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India and Pakistan remain united in efforts to wipe out polio

Despite diplomatic tension and Taliban killings, nations are working together to eradicate the disease.

NEW DELHI // Even as Indian and Pakistani troops watch each other across the Line of Control in the disputed region of Kashmir, medical teams from the two countries are collaborating to eradicate polio from Pakistan.

The campaign is in the interest of both countries: India has been polio-free for two years but always faces the possibility that the virus may creep back across the border.

"For such a long time, we were exporters of the polio virus but now we are on the receiving end," said Naveen Thacker, a paediatrician who served for seven years on India's polio advisory group.

The 3,000km border with Pakistan is a particularly worry, as it is one of only three countries in the world, with Afghanistan and Nigeria, where polio is still endemic, according to the World Health Organisation (WHO).

At a function last week to mark India's two polio-free years, Anuradha Gupta, an additional secretary at the ministry of health and family welfare, said: "We are mindful of the persisting risk on account of importation. India is now free of polio but the world is not. Our neighbouring countries are not free of the virus."

Dr Thacker said the government was paying particular attention to immunising children in border areas. "Our capacity to respond near the border is very high," he said.

Ms Gupta noted that collaboration between health officials from India and Pakistan had continued despite border tensions this year. "Teams from Pakistan have been interacting with India to understand what we did right to make our country polio-free," she said.

Pakistan's progress towards wiping out polio has been erratic. According to Unicef figures, there were 47 cases last year, down dramatically from 154 in 2011. But compared with 2005, when only 28 cases were registered, the situation has deteriorated.

In contrast, India had roughly half of the world's polio cases until 2009. Its last case was reported in January 2011. The success of India's 16-year campaign against the disease, Dr Thacker said, could translate easily to other countries.

"We have a very good model - in terms of how we track the virus, how we chart its concentration in high-risk areas - and all of this can be replicated," he said. "In fact, we have teams stationed in Afghanistan and Nigeria also.

"Of course, because of our border with Pakistan, it's in our best interest to ensure Pakistan becomes free of polio."

But it is uphill work in Pakistan, where the polio immunisation campaign has been heavily politicised.

In many tribal areas, the Taliban has announced a ban on immunisations, particularly after the US Central Intelligence Agency used the cover of a fake vaccination drive to pinpoint the location of Osama bin Laden in Abbottabad.

Last December, nine health workers were killed, and some Islamic leaders have told their communities to distrust the vaccine.

Deepak Kapoor, the chairman of Rotary International's Polio Plus committee in India, said that, until the murders of the health workers, "Pakistan had been making a lot of progress". "Now I believe they're using armed forces to deliver the medicine," he added.

The Polio Plus committee, which works with the Indian government and organisations such as Unicef and WHO, had once struggled with similar resistance from Muslim religious leaders in India, Mr Kapoor said. In Uttar Pradesh, where 548 out of India's 676 polio cases in 2006 occurred, 59 per cent were among Muslims, who made up less than a fifth of the state's population.

"The entire programme was being derailed," said Mr Kapoor. "So we started advocating with the religious leaders and got some of them to serve on an ulema committee. It wasn't easy even to get them in the same room, as some wouldn't talk to others. There were so many different sects."

Eventually, many of these leaders even allowed vaccination booths to be set up inside mosques and used their loudspeakers to call parents and children to be immunised. "And in Pakistan now, they've set up an ulema council along similar lines," Mr Kapoor said. "It seems to be succeeding."

These contacts between civil society organisations supplement the government-to-government contacts that are ongoing.

Last May, a Pakistani delegation headed by Shahnaz Wazir Ali, the prime minister's special assistant on polio eradication, came to India to study the fundamentals of the Indian model of fighting polio.

"We opened the whole book in front of them," said Mr Kapoor, who was part of the Indian team that met Ms Wazir Ali and her delegation. "Even down to where we placed the microphones and how we conducted street plays to spread awareness."

Mr Kapoor said teams of doctors and officials will continue to go to Pakistan, despite heightened tensions this year after the deaths of three Indian and two Pakistani soldiers in Kashmir. "I don't think health partnerships will be affected by that. At least, I hope not."


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