Anti-polio drive in the southern Pakistani province of Sindh has run into difficulties, raising alarm in many quarters. There is a very real threat that the virus could travel to polio-free areas of the country, experts apprehend.
Sindh is considered the new polio hotspot in the country, but its authorities are refusing to accept the federal government's help in controlling the new outbreak and say they can handle the situation on their own.
The confirmation by doctors on 1 May that a two-year-old child had tested positive for the polio virus brings to five the number of cases of the disease in the province in 2008.
Nineteen positive polio cases have been found across Pakistan in the past six months. At the end of April, an 11-year-old girl in Karachi, Sindh's capital, was diagnosed as having polio.
The emergence of new positive cases in Sindh has triggered urgent meetings between WHO representatives and Sindh health officials to discuss the situation.
"Decreasing resistance levels may be a factor in the case in Karachi," Mazhar Khamisani, director of the Expanded Programme on Immunisation, Sindh, said.
He said the affected girl, who was paralysed on one side of her body, lived in a north Karachi locality where there was also a sizeable population of people coming in from other parts of the country, and some of them may have transmitted the infection to the child.
Pakistani health officials have repeatedly said the polio virus was being brought into the country by Afghans moving across the border.
Like Pakistan, Afghanistan remains one of only four polio-endemic countries in the world. The others are Nigeria and India.
A new programme to vaccinate children at special stations set up on major highways is now being initiated with the support of traffic police.
"This may help ensure coverage for all children, since many travel to Karachi, Hyderabad and so on from other parts of the country," the national manager, Expanded Programme on Immunisation, H. B. Menon, said.
Meanwhile, health officials in the North West Frontier Province (NWFP) have been meeting to discuss the possibility that around 10,000 children may not have been immunised during the most recent anti-polio drive on 8-10 April, as their parents refused to have them vaccinated.
Such refusals have remained a major obstacle in the highly conservative NWFP, where parents insist it is against their "tradition" to allow vaccinators into homes.
Rumours that "Western" anti-polio vaccines are intended to render children sterile, add to the problem.
The situation became so bad last year that a senior government official was killed in a bomb explosion in Salarzai, a village about 50 kilometres northeast of Khar, the main town in Bajur Agency, when he was returning from a jirga (tribal council) to convince people to immunise their children against polio.
The blast killed Dr Abdul Ghani Khan, chief surgeon at the main government hospital in Bajur, at the scene and injured three others in his car, the officials said.
Paramedic Hazrat Jamal, one of the three injured in the explosion, said that the residents of Mullah Said Banda were against the polio campaign. "As soon as we reached there, an armed prayer leader
warned us against visiting the area."
"On the one hand, our enemy (a reference to the United States) is bombing us for no reason while on the other hand you are coming here disguised as polio campaigners to spread vulgarity,"
the locals had then told the vaccinating team.
According to current reports, targets set for vaccinations have been missed in Lakki Marwat, Mardan and Bannu districts of the NWFP.
In Sindh, however, the problem seems to be rooted not in the attitude of parents but in the effectiveness of the vaccination strategy and a possible failure to reach all children. Experts have said the polio positive cases raised "questions" about the management of the campaign in Sindh.
The issue of coverage in Sindh has been regularly raised in recent months and was also discussed, according to health department sources, at a meeting of the technical advisory group on poliomyelitis eradication in Afghanistan and Pakistan, held in Cairo in the first week of February.
At the meeting, the apprehension was voiced that in some localities in the province, only around 95 percent of children were being vaccinated. A lack of proper supervision of vaccinators was cited as a possible reason for this.
The provincial secretary of health, Malik Asrar Hussain, agreed there was a need to "tighten loopholes and improve supervision."
"The Sindh chief secretary was offered assistance, but he thinks provincial authorities are capable of dealing with the issue," a senior federal health ministry official said on Monday as the country launched this year's second National Immunisation Days (NID) Campaign to vaccinate 33 million children against the disease, whose eradication still remains elusive.
Federal Information Minister Sherry Rehman, who also holds the charge of health ministry, a source said, would be taking up the issue with Sindh Chief Minister Qaim Ali Shah, pleading with him to ensure political and administrative commitment for preventing the spread of polio virus.
Blaming the provincial authorities for the failure of programme, a report by the Technical Advisory Group (TAG) of the World Health Organisation (WHO) said the responsibility rested with the province's management, particularly those who had the authority and capability of ensuring that immunisation was carried out with the required quality.
"Pakistan is closest to eliminating polio. However, many challenges still stand in the way. Increased accountability and oversight by the government can make a difference," SindhUnicef Representative Martin Mogwanja had said in March last.
WHO Representative Dr. Rayanna had said the incidence of polio worldwide had been reduced by 99 percent. The number of countries harbouring polio cases had declined from 129 in the year 1998 to just 4 in 2008.
"An estimated 5 million disabilities have been averted so far through polio immunisation," she said. Expressing concern over the situation in Sindh, Dr. Rayyana had called for a closer assessment of performance.