD – Early this month, tragedy struck Pakistan’s polio eradication campaign once again with the killing of two more polio workers and a policeman on patrol with the vaccination teams. The latest murders in Pakistan preceded the killing of nine polio workers in Nigeria, and follow the slaying of another nine Pakistani health workers in December and the New Year’s Day murders of development workers affiliated with public-health efforts. The continued targeting of such brave workers is posing a severe challenge to these countries’ public-health communities and their collective ambition to reach every child with lifesaving vaccines.

For Pakistan, the irony is that the country has been a success story for polio eradication, with the number of cases falling from 197 in 2011 to 58 in 2012. Despite recent challenges, Pakistan put vaccinators back on the job in 28 districts, where 12 million children needed to be reached. Widespread public support for polio eradication efforts has been reflected in a parliamentary resolution. The Ulema Council, a group of influential clerics, has given its backing as well.

The by the Independent Monitoring Board of the Global Polio Eradication Initiative, released in November 2012, acknowledged Pakistan’s recent progress – in stark contrast to the bleak outlook of its previous report. But it is critical that the country’s upcoming election does not jeopardize recent gains, particularly during the current low-transmission season, which is the best opportunity to stop the disease in its tracks. All political factions must remain committed to the eradication drive if it is to succeed.

Indeed, despite progress in 2012, we have not been able fully to interrupt the spread of the poliovirus in Pakistan, owing primarily to obstacles affecting program implementation and management. These challenges must be addressed through stronger governance at all levels, particularly given that state authority has been badly eroded in roughly a quarter of the country, where complex factors have created distrust in the name of ethnicity, politics, and religion, resulting in a massive breakdown in law and order.

Moreover, Pakistan shocked the global public-health community last year by adopting a constitutional amendment that led to the abolition of the national health ministry. Unfortunately, the sudden devolution of health responsibilities to the country’s provinces occurred without adequate preparation or oversight.

The simultaneous scaling back of the local-government system, along with the divisive politics of coalition governments in Pakistan’s fragile democracy, continues to undermine implementation of the polio eradication program. The resulting shortcomings in the country’s provincial health systems have manifested themselves not just in the inability to eradicate polio, but also in a recent measles outbreak, which has killed more than 300 children.

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