At long last some cheerful news is coming for Rotarians on the polio-eradication front from one of the two polio-endemic countries. In January 2022, Pakistan reported an entire year — 365 days — without the reporting of a single wild poliovirus case. What this means to the Rotarians across the world who have been fighting the Herculean task of ridding the world of polio for over three long decades now, can be seen from the congratulatory note that TRF Trustee and Pakistan National PolioPlus Committee chair Aziz Memon received from the RI headquarters. Signed jointly by RI President Shekhar Mehta and TRF Trustee Chair John Germ, and addressed to the Rotarians of Pakistan, it congratulated them for their country reaching “this historic milestone. For the first time in our decades-long fight to eradicate polio, Pakistan has gone a full year without a report of a single child being paralysed by the wild poliovirus. As one of the last two remaining wild polio-endemic countries, Pakistan’s milestone represents meaningful progress and proves that a polio-free world is possible and within our grasp.”
Cautioning them to be wary of the challenges till the wild poliovirus remains in the environment, the note congratulated them for “raising awareness, advocating with government officials, engaging religious and community leaders, donating, and holding fundraisers, supporting, through our grant funding, thousands of health workers,” etc, it said that till now “we have supported polio eradication activities worth nearly $364 million in Pakistan.”
Memon put on record the interest, support and help extended by PRIP Kalyan Banerjee, who also called to congratulate him, and “who was always in the background, helping, supporting, guiding and in his year as RI president, when India marked a year with no polio case, he said it should be Pakistan who should achieve this next.” He also acknowledged the hard work and dedication of PDG Kassim Dada, who was Pakistan’s first PolioPlus chair (1980–88) and PDG Abdul Haiy Khan (1988— 2009), before Memon took over as the national chair.
But Pakistan’s Rotary leaders are wary of celebrating yet; “we are not even accepting the congratulations that have poured in from across the world… from Rotarians, Rotaractors, our partners and others,” says Trustee Memon. “Even while marking this momentous day as one year without any cases of polio, we know that we have to be very vigilant and this is not the end but the beginning. We can’t afford to be complacent, and will have to continue to work with our partners and the government to ensure there is no relapse, as happened in Nigeria after 21 months. So no celebrations yet as this virus can’t be trusted and can come up anytime anywhere… we have to be very alert.”
But despite this sense of caution, there is more cheerful news on polio from the region. Last year Afghanistan reported 4 cases of polio and with Pakistan and Afghanistan sharing a common border, won’t this remain their biggest challenge, I ask Pakistan’s core PolioPlus leadership team over a zoom call. So have they had any kind of a dialogue with the Taliban who has historically been opposed to immunising children against polio?
Responds its Punjab Polio zonal coordinator PDG Muhammad Saeed Shamsi, “Actually, a major change we see these days is that the new government of Afghanistan (the Taliban) is allowing the polio workers to go from door-to-door for giving polio drops.”
How this is a big change for the positive is explained by Memon who says, “And this has been going on for four months now. Earlier, in that region, there used to be a designated Hujra, or a gathering place, where the polio vaccinators could come and the families would bring their children below the age of 5 to get vaccinated. But this has now been changed by the Taliban to a door-to-door vaccination, something that Rotary has always asked for, but was neither permitted nor possible earlier.”
Adds Shamsi, “As you rightly pointed out we have to be very alert because we share a border with Afghanistan. But I am very positive about the endgame in polio, because this change will really help us and make a difference.” Compared to doing the immunisation in a Hujra, giving the drops at the children’s homes left little scope for missing out children. “So hopefully we will be able to do much better than what we have been able to do in Afghanistan till now.”
Asked to walk down memory lane on when exactly the polio immunisation drive in Pakistan really took off and the extreme moments of frustration the core polio team faced, Memon says: “There were both moments of hope and frustration. At times we felt so close to eradicating polio. For eg, in 2018 we got only single digit cases of polio and felt that we were reaching the end and then suddenly a conspiracy theory was raised by a religious party in Peshawar.”
The rumour was that after polio drops 50 children had died; “the truth was that nobody had died. So we were fighting not just insurgency but also religious misbeliefs… spreading rumours in the name of religion. India too faced a similar situation in Bihar and UP.”
The day the then Pakistan Prime Minister Benazir Bhutto gave the first dose of polio during that campaign to her own daughter Asifa in 1994, was the time this programme got national prominence.
— Aziz Memon
Pakistan’s PolioPlus chair
Going back in time to the precise moment when the polio immunisation drive by Rotarians in Pakistan got traction, Memon, who took over as national PolioPlus chair in 2009, put the defining moment in their polio eradication drive as the day the then Pakistan Prime Minister Benazir Bhutto gave the first dose of polio during that campaign to her own daughter Asifa in 1994. “That is the time this programme got national prominence.”
On numbers, he said that at one time the number of polio cases in Pakistan were much lower than in India. But then the Taliban insurgency began in Pakistan and with the refugees moving in from Afghanistan to Pakistan, and the Taliban becoming very active in Pakistan, the number shot up to 380.
Memon added that after Osama bin Laden was killed in 2011, the Taliban were occupying north and south Waziristan in the Khyber Pakhtunkhwa (KP) province, of which Abdul Rauf Rohaila is the zonal coordinator, and put a ban on polio vaccination. “I went there and held a discussion with them to allow polio vaccination but their only demand was that stop those drone strikes. That was the worst time Pakistan faced in its polio eradication drive.”
But things turned for the better as the Army increased its presence in the NW region, especially after the Dec 2014 attack on an Army Public School in Peshawar by six gunmen affiliated with the Tehrik-i-Taliban Pakistan (TTP), in which 132 children died. The Pakistan Army launched an offensive on the TTP and allowed polio vaccinators access to the region, which saw a decline in the number of polio cases.
Rohaila adds that the KP province has always been the most problematic; law and order is a major issue there, killings take place frequently, and this is a big challenge for them. Rotarians had to, and continue to, deal with the insurgency and security issues, and even three days ago, a policeman guarding the polio workers team was killed in Karak district in KP. Most of the polio-related killings have taken place in the KP province.
Asked to relate any horrific incidents that affected their visits to KP, Memon responds: “About 200 polio workers and security men have been killed in our polio eradication drive across the country. While going to Swat, Bannu and other such places, we do not allow our guests to come there, particularly foreign guests who have come for our NIDs, but if we ourselves don’t go there, who else will go? So Rotarians have taken huge risks and always gone there and will continue to go to so many unsafe places in the KP province.”
A major change we see these days is that the new government of Afghanistan (the Taliban) is allowing the polio workers to go from door-to-door for giving polio drops.
Recalling one incident in 2007–08, Rohaila says that during the Taliban era, “we went to North Waziristan despite the Army not allowing it and the local administration extremely reluctant to allow us. But still when we went there … Aziz Memon accompanied us, despite being instructed not to do so… and spoke in their local language, the people said nobody has come here till now and explained all this to us, and we were allowed to carry out immunisation.”
Gradually, as trust and confidence in the Rotarians were established, requests started coming in for health camps — once the KP chief minister himself requested the Rotarians to organise a health camp some eight years ago. The Taliban were there but they allowed the holding of the camp.
When K R Ravindran was RI president, a PolioPlus Memorial Scholarship was formed in the name of the slain polio workers. It sponsored six deserving students for a two year Masters in Public Health (MPH) programme.
Sindh zonal polio coordinator chair PP Masood Bhali adds that “both Pakistan’s defence forces and national and provincial governments have always helped and supported Rotary’s polio immunisation camps and campaigns.”
Coming to the misinformation campaign done by the Taliban and some religious leaders about the polio vaccine causing impotence, and how the PolioPlus core team combated this problem, Memon says they have set up an ulema committee which conducts regular workshops all over Pakistan to give the right information. “The Pakistan government also helped us by getting ulemas from Mecca and Medina to address meetings and workshops making it clear there are no religious or medical concerns in getting these drops which actually protect your children from a crippling disease like polio. The children who take these drops can indeed become fathers and gradually the religious misconception subsided.”
About 200 polio workers/security men have been killed across the country; while going to Swat, Bannu etc in KP province, we do not allow foreign guests to accompany us for the NIDs. But if we ourselves don’t go there, who else will?
— TRF Trustee Aziz Memon
Pakistan’s Rotarians have had to grapple with misinformation of various kinds. As Trustee Memon points out, after Osama bin Laden was killed, both in North and South Waziristan a ban was put on OPV (Oral Polio Vaccine). “One of the main reasons was the charge that when the vaccinators come, they do the mapping and pass on the information to the CIA, about where the Taliban or other insurgents are hiding, so they can carry out drone attacks. Hence they were not allowing our vaccinators. So we said we will all come without cell phones, not take pictures, etc. So the drone attacks also lengthened our fight against polio, because after bin Laden was killed the misinformation spread was that information on his location was given by a polio worker.”
Balochistan coordinator Salim Raza says that only one case was reported in the last year in Killa Abdullah, the red zone of polio. Awareness campaign involving Killi elders, religious leaders, and others helped in reducing the refusal rate. “Being close to Afghan border, it is a challenge to control the virus. So all incoming and outgoing people are being vaccinated and monitored,” he says.
Frontline workers of Permanent Transit Points (PTPs) erected on roadside at selected points, are very proactive and helpful in checking and administering polio drops. “We have to be extra careful to sustain the tempo of awareness campaigns, and ensure access to polio drops for all children.”
After trust was established, the community approached Rotarians saying they had no water, roads etc. “Building roads is a huge job which only the government can do, but wherever we could, we have helped the local communities in several ways. We’ve set up water filtration plants, permanent immunisation centres (PIC) and conducted several health camps to emphasise on the ‘Plus’ in our Polio-Plus programme and give the message that we come not only to give two drops to their children but also to take care of the health of the whole family. This has increased the acceptance and the confidence in us.”
The Rotarians also conduct polio corrective surgery, with many clubs such as RCs Karachi and Lahore having permanent centres to rehabilitate those afflicted by polio. “Much more than surgery, we give crutches or fit the Jaipur foot. Donors come forward to support surgery and rehabilitation efforts,” says Memon. Shamsi adds that in Lahore corrective surgery is being done by Rotary from 1964.
On what next Memon underlines the need for vigilance, as “our biggest problem is a high-risk mobile population”. The PTPs set up by the polio immunisation programme will ensure precaution is taken when migrants cross over from one province to another. In Sindh alone there are 29 such PTPs and 42 across the country. Shamsi explains that as the Punjab province is economically better than the others, there is a lot of crossing over of people who come here for work. “We ensure that these are manned for 24 hours and if the workers bring children, polio drops are given to them.”
Memon adds that at the Pak-Afghan borders, Rotary has put up All-Age Vaccination (AAV) immunisation posts and even adults are given drops as they can be carriers too. “Just as when you go for Haj, the Saudi government ensures that all adults have taken polio drops.”
Pics: Pakistan’s PolioPlus archives
The gender bender
While interviewing Pakistan’s PolioPlus chair and Trustee Aziz Memon on Pakistan marking the one-year milestone without any wild poliovirus case, I ask him on whether the false propaganda that the polio drops caused impotency, resulted in more girls than boys getting vaccinated. He responds: “It’s a very interesting question that you have raised! About four years ago, when the polio numbers from Peshawar and other regions in KP came up, we found most of those were boys. We were wondering what had gone wrong with the immunisation drive and then we discovered that when the polio teams came to give the drops, the mothers would take only their daughters to get the drops and hide their sons, thinking they will become impotent.”
The sad result was some of these boys got polio and became crippled. But when those who became fathers after getting the drops, it was enough evidence to tell the community that this propaganda was incorrect.
Adds Punjab coordinator Shamsi, “Before going on every campaign we do a total mapping of how many children are to be vaccinated in a house. So when we found more boys than girls getting infected with the virus, we could assume that the boys were getting hidden by the parents. In many cases, we knew that a house had 2, or 3 or 4 children, and wanted to ensure all of them got vaccinated. But there were times we were not able to convince the parents.”
No certification yet
Trustee Aziz Memon explains that even though Pakistan has gone without reporting a single wild poliovirus case for a whole year, it will not get any certification from RI right now, because this works region wise in Rotary. “For eg, Sri Lanka became polio-free 18 years and Bangladesh 12 years before India but both the countries had to wait for India to become polio-free for the region to get the certification. We come under the EMRO or the Eastern Mediterranean Region, and need to wait for Afghanistan to register zero cases to be certified polio-free by EMRO.”
Till then, he adds, “we will have to continue our struggle in the coming days and months to ensure we reach the certification of a polio-free region.”