By Asmat Ullah Malik, Emerging Voice 2010 from Pakistan, Technical Advisor at the Integrated Health Services

It is yet to be seen whether the Global War on Terrorism achieves its political and military objectives but its interventions have seriously undermined the efforts to eradicate polio in Pakistan. You must know that recently, the US Central Intelligence Agency (CIA), in a covert military operation, recruited a senior local doctor in Pakistan to launch a fake vaccination drive that helped in tracking down Osama bin Laden by gathering DNA from members of bin Laden’s family.

The modus operandi of the CIA’s interventions have been heavily criticized even by the Western analysts (see the opinion piece by Laurie Garret that was discussed further on Humanosphere) for its implications for global commitments on polio eradication, but the damage has been done.

In Pakistan the local sentiments are against the US for its political and military motives in this region, and a non-ending series of drone attacks in the northern areas of Pakistan bordering with Afghanistan are one of the main reasons. The CIA’s covert vaccination campaign has further fueled these sentiments and taking an advantage of the situation,  the Taliban have effectively banned vaccination in those areas. They are tactically using this campaign to their strategic advantage in order to put pressure on the national and international community, especially after the NATO supply routes have been reopened through Pakistan. Unfortunately, this has put more than 250 000 children at risk.

Polio remains endemic in Pakistan despite conducting special national and sub-national immunization days to eradicate polio since 1994. The achievements of the regular Vaccination Program have remained below satisfactory level. According to the latest Demographic and Health Survey from 2006,  only 39% of children were fully immunized in time. Besides weak implementation capacities of the vaccination program, low acceptability for vaccination among the local communities is a major factor, for different religious and cultural reasons.

Since a long time ago, a number of religious clerics have considered campaigns for vaccination against polio as part of the Western agenda against Muslims. Pakistani officials are fighting to negate that discourse. The situation has improved over years but the building of confidence and trust among the local masses remains a slow process. In this context, the media publicity of CIA’s surgical interventions has provided fuel for these rumor churning factories.

The CIA’s military operation has burned such bridges in a day that were patiently built by public health experts over years to address resistance in the Pakistani communities. This operation has  shot the WHO in the back in terms of its recent successful progress to eradicate polio and money will not be enough. The present situation is interwoven by multiple complexities. Solving these will require complex and multiple interventions. Today’s article in The Lancet suggests a number of strategies to be implemented to achieve polio eradication globally. For Pakistan however, rebuilding the bridges with the communities will take years as trust has been seriously undermined. The world has to accept that Pakistan needs a long-term action plan that suits the local context. The threats of imposing a travel ban on Pakistanis if polio remains there beyond 2013 will not change anything. There will be polio in Pakistan beyond 2013.

Even if all is fair in love and war, public health generally finds itself on the losing end. The situation is not different in Pakistan. How can we make every child count?

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