"If you think education is expensive, try ignorance." This is a principle that never fails to prove true. However, this is a principle rarely followed by most in the less developed countries. Virus and viral are two words that get infinite attention in the world. One because it denotes disease and spread of some lethal infections and second because on the social media anything viral is anything well communicated. Common in both is the fast and vast spread and its good or bad implications. There is nothing more tragic when good health measures in children become a victim of bad education measures; there is nothing more tragic when parents who love their children expose their children to debilitating virus all in good faith and poor literacy; and there is nothing more tragic than great efforts on ground by brave vaccinators are diluted underground by leaking sewerage pipes.

The latest fiasco in anti-Polio drive is a recurring reminder that vaccine sets will many times be defeated by mindsets. It is also a reminder that causes of polio virus spread will always triumph over treatment of polio virus if treated as secondary. Pakistan has been put in quarantine previously for being a country unable to control and eradicate polio and unless work does not go beyond house to house visits by health workers resurgence of polio will be a predictable reoccurrence. Governments since 2014 have put in more effort to control this menace and also declared victory in almost eradicating it. The reality however was and is harsh and contradictory. The 16th IMB report (International Monitoring Board) 2017-2018 has clearly denied such claims by stating "The underlying belief among the senior government figures in Pakistan has been that the polio situation in Pakistan is under control. This is not true". It goes on to state "Pakistan's failure to address variations in the quality & general inconsistency in performance of polio vaccination rounds is coming home to roost. Too many children, particularly in high-risk mobile populations, are being missed, something that the IMB has expressed serious concern about in previous reports".

Dealing with national health issues, especially those that are controversial, are matters more of behavior modification than molecule modification. Behaviours get modified or reinforced by the help of awareness, appreciation, admonishment and punishment. A combination of all these methodologies is prescribed to bring about a change in perception, belief and actions. The imbalanced use of either incentives or punishment may give results but will not have inbuilt sustainable behavior changes. China used legislation to control population and instituted the one child law. It did help control population growth but led to many more social issues. Parents who wanted male child indulged in abortions on the discovery of female foetus. After almost two decades the male population is much more than female population causing a huge socio cultural crisis.

Polio drives in Pakistan have achieved considerable success over a period of time. Between 1994 and last year, the number of infected children in Pakistan plunged from 20,000 to just 12. But 15 new cases have been reported this year and some expect this number to go up to 50. The parent refusal spikes are responsible for this rise. Afghanistan and Pakistan have been subject to these bouts of good and bad years. The main propaganda of these drops being anti west agenda was originated by the extremist tendencies post war on terror. The northwest tribal belt, an ethnic Pashtun region near the Afghan border and the epicenter of polio in Pakistan, is deeply conservative, religious and suspicious of authority. Previously these areas were tackled through getting some religious leaders to promote the safety and necessity of polio drops. When Khyber Pakhtunkhwa started its polio drive four years ago the late Maulana Sami ul Haq was seen administering the drops to infants.

While Information highway has provided great avenues for spreading information it has provided the same speed for spreading disinformation. A video showing how children collapsed after polio drops were given became viral. On April 22, vaccinators spent the morning at a school in Mashokhel, a few miles outside Peshawar, the capital of Khyber Pakhtunkhwa province. Soon after they left, school administrators reported that dozens of students were vomiting and fainting. Among local residents the video and the vomiting were correlated and what followed is a frenzy of reactivity. An angry mob attacked the school and burned down the local health clinic.

This incident has left marks on a Polio Drive that is driving on a cliff edge. One of the reasons is that people feel threatened by the repeated calls and force of officials on their houses. They are asking a million questions. Why do we need more doses? Why does a 10 year old need to be vaccinated. The more their questions and the more the answers are unavailable, or given in a threatening manner, by polio team the more the suspicion and refusal rate. Polio is spread through fecal matter, especially in poor and unsanitary conditions. Pakistan has poor sewerage system and the infrastructure is leaking where underground pipes of sewerage mixes with drinking water. In Rawalpindi, water and sewer samples from many poor Pashtun communities have repeatedly tested positive for the polio virus. Thus vaccination may make the resistance against polio strong but the breeding ground of this disease remains fertile with active agents making its total eradication very difficult.

What is needed is a review of the communication strategy of Polio drive. Four major steps need to be undertaken with more accurate targeting. Firstly, Opinion leaders like Maulana Sami ul Haq need to be identified from every refusal and resistance area who can then be engaged and incentivized to promote the safety and necessity of drops. Secondly, local parents who have suffered due to refusal need to be hired to assist entry into neighbourhoods that do not allow outsiders. Thirdly, a general awareness campaign through celebrities, religious scholars and medical doctors etc needs to be actively run on social media and through Public Service spots on electronic media making people aware why repeated drops at an older age are also necessary. It is a fact that even the educated people believe that polio is a vaccination at early age not to be repeated later. Fourthly and most importantly, the roots need to be cleaned. The poisonous underground drainage system that no government has ever tried changing needs to be prioritized for repair and overhaul.

When life savers are perceived as life destroyers it symbolizes how deep the virus of illiteracy is. It also embodies entrenched mindsets. It also manifests the decay in society. The irony is that most governments have tried to run anti polio virus campaigns and not the anti-illiteracy virus campaigns. While billions have been spent on roads, very little has been spent on the breeding poison beneath the roads in the water pipes or cleaning the air above the roads in the environment. With the result that the water we use and the air we breathe in the most budgeted city like Lahore has become the fertilizer for chest, lungs, stomach and polio virus. As the saying goes "If you want to change the fruits you have to change the roots".

(The writer can be reached at [email protected])

Copyright Business Recorder, 2019