Pakistan, which has reported 14 cases of polio this year, is focusing its anti-polio drive on tribal agencies along the Afghanistan border where militant violence has affected eradication efforts, say officials.
Last year, 198 cases were confirmed - the highest for any country in the world, despite the government’s launch of a National Emergency Plan against polio in 2011 and the setting up of a task force to combat the disease.
“Frankly speaking, this is very embarrassing for us as a nation. India’s success is pointed out at every meeting,” a health department official in Islamabad, who asked not to be named, told IRIN.
India has remained free of new cases for a year, and been removed from the list of polio endemic countries by the World Health Organization (WHO). Pakistan remains on the list alongside Nigeria and Afghanistan.
One area where attention is being focused is Bara `tehsil’ (administrative unit) in the troubled Khyber Agency, one of seven tribal agencies along the Pakistan-Afghan border. Here, militant violence has consistently impeded vaccination drives.
At a meeting in Islamabad in March, experts warned that displaced persons moving out of the Khyber Agency and into camps such as Jalozai, could trigger a crisis by spreading the disease.
The first anti-polio drive in nearly three years began in Khyber and Bara `tehsils’ on 25 March, according to Mazhar Zeb, the officer in charge of administration in Khyber Agency. Vaccination began at Jalozai Camp, near Peshawar, the next day.
“Since September 2009, most of Bara tehsil had not been vaccinated against polio,” Sona Bari, a spokesperson for the Global Polio Eradication Initiative (GPEI), told IRIN. "Vaccination points are being set up wherever people are moving so that children can be reached.”
Children up to 15 being vaccinated
Bari also said the age of vaccination had been raised to cover a wider population, and “locally suitable” methods were being used to raise awareness.
Children up to 15 are being vaccinated, rather than those aged up to five, as is the usual practice. Some 38 cases of polio have been confirmed in Bara since 2010. But as movement continues out of the Agency, there is concern also about reaching people moving to camps.
“The campaign in IDP [internally displaced persons] camps is very important,” Elias Durry, a WHO spokesperson, told IRIN in Peshawar.
Duniya Aslam Khan, a spokesperson for the UN Refugee Agency (UNHCR), told IRIN that “as of 17 March, a total of 126,605 IDPs have arrived from Bara. Of the total displaced, 82 percent of IDPs do not reside at camps.”
Despite the vaccination points set up by WHO and government health teams to reach people on the move, it is uncertain if all the people moving to different places, usually to live with relatives, are being reached.
“The situation here is quite chaotic. Members of the anti-polio teams are fearful, and people trust no one. This makes the work of reaching everyone in Bara very hard,” Zarina Bibi, a member of one of the over 70 teams working in the area, told IRIN. She also said it was unclear where people were going - with some even moving to places as far off as Karachi.
Recent US drone attacks and a sense that people are more concerned about saving themselves from violence in their home areas than having their children vaccinated, have added to the difficulties.
Others know what they want: “I want my three children, aged four, six and nine to be vaccinated. No team has come here yet, but I hope it will happen soon,” said Arif Khan, 35, from his village in Bara. “I have seen the effects of polio, and want my children saved. It is not their fault there has been no campaign here for so many years.”