Pakistan’s Problem with Polio Programmes

Rob Crilly, Telegraph (London), October 30, 2013

The global war against polio is in sight of its final objective. Rid Pakistan of the disease and we will be within touching distance of ridding the world of the virus once and for all, runs the message. Along with Nigeria and Afghanistan, it is one of the last remaining reservoirs. And health officials believe that with Pakistan polio-free, then Afghanistan would quickly be purged of the disease too. But Pakistan is proving a tough one.

Not only are there the extremists of the Pakistan Taliban, who have banned vaccination teams from entering their territory, but there is also a baffling, widespread perception that immunisation is part of some kind of Western plot.

Take the latest manifestation. A jirga of elders this week threatened to boycott the latest vaccination push if there areas did not see an end to power cuts. Similar demands have been made before.

One way to understand it is a brutal attempt to use the future health of children as a bargaining chip. But it also suggests a failure in public health campaigning.

To promote vaccination as a means of ridding the world of polio has led too many here in Pakistan to conclude that they can use their position as leverage.The West wants something, runs the argument, so what’s in it for us?

Just as governments have used Pakistan’s location after 9/11 to wring money, arms and favours from foreign powers, so too polio vaccination offers an opportunity for imaginative deals – whether for electricity or an end to drone strikes.

It shouldn’t be hard in a country where crippled beggars dragging themselves along the ground are a far from rare sight to change the messaging away from a global campaign to a local one. (Just like US justification of drone strikes often fail to describe the improvements in local security for Pakistanis.)

But while Pakistan prefers to resort to forced vaccinations or to sending in the police with vaccination teams, there is a danger that local populations will reject important public health campaigns as an unneeded foreign intervention.

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