MEMORANDUM--Waqar Ahmad

MEMORANDUM

TO: Prime Minister of Pakistan
FROM: Waqar Ahmad   
SUBJECT: Revising the Polio Vaccination Policy                                                                        DATE: 11/09/2014

In their efforts to eradicate polio, present and past governments in Pakistan, in collaboration with international organizations, have done their best to vaccinate the children across the country. Children under the age of five have been periodically vaccinated against polio for the last many years, resulting in improved situation. Continued decline in polio cases can be seen from the fact that number of polio cases per year dropped from more than 20,000 (in early 1990s) to only 58 in the year 2012 [1]. However, in last couple of years, despite government’s efforts, polio has started spreading.  In this year only, number of polio cases registered in the country has crossed 200 [2]. This has raised concerns about effectiveness of country’s policy to combat the disease. Therefore, reconsideration of the current polio vaccination policy is necessary in order to eradicate polio from the country.

Pakistan is currently facing many challenges including poverty, energy crisis, terrorism, political instability, illiteracy, and health issues. Each of these problems is of such a large scale that successfully dealing with even one of them would probably be a significant achievement for a government in its five years tenure. Within health sector, polio is a unique kind of issue in the sense that it has both national and international implications. Pakistan needs to fix polio problem for safety of not only its own people but also of international community.  Therefore, the country has faced increased pressure from organizations like WHO (World Health Organization) to take effective and efficient measures to address the problem of polio spread. Problem is not availability of polio vaccination but accessibility of polio vaccination to everyone in the country.

It is for the reasons mentioned above that I want to address the policy question of what actions, if any, Government of Pakistan should take to make polio vaccination accessible to everyone in the country? In prevailing socio-political circumstances in the country, conflicts of various kinds including economic, religious, and political have made addressing the polio problem even more challenging. Question of addressing polio is not merely a health issue; it is in fact more about how diverse interests of various stakeholders can be incorporated. Here I am primarily concerned with issues related to Polio only because I believe that Polio is the problem being faced by community, and this problem should not be seen in the context of political or religious conflicts. Therefore, I have tried by best to keep my opinion impartial to any political or religious rivalries.

One way the circumstances can be improved is to build confidence of the local people in usefulness of the polio vaccination program by involving them in program implementation at grass root level. Due to some negative propaganda and lack of awareness, many people in some regions of Pakistan have started assuming that there is some political, instead of health, agenda behind polio vaccination programs. Underlying motivation for this policy alternative is that when people who are being affected most by polio become part of the program implementation, their overall confidence in usefulness of the program will be increased and they will stand themselves in favor of the polio program in particular and similar other health programs in general.  Moreover, this will not require government advocate the usefulness of such programs all the time. This differs from the status quo in the sense that current policy has been implemented by government using top-down administrative organizations and this alternative suggests building bottom-up infrastructure as well that complements existing top-down infrastructure.

Another way to improve circumstances is to keep political and religious conflicts separate from public health by engaging a third party that can mediate between Government and influential non-state actors who have banned administration of polio vaccination in areas under their control. In quite a few regions in the country, government and some non-state actors are at war with each other due to apparently political and religious differences and, therefore, non-state actors resist implementation of government policies, even if the policies are related to public health in general. Underlying motivation for this policy alternative is that public health should be considered separately from political or religious conflicts among organizations. This policy differs from status quo in the sense that government and non-state actors, who are at conflicts with each other in some domains, will not interfere with each other in health sphere, resulting in better public health irrespective of who is politically or religiously influential in certain regions.

References

[1] http://www.endpolio.com.pk/polioin-pakistan

[2] http://www.polioeradication.org/dataandmonitoring/poliothisweek.aspx

[3]http://www.polioeradication.org/Portals/0/Document/InfectedCountries/Pakistan/2014_NEAP_Pakistan.pdf