By Tim Craig
In a surprising turnaround, Pakistan appears to be finally getting a handle on its polio epidemic, thanks to unorthodox tactics such as tracking residents’ cellphones.
The 85 percent decline in new cases this year is boosting confidence that Pakistani officials are on pace to stop the spread of the virus here, perhaps as early as next year. If Pakistan can achieve that goal, the world will take a major step toward becoming polio-free.
In late September, the World Health Organization declared that polio was no longer “endemic” in Nigeria, leaving only Pakistan and Afghanistan on the list of countries where the crippling virus continues to spread.
The revelation that the CIA had used a fake vaccination campaign to gain intelligence on the whereabouts of Osama bin Laden in 2011 had been a huge blow to Pakistan’s efforts against the disease, especially in areas where Islamist militant groups were strong.
But as the militants have loosened their grip on Pakistan’s northwestern tribal belt, health officials are vaccinating hundreds of thousands of children for the first time.
As a result, Pakistan has reported 40 new polio cases this year, compared with about 240 at this time last year. Pakistani officials say they believe they are on track to vaccinate nearly all children younger than 5 by next summer.
“If the next few vaccination rounds are implemented, and we continue to reach all the children we need to reach, we should be home very soon,” said Mazhar Nisar, head of Pakistan’s emergency polio office. “The key challenge had been security, but now the government has taken that on head-on.”
Many international health experts remain skeptical that Pakistan can rise to that challenge, citing bureaucratic obstacles and uncertainty that the country’s improved security can be maintained. Last month’s earthquake, which killed more than 200 and left tens of thousands of residents homeless, served as a reminder that Pakistan has a reputation as a magnet for crises that quickly distract political leaders and relief organizations.
But Hamid Jafari, director of the Global Polio Eradication Initiative for the WHO, said Pakistan’s government has shown progress as it lurched onto a war footing to combat the disease.
“You see the senior officers of security agencies, and the Pakistan army, now sitting with program managers in emergency operations centers co-planning and co-coordinating,” Jafari said. “You get a very good sense that all the ministries of the government are involved.”
That coordination began late last year as Pakistan’s army pressed into North Waziristan, which had been controlled by Taliban militants and was largely off-limits to vaccination teams.
When more than 100,000 families were evacuated from the area, they were stopped at roadside checkpoints and forced to take a drop of the polio vaccine.
Later, when the displaced residents were registered at refugee camps, they were given a surprising offer: free SIM cards for their phones.
Unbeknownst to the recipients, health officials used the SIM cards to track them as they resettled in other parts of the country. Their locations were mapped in new polio-eradication command centers. When clusters of residents from North Waziristan were identified, teams were sent out to again administer the vaccine.
“We were able to trace them, map them and follow up with them,” said Safdar Rana, head of Pakistan’s Program on Immunization.
The controversial strategy was combined with outreach to religious leaders, the creation of community health centers and a renewed push to put women — not men — on the front lines of the campaign to eradicate polio. But as with many other aspects of life here, the battle against polio is inextricably linked to efforts to overcome the threat posed by Islamist militancy.
Attacks on polio vaccination teams, provoked by the CIA ruse in 2011, resulted in the deaths of 74 people from 2012 to 2014, including 41 last year. So far this year, however, the number of deaths has dropped to 10, according to government figures.
With security improving, health officials are able to vaccinate more children. They estimate that just 16,000 to 18,000 Pakistani children are still “inaccessible” to vaccinators compared with the half-million who were out of reach two years ago.
Back then, that large reservoir of unvaccinated children in North Waziristan and a few other places threatened to become an incubator from which the virus could spread to other countries.
In 2013 and 2014, for the first time in more than a decade, 36 new infections were reported in Syria while two cases surfaced in Iraq. Health officials said they believe the virus was transported to the Middle East from Pakistan. The new cases horrified the WHO, which began publicly shaming Pakistani leaders to step up their response.
Since then, Jafari said, there has been considerable progress in the global fight against polio. The last reported case in the Middle East was in April 2014. The last reported case in Africa was in Somalia in August 2014. Nigeria has not reported a new case since July 2014.
But the gains made in Pakistan this year are threatened by continued insecurity across the border in Afghanistan, Jafari said. To be declared “polio-free,” Pakistan and Afghanistan must go three years without any reported cases, he added.
Vaccinators have been unable to reach 30,000 to 60,000 Afghan children because security has worsened in eastern provinces, Jafari said, in part because Pakistan’s military has driven thousands of militants across the border. So far this year, 13 new polio cases have been reported in Afghanistan, a slight increase over last year’s pace, Jafari said.
The continued potential for cross-border spread of the virus has health officials gearing up for a new fundraising drive. The five-year, $5.5 billion budget for the Global Polio Eradication Initiative will be depleted at the end of 2018. An additional $1.5 billion will need to be spent to continue the campaign through 2019, Jafari said.
In Pakistan, the money has helped pay for 2,000 community health centers that entice parents with basic health-care services and provide an opportunity for medical staffers to vaccinate children.
Pakistani officials also report success in recruiting 4,000 “community volunteers,” with a special focus on attracting women to the jobs who become the public face of vaccination campaigns in their neighborhoods. In conservative areas, mothers are more likely to invite another woman into the house than they are a man.
“This has been a game-changer because now they are able to reach households we missed earlier,” said Aziz Memon, chair of Rotary International’s Pakistan PolioPlus Committee.
Officials also arranged a series of meetings with religious leaders to try to enlist their support in combating rumors that the vaccine can make children sterile or gay.
As for the tracking of North Waziristan residents, Rana said the SIM cards were initially designed to give the government a way to notify the displaced residents about when they could pick up cash assistance payments. Intelligence agencies also had an interest in keeping tabs on where the displaced residents were, according to government officials familiar with the matter.
But when someone suggested that the SIM cards could also be used in the fight against polio, Rana said that his office, the army and the country’s telecommunications office quickly implemented a plan that involved the tracking of about 75,000 families.
“We saw an opportunity, and we took that opportunity,” Rana said. “We will continue to look for opportunities to finish this job.”
Shaiq Hussain contributed to this report.
Tim Craig is The Post’s bureau chief in Pakistan. He has also covered conflicts in Iraq, Afghanistan and within the District of Columbia government.