Pakistan’s failings to fight polio spark global emergency response

Pakistan's failure to stem the spread of polio triggered global emergency health measures on Monday, with the World Health Organisation (WHO) recommending all residents must show proof of vaccination before they can leave the country.

The emergency measures also apply to Syria and Cameroon, which along with Pakistan are seen as posing the greatest risk of exporting the crippling virus and undermining a U.N. plan to eradicate it by 2018.

Pakistan is in the spotlight as the only country with endemic polio that saw cases rise last year. Its caseload rose to 93 from 58 in 2012, accounting for more than a fifth of the 417 cases globally in 2013.

The virus has recently spread to AfghanistanIraqIsrael and Syria, and has been found in sewage in the West Bank, Gaza Strip and greater Cairo, said WHO assistant director general Bruce Aylward. It also appeared in China two years ago.

“In the majority of these reinfected areas, the viruses circulating actually trace back to Pakistan within the last 12-18 months,” Aylward told reporters on a conference call.

Pakistan has called an emergency meeting of senior provincial and federal health officials for Wednesday to finalise how to implement the new requirements.

“The best option would be vaccinating the passengers at the airport departure where polio vaccination cards would be issued to the passengers. Human resource and vaccines would have to be worked out for the purpose,” State Minister for Health Services Saira Afzal Tarar said in a televised broadcast.

“It would be most practical as people often have to fly in emergencies.”


Aylward said Pakistan had done “tremendous” work to restore security in Peshawar after deadly attacks on health workers had impeded the fight against polio. The race to meet a target to eradicate polio by 2018 was still feasible, he said.

“In terms of the 2014 working target to try and stop transmission, from the data presented, clearly Pakistan would be the only country that would be considered 'off track' in terms of its ability to meet that deadline,” he added.

WHO chief Margaret Chan declared the resurgence of the disease to be a public health emergency of international concern, the first such designation since a 2009 flu pandemic.

The travel restrictions should stay in place until there is a whole year with no new exports of the disease, or six months if the countries can show they have carried out high quality eradication activities in infected and high risk areas.

The WHO's emergency committee, an independent group of experts that drew up the recommendations, will meet in three months to assess the countries' actions, or sooner if needed.

The steps published on Monday were the minimum actions that could be taken without unnecessarily disrupting travel or trade, but much stronger measures could have been recommended, Aylward said. Those include full vaccination programmes, restrictions on more countries and recommendations on countries of arrival.

The WHO says 10 million people are walking today thanks to efforts to wipe out the disease, which mainly affects children under five years old. It says economic models show eradicating polio would save at least $40-50 billion over the next 20 years.

Polio passes easily from person to person and can spread rapidly among children, especially in the kind of unsanitary conditions endured by displaced people in war-torn regions, refugee camps and areas where health care is limited.

The virus invades the nervous system and can cause irreversible paralysis within hours. The WHO has repeatedly warned that as long as any single child remains infected with polio, children everywhere are at risk.

There is no cure for the disease but it can be prevented by immunization. The polio vaccine, administered multiple times, can protect a child for life. 

Sitting Idle

Africa is not much on our minds these days. We have obviously been preoccupied by America’s election and by Israel’s chaos. Many of us have long since stopped reading the news from Africa, since it is almost always gloomy — Africa as the world’s basket case, the one continent that seems irretrievably trapped by misgovernment and murder, and now by a horrendous pandemic of AIDS.

Sen. Russell Feingold (D-Wis.), of campaign finance reform, is among the more interesting members of the Senate. A few weeks ago, in explaining his opposition to the death penalty to a synagogue audience in Wisconsin, he carefully reviewed traditional Jewish views of capital punishment. More recently, Feingold spoke at a World AIDS Day reception in Milwaukee, and his disturbing speech warrants a larger audience than the occasion provided.

Worldwide, 21 million people have died of AIDS so far, and another 36 million are infected. Of those 36 million, more than 25 million live in Africa — which is to say that more than two out of every three people in the world infected by AIDS live in sub-Sahara Africa. Every day, another 11,000 people — men, women and children — become infected there; every day, more than 5,500 Africans die of AIDS-related illnesses, many without ever having been treated.

As Feingold put it, “In Africa, people are dying from AIDS alone in numbers comparable to the number of deaths in the United States from heart disease, and cancer, and stroke, and accidents, and pneumonia, and diabetes and nearly all other causes of death combined.”

By the year 2010, some 20 million children, most of them African, will have lost one or both parents to the diseases. In Zimbabwe, where one out of four teenagers between the ages of 15 and 19 is HIV positive, some reports have suggested that life expectancy has dropped from 65 to 39.

It is true that Africa is very far away from us and Africa’s problems are hard to think about. It is also true that we have other problems much closer to home, and what happens in Africa doesn’t have much immediate impact on our lives.

But here are two things that are not true: There’s nothing to be done about the crisis of AIDS in Africa. And racism is irrelevant as an explanation of why, so far, so little has been done. (Imagine, for example, that a pandemic of similar scope were unfolding in Europe. Would there not be a nearly immediate response?)

The central issue in our own public policy agenda regarding the crisis has to do with making low-cost medications available to the people of Africa. Average annual income in Africa often barely exceeds $1,000, while life-saving medications can easily cost as much as $12,000 a year. The issue: The $12,000 price tag is the conventional cost charged by the pharmaceutical industry; around the world, there are dozens of companies eager to produce and market the very same drugs at a fraction of that conventional cost.

Last year, Feingold, along with Sen. Dianne Feinstein (D-Calif.), introduced a modest piece of legislation that would have prohibited the United States from taking action against countries trying to make low-cost AIDS medications available. The Senate accepted the proposal, but in committee, after heavy lobbying by the pharmaceutical industry, the proposal was stripped out of the bill to which it had been attached. As a result, poverty and Africanness are conditions that render AIDS vastly more lethal than it would be otherwise.

It is disturbing to be the object of an effort to force yet another crisis onto our personal agendas, so crowded with crisis as they are already. And if the crisis that’s being forced upon us is so remote, it is easy enough to respond with a “tsk tsk” and to go on about our business. Where and how shall we make room for this distant problem?

“Where” and “how” are very real questions, but “why” is not. The answer to the “why” question is in the eyes of the orphans, in the eyes of all the bereaved; it is in the collapse of gross domestic product in sub-Saharan Africa, and in the collapse of life expectancy; it is in the national security implications of the crisis; above all, it is in the shame with which our inaction will be recorded, the shame that quite properly attaches to a people that watched passively while millions of people needlessly died.

When we speak of the Holocaust, we sometimes wonder how many Einsteins, how many Sabins and Salks, how many Amichais and Bernsteins there were among those who perished. That’s a fair question, and a painful one. The same question, of course, applies in the case at hand, as does the classic stricture we are so fond of citing: “Thou shalt not stand idly by the blood of thy neighbor.”