July 17, 2012 | By Bill Gates
In Pakistan, Victory Against Polio is in the Hands of Local Officials
Pakistan is one of three countries in which polio remains endemic. But I met recently with a group of national and provincial officials who seem to have a clear-eyed view of what it will take to finish the job.
I met recently with a group of Pakistani national and provincial leaders waging war against polio in a handful of areas where the dreaded disease still exists.
Over the last 25 years, 122 countries where polio was once endemic have eliminated the disease. Just three countries remain: Pakistan, Afghanistan, and Nigeria. Reducing polio infections by more than 99 percent over the last quarter-century could not have been achieved without a sustained commitment from all countries to mount this successful global public health effort. But the hard work of reaching thousands of vulnerable children is largely a challenge that falls to local officials.
In Pakistan, eradicating polio is an especially unique challenge—although I’m optimistic, Pakistan will continue to make progress. A recent report by the Independent Monitoring Board affirms this optimism.
Last year, Pakistan had more polio cases than any other country. But since the beginning of this year, overall, polio cases in Pakistan have dropped by 67% - from 69 cases in 27 districts at this time last year, to 23 cases in 13 districts since the beginning of 2012.
It recently devolved its national health ministry, which means provincial and local officials have to work extra hard to coordinate polio and immunization activities. There are areas such as the semi-autonomous tribal region in northwest Pakistan where conflict and insecurity prevent vaccination activities. Much has recently been written about new challenges that have arisen, including an alleged ban on immunizations by some local leaders in North and South Waziristan, Federally Administered Tribal Areas (FATA). While this further complicates running immunization campaigns in an already-challenging environment, efforts are being undertaken to address the situation. It also is important to note that this affects not even 1% of the country’s target population. However, there are still some areas where the management of local polio campaigns needs to improve. Pakistan is effectively tackling these challenges with new approaches and adopting lessons learned from India.
In the U.S. and other developed countries, we take the administration of vaccines for granted. Young children get immunized when they visit the doctor. But in Pakistan, heroic health workers often have to surmount obstacles, and even risk their lives to reach children who are unprotected. Vaccine teams are enlisting the support of religious leaders to help counter misperceptions about immunizations and suspicions that they are part of a plot. They also are adopting proven methods to reach children in migrant communities where vaccinator teams that speak the local dialect have been recruited to reach local populations and give them more confidence in their efforts. And where it’s encountered political instability and insurgency, the polio program has tried to coordinate with the Pakistani military to get access for vaccinator teams and to try to ensure their safety.
As of last month, there were 16 cases of polio reported in Pakistan.
That doesn’t sound like a large number, and the progress that it demonstrates is worth acknowledging.
But polio is a cunning disease. Ninety-nine percent of the people who carry the virus don’t show any visible effects, so it’s hard to know who has it and where it’s traveling until a reported case shows up. In a country with a population of 175 million people, you can imagine how difficult this is.
But India has proven that it can be done in a country with a population of 1.1 billion. Earlier this year, it was removed from the list of polio endemic countries after going a full year without a new case of wild poliovirus. India’s success proves that polio can be defeated in the most challenging circumstances.
It was clear in my meeting with the Pakistani provincial leaders and several national officials who joined them that there’s a strong resolve to finish the job. They were very open about where efforts have fallen short. And the fact that the Pakistanis were willing to travel to India to meet with Indian health officials after their meeting with me really underscored their commitment.
India and Pakistan don’t always see eye-to-eye on things, so seeing the Pakistanis and the Indians sharing what is working and some of their common problems in solving polio was very encouraging. Their meeting was also a chance for India to help their neighbor, and a reminder that they need to stay vigilant in their own country.
Failing to completely eradicate polio would create a very real risk for the rest of the world - a resurgence that could affect tens of thousands of children worldwide getting infected. On the other hand, eradicating polio will result in benefits of up to $50 billion by 2035 in the world’s poorest countries. Our investment in polio eradication is also laying the foundation for delivery of other cost-effective health services—including vaccines for other preventable diseases.
Despite current challenges, my meeting with the Pakistanis and action taken on polio and vaccines by the World Health Assembly reinforce my confidence that we truly are on the verge of ending polio. India has proven that a strong commitment by political and community leaders, well-managed and high-quality vaccination programs tailor-made to local circumstances, and adequate financial resources can get the job done.
When it comes to polio, the Pakistanis and the Indians want the same thing we all do—a world in which no child ever gets this preventable disease again. But the responsibility to end this disease doesn’t just lie with the countries where polio transmission continues, we all have a responsibility to ensure a polio-free world.
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