Reaching every child in every home in conflict-ridden FATA

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Child receiving polio vaccine
A child receives an orally administered polio vaccine. Polio immunications have increased tremendously in FATA. 

The Federally Administrated Tribal Areas (FATA) of Pakistan is a semi-autonomous tribal region in northwestern Pakistan, bordering Pakistan's provinces of Khyber Pakhtunkhwa and Balochistan and Afghanistan to the west and north. It consists of seven tribal agencies and six frontier regions and are directly managed by Pakistan's Federal Government. 

FATA has been in the spotlight for all the wrong reasons. The region has seen conflict and instability for almost three decades. Since the start of the 21st century, it has suffered more with escalation in violence, forced isolation of its population by extremist groups and instability. But things have begun to change. The security operation in North Waziristan Agency has been followed by large scale programmatic/development interventions by civil authorities. This has resulted in decrease in violence, initiation of the return process for the internally displaced populations and the restoration of the writ of law.

As a new FATA emerges, there is an opportunity to reduce the large pool of polio cases and stop the transmission of the polio virus. In 2013 and 2014, FATA had the largest number of reported polio cases in the world. The instability in the region had compromised a range of activities, including the outreach of routine immunization and polio campaigns. This lack of access created a population segment without protection against polio. As a result, polio cases peaked in 2014.
Figure 3: Per capita income by municipality, 2017 (in current US$)

Despite the government’s success in vaccinating children in other parts of the country and reducing polio transmission, the wild polio virus [2] could not be contained, given the large-scale movement of people from these areas. The majority of polio cases were from Pashto-speaking families living in inaccessible areas of FATA. North Waziristan and the Khyber Agency became a challenge for polio teams due to inaccessibility. Policymakers and technical experts in FATA acknowledged that violence, large scale population movements and inaccessibility, rather than people’s refusal to vaccinate their children, was the real issue. 

As Secretary Law and Order and Planning and Development in FATA, I was responsible for coordinating FATA’s response to the polio challenge. We made an intensive effort to facilitate access to polio services through religiously and culturally sensitive awareness campaigns and media engagement. The people in FATA were made to believe that polio vaccination was against their religious and cultural beliefs. As social mobilizers worked with polio vaccinators to reach the remotest communities in FATA, they realized that the parents recognized that polio vaccination was a critical investment in the overall health of their children. Interestingly, the hesitation to get children immunized extends to other parts of the world. The Los Angeles Times reports [3] that, in Orange County, California, about 3 percent of children in kindergarten have “personal belief exemptions” secured by their parents, which allow them to opt out of immunizations.

ImageAs the graph illustrates, there is a decline in the number of children who were inaccessible for polio immunization. It has dropped from 330,618 (31%) in January 2015 to 16,576 (2%) children in September 2015. Through our concentrated efforts to gain access to unimmunized children, the number of polio cases fell from 179 to 11 during this period.
For sensitive areas such as North Waziristan and the Khyber Agency, continuous community-protected vaccination approaches ensure prolonged episodes of vaccination, reaching every child in every home. In these areas, teams carried out seven-day anti-polio vaccination campaigns as compared to the usual three-day campaigns in most parts of the country.
Refusals have remained well below 1% of the target population during 2015 and have plummeted further since May 2015. This trend is extremely positive and is likely to bring us close to the day of celebration when FATA will be declared polio-free.

[1] Secretary Law and Order/Planning and Development, FATA.
[2] Wild Polio Virus are field isolates and reference strains derived from polioviruses known or believed to have circulated persistently in the community. It invades the nervous system and causes irreversible paralysis in a matter of hours and sometimes causes death. 





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