By Kathryn Salucka
Around 350,000 children will be denied polio vaccines in this week’s immunization campaign in Pakistan. A World Health Organization doctor was nearly killed on the 17th of July in the city of Karachi while participating in the polio eradication campaign. In the North Waziristan region, over 160,000 children were denied polio vaccinations last month. In the war against polio, Pakistan is coming up short. Its most recent remedy? Recruiting a new figurehead in its campaign against polio: national cricket star Shahid Afridi. This announcement is likely in response to last month’s decrees from multiple Taliban commanders throughout Pakistan banning polio vaccinations in retaliation for the continued U.S. drone strikes in the country. These decrees directly resulted in children not receiving polio vaccines. Furthermore, the Taliban has declared polio vaccinations “un-Islamic,” an argument no cricket super-star can counter.
Instead of looking to the sports hall of fame for the key to winning the war on polio, Pakistan should look to the House of Saud. The Pakistani government should adopt the Saudi policy response to infectious disease threats, and directly enlist their religious leadership to make a lasting stand against polio. Serving as a bulwark for much of the Islamic world, Saudi Arabia provides the religious legitimacy—and technical expertise—Pakistan is lacking in the fight against polio.
Pakistan remains one of three remaining states plagued with the disease, and shows no real signs of curbing this epidemic. In 2011, polio cases increased by nearly 28 percent in the country from the previous year, though neighboring India succeeded in eradicating polio in early 2012. To enact a more effective stance on polio vaccinations, the Pakistani government should take its cue from an unlikely source in the global health community: the Kingdom of Saudi Arabia. The keeper of Mecca and Medina, in 2009 the Kingdom began requiring that all pilgrims to Mecca receive oral polio vaccination drops, provided on-site in Saudi Arabia. More recently, the Kingdom of Saudi Arabia committed $30 million USD to the Global Polio Eradication Initiative, delivering over half of its contribution by 2011. The Kingdom’s commitment to eradicating polio is certainly apparent, and its mandate of vaccinations before the most spiritual pilgrimage a Muslim can take pokes considerable holes in the assertion that polio vaccinations are “un-Islamic.” Pakistan should seize this opportunity and actively seek Saudi involvement in Pakistan’s polio campaign—from bringing over Saudi religious leaders to calm the populace’s fears, to recruiting the same doctors that administer the oral vaccine drops to pilgrims to provide drops to children of suspicious parents. If Saudi-sponsored doctors are providing the same vaccines given before the hajj, the “vaccines are un-Islamic” argument is seriously weakened.
Timing could not be more critical for the Pakistani government. A study released last week demonstrates an increase in polio cases in both Pakistan and Afghanistan as a result of a lack of vaccinations. Even when vaccinations have been provided, the results have been unsuccessful. In May, expired polio vaccines were administered to about 3,000 children, further deteriorating the already wavering trust in the vaccine program. Cause for concern is legitimate, as the delivery of expired measles vaccines recently resulted in the deaths of three children in Pakistan. In certain regions of the country, vaccines have also been blacklisted after the CIA used a hepatitis B vaccine plot to try to uncover the whereabouts of Osama bin Laden.
At May’s World Health Assembly in Geneva, polio was declared a global public health emergency. This pronouncement should also make Saudi Arabia appear as an attractive model and public health ally to Pakistan. In addition to its belief in polio vaccines, Saudi Arabia has also demonstrated its ability successfully to avoid a massive public health crisis, as it was able to prevent an outbreak of H1N1 at the 2009 hajj while much of the world was struggling to curtail the disease. Saudi Arabia’s experience in managing public health and mitigating severe infectious disease crises can serve as a guide in health policy. Saudi aid and involvement in Pakistan certainly isn’t new: in 2010, Saudi Arabia was the largest donor to disaster relief when floods ravaged the country. Pakistan should build upon this relationship.
In addition to chancing a major outbreak, Pakistan’s failure to address its public health problems could exacerbate the tenuous security situation in the region. India views the growing cases of polio and decreasing vaccination coverage in Pakistan as a serious threat to their recent public health triumph. In an already unstable environment, India’s potential reactions to Pakistan’s growing cases of polio could be drastic and damaging. In this instance, Saudi Arabia can again serve as a desirable guide, especially given the Kingdom’s recent cooperation with India on other matters, and the seemingly growing rapport between the two countries.
The Pakistani government has made it clear that it takes polio seriously and has taken considerable steps to curb the epidemic, including firing government officials that showed “poor performance” during vaccination campaigns. However, these moves have proved fruitless, and it is time for a new approach. This new strategy should encompass seeking the support and the direct involvement of the Saudi Arabia. It is in Pakistan’s best interest to enlist the religious leadership and technical expertise of the Kingdom for the benefit of many future generations to come.
Kathryn Salucka is a Research Associate at the Global Health Program at the Council on Foreign Relations.
[Photo courtesy of the Gates Foundation]