Pakistan’s Polio Tipping Point

At the same time, local governments’ difficulties are having an adverse effect on provision of clean water and proper sanitation, which are vitally important for polio eradication and public health more broadly. There have also been cases of refusal by parents to vaccinate their children, typically at the behest of clergy members, owing to the belief that such public-health efforts are in fact a covert sterilization program. Indeed, refusal to vaccinate accounts for 2% of the children who are missed. A recent smear campaign aimed at discrediting polio vaccination, in which several MPs publicly took part, has complicated matters further.

Daunting as all of this may be, stalling vaccination is not an option. It is well established that when vaccination is impeded, the number of cases rises drastically, as was shown in Nigeria in 2003, where a ten-month delay led to the infection of thousands of people domestically, and to reinfection in more than 20 other countries.

A similar outcome was observed in Pakistan’s Swat Valley after the militant takeover of 2009 rendered the region inaccessible for months. This month’s decision to hold back vaccination in Karachi after health workers there were threatened, though understandable, is nonetheless a cause for serious concern in this respect.

As in Nigeria, vaccination delays will be highly detrimental for neighboring countries. Nomadic populations move freely back and forth across the vast and porous Afghanistan-Pakistan border. In 2011, a polio outbreak in China was traced back to Pakistan. India, polio-free for the last two years, is well aware that lasting domestic success depends on eradication efforts elsewhere.

Potential international risks go beyond the immediate neighborhood. Already, Pakistan is responsible for the recent appearance of wild poliovirus in Egypt. Fortunately, there is no evidence of transmission, but we may not be so lucky in the future. Indeed, the risk that Pakistani pilgrims could carry the problem with them on the 2013 Hajj, the largest annual congregation of Muslims, is not just a theoretical threat. A worst-case outcome there could set back the fight against polio by decades.

The scale of the challenge, and hence the multifaceted response that is needed, must not be underestimated. Polio today has become an example of the complex problems plaguing Pakistan’s state and its society.

Pakistan must increase its efforts on polio eradication for reasons that go beyond fulfilling a global health promise (which is reason enough in its own right). Success would be a sign of Pakistan’s ability to conquer complex challenges, and it would provide a blueprint for further development interventions. In eradicating polio, Pakistan would not just play its part in eliminating the disease worldwide. It would also reclaim its own global prestige and potential for progress in other areas.

Sania Nishtar is the founder and President of the NGO think tank Heartfile.

Copyright: Project Syndicate, 2013.

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