Fake ‘Pinky Marks’ another obstacle In Pakistan’s Push To Eradicate Polio

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“People insist on to only stain on the left pinky of their children and not administer polio drops during door to door anti-polio vaccination campaigns and they think children die with the vaccines and it is the Non-Muslims agenda against Muslims for family planning,” A polio team member revealed.

World Health Organization and government of Pakistan are jointly making efforts to make Pakistan of polio-free, however there are different hurdles due to which the polio program thwarted in hardcore areas.

According to the polio programme record displayed on its website, at least 33 cases surfaced in 2015, as many as 10 cases were reported in 2016. Though, the number declined to only one case in 2017 yet the number of polio cases once again climbed up to eight and saw an unexpected jump to 48 in Khyber Pakhtunkhwa till September 2019 while the number of polio cases was recorded 64 across the country in the same period.

In district Shangla only one case was reported in May, 2019 while 6 cases occurred in the neighboring district Torghar till September, 18, 2019.

Religious clerics in Shangla claim that the vaccines administered for family planning is a conspiracy of non-Muslims against Muslims.

“It is questionable when some suspected activities regularly take place and numerous deadly diseases spread out and the government doesn’t give them attention but it gives undue focus on Polio and spends billions of rupees on it,” A religious cleric, Tahir Altaf* said and added, if the vaccines were for anti-polio then why a vaccinated child in Kamach area detected with polio virus?

“I have a book in which a doctor claimed that he had conducted a test of the polio vaccine and claimed it was an agenda of the non-Muslims,” He claimed.

One of the polio team members, Faisal Khan* said that during his last two campaigns a family of a Provincial Management Service PMS officer had refused to get their children vaccinated against polio and asked them to only stain their children left pinky fingers.

The polio team member, further said that about 30 percent children in his target area were silent refusals who insisted on fake finger marking.

Wali Khan, a medical officer at a militancy hit area Kabalgram union council said that about 95 percent people in his area were refusals of routine vaccination, and 60 percent of them were against polio, however, they did their best to administer the drop to every child under five year of age.

According to Expended Program on Imunization Shangla, a polio case was surfaced in May this year at Kamach in Nusrat Khel union council, a remote village of Martung tehsil, located along the Indus river and opposite to the district Torghar where an 18-month old boy Ali Sher detected of polio virus.

Following the reporting of the case, the National Rapid Response Unit NEOC team reached the affected area for investigation. The report of the eight members mission revealed negligence at the EPI part.

It stated that during the investigation zero dose was found in all children for routine vaccination while one vaccination card was also found fake. All mother respondents in the communication assessment stated that hospitals don’t give Oral Polio Vaccines as part of the routine immunization.

The report further mentioned that fake finger marker was found during the investigation indicated by mothers to the female mission member.

It stated there were many instances where the children accompanied by their teacher, parents or siblings going to schools were finger marked without being vaccinated.

“I monitored the last two (Case Response Activities) campaigns of the anti-polio vaccination and found a case of fake finger marking. A family had stained its child finger with a marker telling the team that the drop was administered to the child somewhere else and when the team asked them to bring out the child that they would like to check the marker but they refused,” Fidaul-Karim, Assistant Commissioner Alpuri and UPEC Chairman, said.

He said, however the team traced the house and found that the family was non-local and had brought a marker from the market to mark the child right hand finger instead of the left hand.

Afterwards, the AC, said, they administered drop to the child.

“Women in the area resists to anti-polio vaccination teams and refuse to administer vaccination, especially the issues surges after the Peshawar video case surfaced showing a man claiming children of schools fell unconscious after being administered with polio drops,” the UPEC chairman, explained.

Arshad Subhan* father of four children, said that whenever polio teams visited his house, on his request the team only mark the children fingers and chalked the gate.

He said, that he had heard about the polio vaccines were not good for health and affected the growth system of children.

The World Health Organisation’s Technical Advisory Group (TAG) on Polio Eradication has observed in a recent report on August 29th that some parts of Khyber Pakhtunkhwa are major barrier to polio eradication efforts in Pakistan.

The advisory group acknowledged that Federally Administered Tribal Areas’ (Fata) merger with KP and fake finger markings are major challenges, but observed that the communication strategies being used by the KP polio programme were “not fit for the purpose”.

TAG on polio eradication is a group of globally acclaimed experts. They work on behalf of the Global Polio Eradication Initiative for assessments and as advisory to polio endemic countries. TAG meets after every six months.

“My 2-year-old grandson Jawad has fallen disabled the very next day of being administered with polio drops by a polio team. They also took pictures of the crippled child to conduct investigations but still waiting for the test result,” Zakirin Khan, said.

According to EPI Shangla, several families in Kabalgram are silent refusals including the Jawad’s family and do not let their children to administer them anti-polio drops.

One of the polio campaign area in-charges revealed that non-local Kohistani families are mostly refusals and ask teams to stain their children fingers, including an EPI official of the Kohistan district.

Zahid Khan, an UCMO said that he recently reported an Acute Flacid Paralysis case, the 18-month-old child Ayan Hamid of Butyal was among the refusals.

He said that it might be a polio case and the concerned authorities would come to take samples for conducting tests.

After surfacing polio case in the district and neighbor Torghar district, the two Case Response activities campaigns held in the district Shangla and the next drive will be held in November.

According to the document, about 54 refusals cases were reported in the last campaign held from August 26 to 29.

Shujat Ali, a crippled senior journalist, said when he was just six months old he was detected with polio virus which paralysed him. That time there was no vaccine against polio patients. “I wish to be a normal human being with fit body,” he said.

“We have devised new strategy for polio vaccination teams and in the last campaign to control fake finger marking. We have also asked the teams to report refusals instead of only marking children pinky and tell truth to the supervisors and UCMOs,” Doctor Wajid Ali, district coordinator EPI, Shangla, Said.

Answering a question, he said that WHO should change the colours of markers for every next campaign and also suggest different markers for teams, which would help them to control fake finger marking.

About the polio case, he acknowledged that there was negligence on the part of staff as the child had zero dose of routine vaccination. “However the mission’s report is biased and prepared by one organisation,” he said.

He suggested participation of the government officials, UNICEF, EOC and local heads for investigating the case.

Anees Ur Rehman, Imran Sahir, Irfan Yaqoob, and Sidra Zulfiqar

Department of Management Sciences, Institute of Business and Management UET, Lahore, Pakistan conducted a research in 2017 stating, In the last few years, Islamist insurgency had strong effect on polio elimination program, these insurgents spreading negative information which undermine the importance of polio campaigns and continuous attacking polio workers and vaccinators. These Islamist insurgencies increased due to use of drone attacks and the CIA’s use of fake polio campaign in Abbotabad, for the assassination of Osama Bin Laden and seriously damage the GPEI’s activities. War on terror by Americans in Afghanistan and drone attacks in Federal Administered Tribal Area (FATA) in Pakistan destructed polio elimination efforts. In Pakistan, mostly refusal cases came from FATA and KP, the reason behind this, the areas remained under the influence of the Taliban. Taliban claimed the polio campaigns were used by American agencies to gather data about them, like the Osama Bin Laden’s case. The militant groups banned polio workers to move in their under-control areas and also threatened local population to avail the services of the anti-polio workers. Attacks on polio teams and lady health workers in Pakistan appears that these militant groups do not like continuation of the polio campaigns in their under controlled areas. In Pakistan, the vaccination program was successful going on in the right direction without any interference for the last 15 years.

But in the recent two years, polio team workers have been killed in FATA and other areas of Pakistan. The purpose of the killings of polio teams and vaccinators is to achieve attention of international media which led militant groups to believe that they can acquire their aims by this interference.

One major problem in polio eradication is the misconception of people about polio vaccine. They have misconception about polio vaccine that it causes infertility. Owing to the rumor about vaccine 40000 plus parents refuses to vaccinate their children in every polio campaign in FATA and KP.

According to the record of EPI Shangla, about 170,000 children under the age of 05 were vaccinated during the last polio campaign in the district.

Ihsanullah, an EPI technician in Basic Health Unit, Kabalgram said the main reason was lack of education in the area and majority of people were unaware of the importance of polio vaccination. “People follow religious clerics who propagate anti-polio conspiracies,” he said.

He, said, with the help of lady health workers the polio program could be made successful because they could go inside houses and no one could hide children from them but there was no LHW in the entire area.

“I have been working as polio vaccinator since the last 17 years but for the first time faced resistance from the community who did not allow to administer polio drops to their children by referring the Peshawar incident aired on TV,” Tajida, an old lady health worker in Lilonai, said.

She said that she convinced the families and administered the drops but overall people in Lilonai were cooperative and respected her by letting her to administer their children for anti-polio drops.

The LHW, however regretted over inadequate payment to polio team member and said that only Rs300 are paid for training and Rs2000 are paid for four-day campaign to each LHW, team member.

“There is no LHW where the polio case surfaced. If government increases the number of LHWs there will be no polio case in the region because LHW keeps records of all children of their catchment areas,” She suggested.

LHWs program data shows, the LHWs coverage in the district is very poor as just 32 percent area is covered with LHWs in the entire district, while in the rest of the areas there is no lady health workers appointed where men vaccinators work in both anti-polio and other vaccination drives.

Deputy Commissioner Shangla, Imran Hussain Ranja, told this scribe that fake finger marking was due to lack of community awareness on polio.

About the police case, he said, “the polio case surfaced in Kamach because the child was not vaccinated in the Routine Immunization nor during the polio campaigns which was also proved by the NIH Lab from the blood sample of the affected child which showed that the child has zero percentage seroconversion against the polio virus.

Mr Ranja said people refused due to lack of education and misconception about the polio vaccines.

“Fake finger marking is a new tactics to thwart the polio program in the region,” he said.

Social moblization is essential for making the polio program effective and eradication the crippling disease from the country. When the people of the militancy hit conservative society were educated about the vaccine and its advantages for their children health, the issues of fake finger marking and silent refusals would no more exists and people would start cooperation with the teams.

The immunization program could not be made successful by force, Police must develop pressure because people start further suspicions over the vaccine and the program, also women in the houses try to hide children from teams, however Lady Health Workers perform the polio duty with zest and zeal and achieve targets.

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