Tuesday, January 01, 2013

An Obama apology may save polio campaign in Pakistan

by Salman Hameed

More grim news: Seven health workers, including six women and one male medical technician, were killed today. I don't know if this was related to polio vaccination or not - but certainly they were targeted for being health workers for an NGO.

The polio campaign is in tatters after the killing of several health workers in Karachi and near Peshawar. Polio has been eradicated from much of the world, and only a handful of places are left with live cases (see earlier posts here and here). Even the Taliban were on board for the vaccination - despite their mistrust of anything western. However, there is now a reaction to the news that CIA used a vaccination ruse to (unsuccessfully) obtain the DNA of Osama Bin Laden's family members to confirm his presence in Abbottabad (see earlier post: Polio may be the winner between the Taliban and the CIA). The Taliban actions against the health workers are indeed despicable. However, the use of a vaccination program by the CIA is also appalling, and they will share an equal blame if polio spreads again at a wider scale.

So what to do? This will never happen, but it will be a start if President Obama offer an apology for endangering the lives of health workers in Pakistan because of CIA's half-brained scheme. But more importantly, he should make a public statement that the US will not use any health workers for the purposes of spying. These health workers should be considered neutral parties. Maybe - and just maybe - the Taliban may allow vaccinations to happen in peace.

In the mean time, here is a thoughtful article in the New York Times on polio vaccinations, and it talks about these challenges:
How in the world did something as innocuous as the sugary pink polio vaccine turn into a flash point between Islamic militants and Western “crusaders,” flaring into a confrontation so ugly that teenage girls — whose only “offense” is that they are protecting children — are gunned down in the streets? 
Nine vaccine workers were killed in Pakistan last week in a terrorist campaign that brought the work of 225,000 vaccinators to a standstill. Suspicion fell immediately on factions of the Pakistani Taliban that have threatened vaccinators in the past, accusing them of being American spies. 
Polio eradication officials have promised to regroup and try again. But first they must persuade the killers to stop shooting workers and even guarantee safe passage.
That has been done before, notably in Afghanistan in 2007, when Mullah Muhammad Omar, spiritual head of the Afghan Taliban, signed a letter of protection for vaccination teams. But in Pakistan, the killers may be breakaway groups following no one’s rules. 
Apart from the CIA ruse, the article also points out the general mistrust in the northern areas of Pakistan:
Even in friendly areas, the vaccine teams have protocols that look plenty suspicious. If a stranger knocked on a door in Brooklyn, asked how many children under age 5 were at home, offered to medicate them, and then scribbled in chalk on the door how many had accepted and how many refused — well, a parent might worry. 
In modern medical surveys — though not necessarily on polio campaigns — teams carry GPS devices so they can find houses again. Drones use GPS coordinates. 
The warlords of Waziristan made the connection specific, barring all vaccination there until Predator drones disappeared from the skies. 
Dr. Bruce Aylward, a Canadian who is chief of polio eradication for the World Health Organization, expressed his frustration at the time, saying, “They know we don’t have any control over drone strikes.” 
The campaign went on elsewhere in Pakistan — until last week. 
And there are all other rumors about vaccinations:
The fight against polio has been hampered by rumors that the vaccine contains pork or the virus that causes AIDS, or is a plot to sterilize Muslim girls. Even the craziest-sounding rumors have roots in reality. 
The AIDS rumor is a direct descendant of Edward Hooper’s 1999 book, “The River,” which posited the theory — since discredited — that H.I.V. emerged when an early polio vaccine supposedly grown in chimpanzee kidney cells contaminated with the simian immunodeficiency virus was tested in the Belgian Congo. 
The sterilization claim was allegedly first made on a Nigerian radio station by a Muslim doctor upset that he had been passed over for a government job. The “proof” was supposed to be lab tests showing it contained estrogen, a birth control hormone. 
The vaccine virus is grown in a broth of live cells; fetal calf cells are typical. They may be treated with a minute amount of a digestive enzyme, trypsin — one source of which is pig pancreas, which could account for the pork rumor. 
In theory, a polio eradicator explained, if a good enough lab tested the vaccine used at the time the rumor started, it might have detected estrogen from the calf’s mother, but it would have been far less estrogen than is in mother’s milk, which is not accused of sterilizing anyone. The trypsin is supposed to be washed out. 
In any case, polio vaccine is now bought only from Muslim countries like Indonesia, and Muslim scholars have ruled it halal — the Islamic equivalent of kosher. 
And ultimately, we all have to deal with this:
Reviving the campaign will mean quelling many rumors. It may also require adding other medical “inducements,” like deworming medicine, mosquito nets or vitamin A, whose immediate benefits are usually more obvious. 
But changing mind-sets will be a crucial step, said Dr. Aylward, who likened the shootings of the girls to those of the schoolchildren in Newtown, Conn.  
More police involvement — what he called a “bunkerized approach” — would not solve either America’s problem or Pakistan’s, he argued. Instead, average citizens in both countries needed to rise up, reject the twisted thinking of the killers and “generate an understanding in the community that this kind of behavior is not acceptable.” 
Read the full article here.

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