A tipping point

The number of polio cases detected in Pakistan so far this year stands at 202, according to the country's health officials. This is the highest figure in 15 years exceeding the previous record of 199 infections in 2001. The South Asian nation is one of the three places in the world, along with Afghanistan and Nigeria, where polio remains endemic.

Polio is a crippling and potentially fatal viral disease that mainly affects children under the age of five. The highly contagious virus spreads best in unsanitary conditions, making vaccination essential. There are also concerns that the virus could spread to other countries from Pakistan. However, eradication attempts in the country have been hindered by militants groups who have banned immunizations.

In a DW interview, Sona Bari, spokeswoman for polio eradication at the World Health Organization (WHO), says that although the militants and the climate of fear have definitely played a role in Pakistan's failure to eradicate the disease, management and accountability failure on the part of authorities have also contributed to its prevalence.

DW: How critical has the polio situation become in Pakistan?

Sona Bari: The current polio situation in Pakistan is critical. The country is really at a tipping point. All the other places in the world where people are still infected have seen massive decreases in the number of new cases.

In fact, Pakistan is the only country with more than ten cases this year, with the total number of children contracting the disease exceeding 200 this year. It's therefore a concern not only for the future of polio eradication in Pakistan, but also for the world as the virus from the South Asian nation has caused outbreaks in places like the Middle East.

Where are most of the infections taking place?

In Pakistan's North Waziristan region local leaders imposed a ban on polio vaccination in June 2012. People in that area had no access to vaccination and that was a problem. But the beginning of military action in the area this June and the subsequent displacement of nearly the entire population finally provided an opportunity to vaccinate those who had been living in the region for two years without vaccination.

In such situations, however, there is also the risk of the virus spreading to new areas as it travels out with the people who haven't been vaccinated for a while. That is actually what we are currently witnessing. Essentially, close to 80 percent of the new cases are registered in the country's Federally Administered Tribal Areas (FATA).

But there are other challenges. In other parts of Pakistan such as Karachi and in the province of Khyber Pakhtunkhwa, the problem is that the vaccination activities are not of good quality. Sometimes, this is just because local officials who are in charge of having children in their district vaccinated haven't done their work in a manner that ensures the vaccination is delivered properly. There are a number of reasons for this as they may not have the tools, resources, training or even the political support necessary to do their job.

To which extent is intimidation by militants playing a role in Pakistan's failure to eradicate polio?

It's definitely one of the factors. In every place where polio still survives, a mix of complex local politics play a part in either preventing health workers from accessing children or enabling local groups to use polio as a bargaining tool.

But a lack of security is not the only reason for Pakistan's inability to stop the spread of polio as there are also areas without security-related issues which have not achieved a high level of vaccination. This aspect points to a management and accountability weakness in these areas.

So we cannot say that the failure is only because of the militants, although they and the climate of fear have definitely played a role.

What are the reasons behind the officials' failure to ensure that all children in the country are vaccinated?

There are multiple reasons for that. For instance, officials may not have had access to certain areas to vaccinate children, such as some parts of Karachi which are extremely dangerous, or maybe they don't have a vaccinator with the right training.

But it has to be noted that there are also many successful vaccination drives in the country. In Peshawar, for instance, local political leaders managed to hold a series of vaccination campaigns every Sunday over a period of 12 weeks without a single security incident and the coverage rate was very high.

Another display of innovation took place when authorities set up hundreds of so-called transit vaccination posts when people from North Waziristan were displaced. Nearly a million people were vaccinated. These campaigns prove that eradication of virus can be done.

Another recent development that has been quite encouraging in Pakistan is that religious leaders have taken a very strong stand in support of vaccination in the country, and there is now something called the National Islamic Advisory Group, which is ramping up efforts to make people realize that it is in fact a religious duty and obligation to protect children.

What measures are required of the central government in Islamabad to tackle the problem?

In a federal system like Pakistan's, I believe the central government needs to have strong leadership and oversight at the highest level which should then be replicated at the provincial level. Oversight and rapid funding are two critical areas. If they can be taken care of, then with its strong civil administration, we are confident that Pakistan will be able to tackle the issue

Pakistan was recently described as one of the taps for the virus and mandatory immunization points were set up at airports. How effective has this measure been in terms of containing the spread of the virus to other countries?

Neighboring Afghanistan will continue to see cases that are linked to Pakistani virus for a while, given the porous border between the two nations as well as the family and trade ties connecting both peoples. But it's an encouraging sign so far that there haven't been any new importations of the virus into places like the Middle East or China or other countries that are vulnerable. Neither Syria nor Iraq has had any new polio cases due to the spread of the virus from Pakistan.

That said, I think that the temporary recommendations will need to stay in place until the WHO Emergency Committee meets again sometime in early November. The committee will then reassess the situation.

How can the international community assist Pakistan?

The international community can assist Pakistan by providing technical support and staff to the country. It's important to make sure that the high-risk districts in the country are offered all the technical knowledge and human resources they need. Furthermore, it is also necessary to ensure adequate financing and that the country doesn't fail in its efforts just because of a lack of funding.

The international community must also show solidarity. This is not about Pakistan failing the rest of the world, but it is about the rest of the world standing by Pakistan and helping one of the last countries to cross the line. The entire world will benefit when Pakistan eradicates polio.

Sona Bari is a spokeswoman for polio eradication at the World Health Organization in Geneva, Switzerland.