- Rafia Zakaria
a columnist for Dawn, Pakistan’s largest English newspaper. She has been covering the rise of polio in Pakistan since the Osama bin Laden raid. Last year, she wrote an article for Warscapes called "The War, the Women, and the Vaccine."
- Zulfiqar Bhutta
medical doctor and founding director of the Center for Excellence in Women and Child Health at the Aga Khan University, Karachi, Pakistan, and also the Robert Harding Chair in Global Child Health and Policy at the Center for Global Child Health at the Hospital for Sick Children, Toronto.
The World Health Organization has designated the spread of polio in Asia, Africa and the Middle East a global public health emergency requiring a coordinated "international response." Three countries pose the greatest risk of further spreading the paralyzing virus: Pakistan, Cameroon and Syria. In an unusual step, the WHO recommended all residents of those countries, of all ages, to be vaccinated before traveling abroad. The organization also said another seven countries — Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Nigeria and Somalia — should "encourage" all their would-be travelers to get vaccinated. Until recently, polio had been nearly eradicated thanks to a 25-year campaign that vaccinated billions of children. In Pakistan, the increase in polio is being linked to a secret CIA ploy used in the hunt for Osama bin Laden. With the help of a Pakistani doctor, the CIA set up a fake vaccination campaign in the city of Abbottabad in an effort to get DNA from the bin Laden family. The Taliban subsequently announced a ban on immunization efforts and launched a string of deadly attacks on medical workers. We are joined by two guests: Rafia Zakaria, a columnist for Dawn, Pakistan’s largest English newspaper, who has been covering the rise of polio in Pakistan since the bin Laden raid; and one of Pakistan’s leading polio experts, Dr. Zulfiqar Bhutta.
AMY GOODMAN: The World Health Organization has announced the spread of polio is a global public health emergency. According to the WHO, outbreaks in Asia, Africa and the Middle East are an "extraordinary event" requiring a coordinated "international response." The organization pinpointed three countries as posing the greatest risk of further spreading the paralyzing virus: Pakistan, Cameroon and Syria. In an unusual step, the WHO recommended all residents of those countries, of all ages, be vaccinated before traveling abroad. It also said another seven countries should "encourage" all their would-be travelers to get vaccinated. Those are Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Nigeria and Somalia. Bruce Aylward, the assistant director-general of the WHO, announced the emergency declaration.
DR. BRUCE AYLWARD: The director-general has declared the international spread of wild poliovirus today in 2014 a public health emergency of international concern. There’s been 74 cases of polio due to wild poliovirus so far this year. Fifty-nine of those cases have been reported from Pakistan. If the situation as of today and April 2014 went unchecked, it could result in failure to eradicate globally one of the world’s most serious vaccine-preventable diseases.
AMY GOODMAN: That was Bruce Aylward, the assistant director-general of the World Health Organization.
Until recently, polio had been nearly eradicated, thanks to a 25-year campaign that vaccinated billions of children. In Pakistan, the increase in polio is being linked to a secret CIA ploy used in the hunt for Osama bin Laden. With the help of a Pakistani doctor, the CIA set up a fake vaccination campaign in the city of Abbottabad in an effort to get DNA from the bin Laden family. The Taliban subsequently announced a ban on immunization efforts and launched a string of deadly attacks on medical workers.
For more, we’re joined by two guests. By Democracy Now! video stream, we’re joined by Rafia Zakaria. She is a columnist for Dawn, Pakistan’s largest English newspaper, who has been covering the rise of the polio in Pakistan since the bin Laden raid. Last year, she wrote a piece for Warscapes called "The War, the Women, and the Vaccine."
And we’re also joined by phone by one of Pakistan’s leading polio experts, Dr. Zulfiqar Bhutta. He’s founding director of the Center for Excellence in Women and Child Health at the Aga Khan University in Karachi, and a doctor at the Hospital for Sick Children in Toronto.
We welcome you both to Democracy Now! Rafia, let’s begin with you. What do you think is responsible for this outbreak of polio in Pakistan?
RAFIA ZAKARIA: Amy, thanks for having me on.
I think, you know, in Pakistan right now what you see is kind of the perfect storm, where there’s a collusion of factors coming together to cause a tremendous health emergency for Pakistan’s women and children especially. You mentioned the CIA program that was used, you know, the fake vaccination program that was used to collect DNA. You know, in addition to that is the fact that the Taliban have been, since then, targeting the health workers that provide immunizations in Pakistan, polio immunizations in Pakistan. And the third factor is, of course, just, you know, the underfunded nature of the Lady Health Worker program that provides these vaccinations. So all of these three factors have essentially come together to create a situation where, in just three years—because just three years ago, Pakistan was about to eradicate the poliovirus. And you can see just across the border in India, where these political events did not happen, they did eradicate the poliovirus. But we see 59 new cases.
The cases are spreading, as I’m sure Dr. Bhutta will talk about. They’ve spread not—you know, they used to be just in the tribal areas, where the drone attacks are concentrated, and in Peshawar, which is the biggest city next to the tribal areas, to now all the way south in Karachi, which is a city of 20 million people, where the spread of viruses like polio can happen very, very fast.
And you have to remember that these health workers that are at the front line of this anti-vaccination—this vaccination campaign are paid $2.50 a day. So you have to see how the people who are at the very front lines of this battle, who are trying to get the virus under control, have very—not only do they have very little remuneration, they have no security. So they’re easy targets for the Taliban and other extremist groups.
But the core issue, the central issue, is the issue of public trust. You know, it is unimaginable that in the Western industrialized nations of the world, that a public health program would be allowed to be used as a front to—you know, to essentially forward a strategic interest in capturing one or another person. But this is what has happened in Pakistan. And so, you have a situation where, among the rural areas especially, and also in the inner cities of Karachi and in Peshawar, people don’t trust the vaccine. They don’t know what it does. You know, first there is a—you know, when there is a rumor that says that Pakistani children are being sterilized by this vaccine, and then you have the truth of the fact that the CIA did use the program, it’s very, very difficult to convince people, even educated people, that the vaccine that their children are going to get is one that hasn’t been tampered with.
AMY GOODMAN: Dr. Zulfiqar Bhutta, can you respond to the virus and the polio emergency that’s been announced by WHO and what’s happening in your country of Pakistan?
DR. ZULFIQAR BHUTTA: Well, thank you very much, and I’m grateful for the invitation to join you this morning.
Let me just add to what Rafia said. I mean, where I agree with her is this current perfect storm of a variety of issues and the lack of public trust in a broad polio immunization program. However, you know, I don’t think the blame for the failure of polio eradication in Pakistan can be placed entirely on the bin Laden episode, which, deplorable as it was, was a problematic issue that happened at a time when we needed to build public confidence, and not the opposite. What has happened in Pakistan is that you have virtually a civil war going on in some parts of the country, notably in the Federally Administered Tribal Areas, the Taliban-controlled areas, where nobody can enter. And yes, of course, health teams cannot enter. And as a result, it’s been impossible to vaccinate large bodies of children, and people moving out of that area have been able to carry viruses to all parts of Khyber Pakhtunkhwa, the neighboring province. And because there’s a large portion of people who travel down to Karachi and migrate there, there is also transmission of virus in those areas. So there is a very close link of polio program in Pakistan with the barriers of conflict and war. And as you can imagine, in the parts of the world where the virus has spread or re-emerged, these are also geographies where there has been conflict and a breakdown of primary care and health services: Somalia, Syria, I mean, the isolation of the virus in Iraq, parts of Afghanistan.
So, I think it is important to recognize that we are trying to eradicate a disease globally in the midst of very adverse situations, of which there are a range of factors, including conflict, takedown of public health services, disinformation, which is flamed by incidents such as the Shakil Afridi CIA ruse, and also the fact that the disorder is now unfortunately being politicized. I mean, the Taliban have deplorably not only resorted to attacking health workers, and thereby creating this climate of fear amongst the primary care health workers program and the population, but have also used polio as a vehicle for political negotiations. I mean, the North Waziristan Taliban leaders stated that they would only really allow polio campaigns or polio entry into their area if the drone attacks were stopped. So, it is a very unfortunate situation, which does place a huge responsibility on everybody concerned to take a very rational, balanced approach to what needs to be done, and not a knee-jerk response.
AMY GOODMAN: Dr. Bhutta, your response to the WHO recommending all residents of Pakistan should show proof of vaccination before they can leave the country?
DR. ZULFIQAR BHUTTA: Well, I mean, I can understand where WHO is coming from. I mean, they are desperately trying to contain the virus from spreading to other geographies. But I do have some reservations on the whole gaming of what might happen with such a draconian imposition of travel restrictions. Firstly, Pakistan is not a small country, so you’re not talking about just a few thousand people traveling. You’re talking about millions of people, the diaspora who live in the Middle East and who travel all over the world, people who travel between the West and East. So, it was always going to be a huge challenge in terms of implementing such a restriction.
Secondly, there is a real risk. And we are already beginning, as people on the ground will confirm, to see a response that is taking away from the core process of focusing on eradication of the disease in the geographies that I mentioned. The government has been forced to set up these vaccination centers in over 130 hospitals. It’s been forced to set up vaccination points at all ports of exit and airports. That will require human resources. That will require a vaccine transportation chain. That will actually require vaccines. Already, I’ve been told, that there is insufficient polio vaccine to vaccinate all travelers—oral polio vaccine—and the government is desperately trying to get the injectable vaccine for all travelers. Now, all of these things will, I’m afraid, take away from the core focus of the program on trying to vaccinate people in at-risk populations in the districts of Karachi, in the FATA areas, strengthening the community program, the Lady Health Workers program, as well as the vaccination program, integration with other services. Those are things that require resources, both human and money. And I’m afraid these travel restrictions may look cosmetically as appropriate, but I don’t think they will do much good in terms of the national polio eradication program.
AMY GOODMAN: Finally, Rafia Zakaria, you report for Dawn, the newspaper in Pakistan, but you’re in the United States. Your message to people in this country who might have no idea what happened with the Osama bin Laden raid, the special forces and how they found him?
RAFIA ZAKARIA: Well, you know, I think—I would like to speak for the Pakistani people, who are kind of caught in the middle of this conflict. You know, on one hand, you have the CIA, the U.S. government, looking at their strategic objectives of catching bin Laden; and on the other hand, you have the Taliban, whose agenda is basically to destroy Pakistan, to spread terror in any way they can. And the tragedy is, is that neither side seems to care at all about the Pakistani people who are caught in the middle. So now the U.S. has Osama bin Laden, and they have a victory that they can tout. But the fact is, is that in the three years after that raid, we’ve got a polio outbreak in Pakistan, and extremist groups have actually been able to increase their number of attacks. The casualties—Pakistan is now the number one—the number one country in the number of terrorist attacks anywhere in the world, more than Iraq and Afghanistan.
And so, I mean, the situation—the question becomes, you know, for Americans, is that: What has the war on terror really accomplished? Not only do you have these extremist groups able to expand their areas of operation, but now you’ve got a huge public health crisis in Pakistan. And I think Dr. Bhutta gave a really great insight on how Pakistan just does not have the resources to contain both of these problems. So I think that Americans have to move beyond this kind of idea that killing one figurehead and the number two leader and the number three leader is winning the war on terror. They have to look at this—at the cost of this that’s imposed on countries like Pakistan and especially on the innocent civilians. You know, the final consequence that I think your listeners should consider is that, because of this war, a functioning program, the Lady Health Worker program, that used very little money to provide basic healthcare to millions of—millions of Pakistani women and children, is now essentially being scrapped.
AMY GOODMAN: I want to thank you both for being with us. I’m sorry we have to end it there. Rafia Zakaria, columnist for Dawn, Pakistan’s largest English newspaper, covering the rise of polio in Pakistan since the bin Laden raid. Also want to thank Dr. Zulfiqar Bhutta, founding director of the Center for Excellence in Women and Child Health at the Aga Khan University in Karachi, Pakistan.
When we come back from break, an update on what’s happening with the almost 300 girls who were abducted by the Boko Haram in Nigeria. Stay with us.