The World Health Organization has identified Pakistan as one of the countries posing the greatest risk of spreading polio. WHO spokeswoman Sona Bari explains how various international outbreaks are linked to the country.
On May 5, the World Health Organization (WHO) declared the spread of polio an international public health emergency, with three countries identified as posing the greatest risk of further exporting the virus beyond their borders: Syria, Cameroon and Pakistan. Among other things, the organization recommended that the governments of these three states require citizens to obtain a certificate proving they have been vaccinated for polio before traveling abroad.
Polio is a crippling and potentially fatal viral disease that mainly affects children under the age of five. Pakistan registered 91 cases of the disease last year, up from 58 in 2012, according to WHO figures. Islamabad reacted to the WHO's alert by announcing it would set up mandatory immunization points at airports to prevent its polio outbreak from spreading to other countries. But Health Minister Saira Afzal Tarar also accused the WHO of playing into the Taliban's hands, saying the health body's recommendations had isolated the country and would make life harder for ordinary Pakistanis.
In a DW interview, Sona Bari, spokesperson for polio eradication at the WHO, responds to the allegations and explains that the situation is critical as almost 80 percent of new polio cases worldwide are reported in Pakistan.
DW: How critical is the current poliovirus situation in Pakistan?
Sona Bari: Pakistan is one of only three countries worldwide that have never managed to put a stop to the transmission of polio. The other two endemic countries - Afghanistan and Nigeria - have made considerable progress against the disease recently, reporting fewer cases in 2013 than 2012 (which was the year we saw the fewest cases in history). Pakistan, on the other hand, saw an increase in cases in 2013 compared to 2012, and 59 of the 74 cases reported globally so far this year - or almost 80 percent - were reported in Pakistan.
The poliovirus is very adept at finding unvaccinated children. In every 200 people infected with poliovirus, only one will actually be paralyzed. This means that the virus can hitch a ride with travelers and move quickly and silently, which is why surveillance for the disease has to be very sensitive.
Virus originating in Pakistan is moving to other countries and paralyzing children. Four cases in Afghanistan this year are all linked to this Pakistani virus, as is the outbreak in the Middle East. Virus of Pakistani origin has been found in the sewage in Israel and has paralyzed children in Syria and Iraq. Pakistan is one of the taps from which poliovirus is flowing. If we turn off the tap at the source, we'll be a lot closer to ending this disease, thanks to progress on all other fronts in polio eradication.
Why has the disease been allowed to re-emerge to the extent of becoming a public health emergency?
Polio can only spread when there are pockets of children who aren't being reached with polio vaccine. The distribution of wild poliovirus has been shrinking geographically, but it is increasingly confined to areas with severe security constraints where communities cannot access vaccination. The transmission of polio in areas without active vaccination taking place, such as parts of north-western Pakistan and some areas of conflict or siege in Syria, has particularly increased the risk of international spread.
Which are the most affected parts of the country and why?
North and South Waziristan together account for more than half of Pakistan's polio cases. Children in North Waziristan are at particular risk, as a ban on vaccination has been in place in the region since June 2012.
Why is the disease endemic in Pakistan and neighboring Afghanistan and could the disease have spread due to the porous border between the two countries?
All cases in 2014 in Afghanistan are related to virus originating in Pakistan. The close cultural and travel ties between the countries and the porous border mean that the virus can travel easily between the countries.
Since Pakistan keeps witnessing a rise in the number of reported cases, has Islamabad been pursuing the wrong approach in terms of fighting the disease?
The strategies to eradicate polio are well-established and have been effective in most of Pakistan. These approaches need to be tailored to the remaining areas where communities are not able to access vaccination, through local leadership and ownership. All parents in Pakistan want to protect their children, and the WHO is there to support national and local leaders in ensuring they can do so.
Saira Afzal Tarar, Pakistan's state minister for Health Sciences Regulation and Coordination, said officials had yet to work out the details of when and how the policy would be implemented. How urgent is the need to control the outbreak?
The WHO's Director General has concluded that the increased international spread of wild poliovirus, especially after the progress made on other fronts against polio, constitutes a public health emergency of international concern. It therefore requires urgent and internationally-coordinated action. We fully understand that governments will need some time to work out the specifics of how they will put the recommendations into action and the WHO's role is to support governments in doing so.
But Saira Afzal Tarar also criticized the WHO for playing into the Taliban's hands. She was quoted by news agency AFP as saying, "By recommending travel restrictions on Pakistan, the WHO has strengthened those forces who actually banned polio drop." What is your view on this?
The measures recommended by the Director-General are purely intended to help reduce the international spread of poliovirus while the remaining polio-infected countries interrupt transmission, in a manner that is internationally coordinated, while avoiding unnecessary interference with international transport and trade.
What is your view on the Taliban and other militant groups' violent opposition to polio vaccination campaigns, arguing that they are a cover for foreign spying?
The delivery of healthcare is impartial. WHO has repeatedly stated that public health interventions should not be used for any other purpose than the improvement of people's health.
Bari: "The transmission of polio in areas without active vaccination and some areas of conflict has particularly increased the risk of international spread"
How does the WHO intend to convince people of its vaccination program as there are still widespread public fears in the country that the vaccine leads to infertility?
The Pakistani public actually wants vaccination and has some of the lowest refusal rates in the world (less than one percent nationally). In parts of the country, there is mistrust of outsiders which is channeled into vaccination mistrust and rumors.
Various Islamic Institutions, including the Organization of Islamic Cooperation (OIC) and the Islamic Advisory Group for polio eradication, have been leading the work with communities to increase public understanding, access and demand for polio vaccination. Furthermore, a network of thousands of community mobilizers - many of whom are volunteers - are working to reassure parents in their own communities that polio vaccines are safe and effective.
Sona Bari is a spokeswoman for polio eradication at the World Health Organization in Geneva, Switzerland.
The interview was conducted by Gabriel Domínguez.