 |
A
boy receives polio vaccination in Pakistan. A Taliban
leader
has barred UNICEF from vaccinating more than
160,000
children in North Waziristan.
Photo
by: Gates
Foundation / CC BY-NC-ND
|
Hundreds of thousands of Pakistani
children will go unprotected against polio after the Taliban banned
vaccinations anew.
A planned three-day campaign to reach 1 million children in Pakistan’s
Federally Administered Tribal Areas had to be postponed Monday (July 16)
following the Taliban’s ban on inoculations in North and South Waziristan, and
Khyber’s Bara district.
The ban comes a month after a Taliban leader barred UNICEF
from vaccinating more than 160,000 children in North Waziristan.
The Taliban issued the ban on both
campaigns in protest of U.S. drone strikes, arguing more people could be helped
by halting the attacks than through vaccines. They also claim immunization
campaigns are used as fronts for Western infiltration and spying — not a
completely groundless accusation following the Central Intelligence Agency’s
use of a hepatitis vaccine program to get Osama bin Laden’s family’s DNA and the subsequent
arrest of the Pakistani doctor who assisted.
But immunizing children in Pakistan
wasn’t easy even before the terrorist group’s ban. Fighting, cross-border
movements and inaccessibility undermined efforts to combat the disease, which
remains endemic only in Pakistan, Afghanistan and Nigeria.
Access, however, was only the most
tangible problem in a cauldron of factors hindering immunization. Polio also
saw resurgence in areas where access was not a problem, indicating there were
other causes behind the disease’s continued toll, according to Sinia Nishtar, founder and
president of Heartfile,
Pakistan’s top health nongovernmental organization and think tank.
Organized factions within Pakistani
society effectively orchestrate refusals, saying vaccines are forbidden in the
Quran or Western ploys to cause sterilization among Muslims, Nishtar said. This
indoctrination has been going on for years and years. Any health initiative
seen as coming from the West is viewed with suspicion.
Political groups endorse these
messages to gain popular support, and the influential local media helps spread
the misinformation like wildfire.
“When you have three parliamentarians coming
on national television one after another talking about polio vaccines causing
paralysis and them not being safe and expired and so forth, it accentuates that
mistrust that years of indoctrination by the clergy has actually achieved,”
Nishtar said.
Commercial interests are at stake for
those who want to get a piece of the polio-money pie. A lot of vaccine
procurement is done through a process involving UNICEF, the World Health
Organization and GAVI Alliance.
But many traders want to see the system fail so that they can offer to procure
vaccines themselves, Nishtar believed. These traders approach politicians and
tempt them with offers of splitting what funds they’ll no doubt pinch off the
top.
A health system riddled with
inefficiency and corruption and wholly unable to deliver is also to blame:
People grow suspicious when they see mothers dying in childbirth, schools empty
of teachers and basic rule of law unenforced, and yet a highly active
government presence in efforts against polio.
The government of Pakistan has
declared fighting the disease a priority, and spends a huge amount of its human
resources in the field on anti-polio efforts. “When it comes to polio the
entire organizational machinery of the government is really behind the wheel,”
Nishtar said. Pakistanis often don’t realize it is part of a global commitment,
and don’t see the palpable benefits of immunization.
That commitment has resulted in a lot
of money being sent into Pakistan to combat polio. The unfortunate but
predictable result has been the establishment of organized channels where
resources are pilfered at every step — what Nishtar termed a “polio economy.”
Officers at every level charge sums to perform tasks, and that is only if they
actually exist — “ghost” officers go door to door to carry out campaigns but in
reality exist only on paper. Only their salaries and fees exist in real life.
This ghost phenomenon in service
delivery is common in Pakistan. Primary health care facilities are even the
covers for nonexistent physicians who don’t work but charge for procedures,
medicine that is never delivered but must be paid for, equipment that arrives
only as receipts. And with polio this is exacerbated because there is a lot
more money flowing, Nishtar said.
At a time when donors are trying to
quit micromanaging local implementation of aid projects, Pakistan needs just
the opposite, according to Nishtar, who argued for increased oversight and
management. She said multilateral organizations that have complex relationships
with the government don’t want to confront it on these issues, but should.
“Staying quiet and not confronting
them upfront is not going to help,” Nishtar said. It’s our children that get
deprived of essential immunizations in the process.”
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