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Pakistan: Army to provide security in polio eradication campaign | The News International.

[November 10, 2018]

Muhammad Saleh Zaafir writes:

ISLAMABAD: Army has articulated its commitment to provide security and enabling environment for the success of the polio eradication campaign in the country.

The resolve was expressed in a meeting of the National Task Force on Polio Eradication held at the Prime Minister Office (PMO) on Friday, and it was chaired by Prime Minister Imran Khan. He said on the occasion that Polio incidence is a very serious issue for the country as it jeopardizes the future of our children. He urged the provincial governments to enhance efforts for complete polio eradication through spearheading of the campaigns preferably at the level of chief ministers, coordinated community level engagements by involving prominent local elders and religious scholars.

The prime minister emphasised that the Task Force meetings should be held more frequently to effectively oversee the progress and to achieve zero incidence in the shortest possible time frame. The meeting was attended by Federal Ministers Amir Mehmood Kiani, KP Governor Shah Farman, Punjab Chief Minister Sardar Usman Buzdar, Sindh Chief Minister Syed Murad Ali Shah, Gilgit Baltistan Chief Minister Hafiz Hafizur Rehman, Pakistan Army Engineer-in Chief Lt Gen Muhammad Afzal, Minister for Health AJ&K Dr Najeeb Naqi Khan, provincial chief secretaries, UNICEF Country Representatives Ms Aida Girma, WHO Country Head Dr Nima Saeed Abid, representatives of partner organisations and senior officials.

Prime Minister’s Focal Person on Polio Eradication Babar Bin Atta briefed the Task Force, in detail, about the current situation and the future Polio eradication strategy. It was informed that Pakistan’s efforts for polio eradication have been recognized world over as polio cases have recorded an exponential decline since 1994 onwards. The participants were informed that the main factors contributing towards Polio incidence in Pakistan were cross-border movement from Afghanistan, poverty, poor sanitation, low coverage of routine birth immunisation, access & security threats and most importantly misconceptions that results in refusal of immunisation. Regarding the future course of action, it was briefed that the strategy needs to be implemented at the grass-root levels with targeted awareness campaigns, countering propaganda and high level engagements with decision makers and religious scholars. Chief Ministers of Punjab, Sindh and Giglit Baltistan apprised the Task Force regarding measures taken at the provincial level for Polio eradication.

Pakistan Army Engineer-in-Chief Lt Gen Muhammad Afzal said that Pakistan Army will continue to provide security and an enabling environment for the success of Polio eradication campaigns in areas with security issues. Dr Christopher Maher, Manager, Polio Eradication WHO praised the high level presence, efforts and support of the government, provincial governments and security forces regarding polio eradication. He also commended the integration of Polio Eradication Programme (PEP) with education, sanitation and other related sectors. The Prime Minister reiterated the government’s commitment towards a Polio free Pakistan and assured that federal government will provide every possible support in achieving this target. He thanked the international partner agencies for providing technical and financial support to PEP.

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Afghanistan Is the World’s Polio Capital. These Afghans Hope to Fix That | The New York Times.

[Nov. 10, 2018]

A health care worker giving a dose of vaccine in Kandahar, Afghanistan, in August.CreditCreditJawed Tanveer/Agence France-Presse — Getty Images

Fahim Abed writes:

KANDAHAR, Afghanistan — At just 2 years old, Madina had been vaccinated seven times. It was not enough: When she fell ill this fall, a trip to the doctor in Kandahar City confirmed that she was among the latest Afghan toddlers to contract polio.

Almost a million children in Kandahar Province alone, like Madina, need at least one dose of oral vaccine a month to head off the disease, health workers say. But many of them also live in the most violent and socially disrupted parts of southern Afghanistan, where the Taliban control large areas and do not want government health workers going door to door.

These realities make a sustained vaccination campaign brutally difficult for health workers here. And Afghanistan, one of three countries where polio is still endemic, is losing ground. Officials have registered 19 cases of polio so far this year, up from 13 each of the previous two years, according to World Health Organization figures.

In August, I followed a polio vaccination crew in Kandahar and saw how, even in areas where health workers have been able to function, many things stand in their way: security fears and drought, deep poverty and stifling tradition, widespread illiteracy and superstition.

Still, starting just after dawn each day, the vaccination teams are at it, hoping to reach just a few more children.

"A medical worker administers a polio vaccine to a child in Kandahar" .By Fahim Abed; embedded short video

Mawlawi Abdul Rashid of Kandahar City, a religious scholar and member of one team, said most of the residents were poor and desperately worried about what their children would have to eat each night. Drought adds to the daily burden, with families in many neighborhoods having to buy water from tankers after wells dry up.

Given that, Mr. Rashid said, “They don’t care about polio vaccine as much.”

Mohammad Shah, 38, said that as a vaccine campaigner in the city he had been visiting more than 100 houses a day in temperatures reaching 100 degrees Fahrenheit. He said some families asked for food and other necessities instead of the vaccine — a need that Mr. Shah, a father of five, said he understood.

“They keep asking us to bring them wheat, soup and other staples,” he said.

Despite efforts to have religious scholars express support for the vaccine, Mr. Shah said mistrust about it still existed. Many worry about whether strict interpretations of Islam allow the vaccine. Some question its contents and believe conspiracy theories that Westerners have manipulated it to cause infertility.

Abdul Razaq, 65, who was administering the vaccine in the Loya Weyala area of Kandahar City, which is dominated by people displaced by fighting, said around 10 of the 200 families there refused it.

“It’s very difficult to convince those families who reject the vaccine,” he said. “But we try our best.”

Most families here hold traditional views wary of letting outside men enter a home if no male family members are present. For that reason, the health workers try to have at least one woman on each vaccination team. But there are not enough female workers, and all-male teams are frequently turned away.

A health worker administering a polio vaccine in Kandahar in August. Credit Fahim Abed.

Polio was eradicated before 2000 in Western countries, but it is still a critical issue for Afghanistan, said Destagir Nazari, of the Ministry of Health. “The world is trying to eradicate the virus completely,” he said. “It is an international responsibility for Afghanistan to eradicate it, and we try our best to do so.”

Across Afghanistan, more than 10 million children require polio vaccine. The United States, Canada and Japan are among the largest donors for the vaccination drive.

The vaccinators’ days are long. They start early in the morning, gathering in health facilities of each neighborhood of Kandahar City to collect the vaccine and vitamin E tablets, which they carry in plastic coolers.

Teams then head out in rented taxis or on motorcycles, armed with lists of families in their areas that have children younger than 5. They go door to door, circling back after a break for lunch and prayer to the houses where children weren’t home in the morning.

At one house, a woman insisted that she didn’t want her 3-year-old daughter, Mursal, to be vaccinated. She wouldn’t give a reason, but the workers suspected she was worried for religious reasons.

Each member of the three-person team tried to persuade her, even reading from a book of religious declarations that allowed the vaccine.

The last member of the team to try, Mr. Razaq, was blunt: If you keep rejecting the vaccine, he asked, will you be able to take care of your daughter when she contracts polio? He pleaded, insisting that he was religious, too, but still made sure all his young children were vaccinated. At last, he got through, and Mursal received her dose for the month.

Sometimes religious scholars, like Mr. Rashid, accompany the teams and help reassure families. “According to Islam, health is very important, and we can use anything to ensure our health,” he said. “We convinced 70 families this month who were rejecting polio vaccine.”

Other times, balloons work.

That was enough at one house: A woman there said no to the vaccine, but the boy with her wanted a balloon — so he got both it and his dose.

But bigger fears at work here than children’s distaste for medicine. Many families know the Taliban are suspicious of the government vaccination drive, and worry that they will become targets if they are seen allowing the health workers into their homes.

Zabihullah Mujahid, the Taliban spokesman, said that the insurgents were not against the vaccine and that they supported administering it in areas under their control. But they will not allow government teams to go door to door in their areas, saying they believe the workers sometimes act as spies.

The Taliban usually insist on distributing the vaccine centrally from mosques. But health workers say only a house-by-house approach can come close to ensuring enough doses are distributed each month.

Mr. Shah, who has been administering vaccine for 12 years, said that as hard as this year had been, it was getting better, at least in his area: Last year 25 families there rejected the vaccine. This year, that dropped to eight.

“When I see a polio victim, I feel very sorry for him and I understand that’s why my job is so important,” Mr. Shah said.

Officials, though, lament that progress is so halting despite all their efforts.

Abdul Qayoom Pokhla, head of Kandahar Province’s public health department, said that even without the stress of war, eradicating polio there would take at least one or two years. “We need a secure environment to implement the polio vaccine campaign,” he said.

"No Title" embedded short video by Fahim Abed

Mujib Mashal contributed reporting from Kabul.

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Progress Toward Poliomyelitis Eradication — Pakistan, January 2017–September 2018 | Morbidity and Mortality Weekly Report (MMWR).

[Open Access] [November 9, 2018 / 67(44);1242–1245]


What is already known about this topic?

Pakistan remains one of three countries (along with Afghanistan and Nigeria) where wild poliovirus type 1 (WPV1) transmission has never been interrupted.

What is added by this report?

During January 2017−September 2018, WPV1 cases in Pakistan continued to decrease compared with previous periods. However, environmental surveillance continues to detect polioviruses, an indication of children who were missed for immunization, as well as poor vaccination program performance.

What are the implications for public health practice?

Stopping WPV1 transmission will require further enhancing the quality of vaccination and surveillance, augmenting cross-border coordination with Afghanistan, strengthening efforts to reach mobile populations at high risk, and focusing on poor-performing areas.

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