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It is said that bad news comes in threes. In recent months, Pakistan has had to deal with the Taliban consolidating their stranglehold over the Frontier province. Now, the government is trying to manage one of the largest displacements of a population the world has ever seen as over two million people have left the tribal areas and Malakand division. What will come next? While many Pakistanis remain preoccupied with the potential break up of the country and reports of the Afghan Taliban’s relocation to Balochistan and Sindh, the next problem we face may well be a health crisis. If immediate action is not taken, Pakistan could be plagued with a polio epidemic.

Along with Afghanistan, India and Nigeria, Pakistan is one of four countries where polio continues to thrive. Twelve cases have been confirmed across the country this year. This number is expected to rise as Swatis fleeing the military operation in their valley spill across the country. The fact is, residents of the Malakand division are extremely vulnerable to a polio outbreak.

Since October 2008, none of the target population – over 377,000 children under the age of five – in Swat has been vaccinated owing to the deteriorating security situation and military offensives. As early as September 2007, threats to health workers disrupted vaccination campaigns in about half the valley. The trouble began when Swat-based extremist cleric Maulana Fazlullah – better known as Maulana Radio – came on air using an illegal FM transmitter to denounce polio vaccination. He argued that polio drops were part of a western conspiracy to render Muslims infertile.

Before Fazlullah’s anti-vaccination campaign gained momentum, a case of polio had not been reported in the valley since 2003. But many in the Frontier province seem to have taken his logic to heart: in January this year, 278 families in Upper Dir, including Dir town, refused to let health workers administer anti-polio medication to their children, describing the drops as un-Islamic. As a result, between January and May this year, five polio cases have been reported from across the Frontier province and part of the tribal areas.

The mass exodus resulting from ongoing military operation presents opportunities as well as serious challenges in terms of a polio epidemic. First, the good news: as they leave the Malakand division, under-immunized children are finally accessible to health workers to administer polio drops. Camps established for internally displaced persons (IDPs) also gather populations in urgent need of polio vaccination in finite localities.

In the past few weeks, health workers affiliated with the Global Polio Eradication Initiative have established themselves at nine transit points along the routes from Malakand, Swabi and Mardan and had successfully immunized 17,850 children with trivalent oral polio vaccine by mid-May. Mobile health teams have also gone tent to tent in 26 IDP camps, immunizing almost 7,000 children last month. These efforts are baby steps that may help counter the precarious health situation created by Fazlullah’s preposterous rhetoric.

But much more is needed. As long as one child is affected, children across Pakistan remain at risk because polio spreads rapidly in populations that have not been immunized. Health workers are quick to point out that haphazard displacement trends and crowded camps make it impossible to ensure that every child under the age of five receives the vaccine. According to provincial health officials, up to 1.3 million children in the Frontier province are expected to miss vaccination owing to the mass displacement. generic cialis online

Moreover, given the lapse in regular vaccination in recent years, it is possible that undiagnosed children already carrying the wild polio virus are now exposing dozens more to the disease in IDP camps. Since many IDPs have scattered across Pakistan to avail of the hospitality of host families, children throughout the country are now at a higher risk of infection.

In this context, National Immunization Days become more important than ever. One hopes that the most recent drive, which occurred on May 28-30, was able to reach the 33 million children nationwide that it was targeting. The government should investigate the thoroughness of that drive and launch another initiative if there are fears that many children were not vaccinated. Moreover, some of the aid pouring in can be used to establish clear systems to ensure that all children in IDP camps have been immunized. Mobile health teams can also continually man heavily trafficked routes in coming months to ensure that IDPs – those leaving or returning to Malakand – have received anti-polio medication.

But what about those families who actively prevented their children from receiving polio drops for fear that the medication would corrupt or sterilize them? One wishes there were a vaccine to counter ideological brainwashing. In the absence of one, the government and international community will have to put health on the agenda as part of any ‘winning hearts and minds’ campaign. Once again, community radio broadcasts (first in IDP camps and subsequently across Fata and the Frontier) featuring correct information about polio vaccination backed by local authorities such as clerics and generic cialis onlinemight be the best way to forever squash Fazlullah’s nonsensical theories.

In the short term, the threat of a polio outbreak should not be used by officials as an excuse to deny IDPs shelter and support. Rather, provincial governments in Sindh, Punjab and Balochistan should reflect on the health crisis among the IDP population as a way to get in some soul searching. The only reason potentially polio-carrying IDPs pose a threat in other parts of the country is because provincial vaccination efforts have not been comprehensive.

For example, the latest confirmed case of polio comes from the Multan district of southern Punjab, one of the most populous in the country. In Karachi, meanwhile, 217,000 children (about nine percent of the target population) were not immunized during campaigns in April 2009. Indeed, polio is on the rise in Sindh – with or without the IDPs (compare five cases in 2005 to 18 cases in 2008). If properly managed by the government, attempts to raise awareness and eradicate polio risk among the IDP population could, in turn, benefit the country as a whole.

It may seem premature to be worrying about a polio epidemic when IDPs barely have access to food, potable water and shelter. But Pakistan has a bad habit of worrying about the benefits of foresight only in hindsight. While making efforts to accommodate the IDPs, the government should simultaneously work towards comprehensive polio vaccination. That way, we may save ourselves another major crisis in coming years.