Islamabad : In spite of an investment worth billions of dollars and tireless efforts spread over almost two decades, authorities working for the polio eradication initiative are yet to come to terms with key challenges facing the programme. Rather than accepting the ground realities, no matter how harsh, and taking corrective measures for result-oriented outcomes, they prefer being in a state of denial, little realising that it is the children of Pakistan who are eventually paying the price of their faulty perspective, and the country itself whose international reputation is at stake. Instead of instituting damage control measures to counter the ill-effects of Dr. Shakeel Afridi's association with a CIA-led operation conducted under the guise of a health campaign, the polio control authorities continue to harp their hackneyed tune. "The scandal has caused no serious damage to the credibility of the polio eradication initiative," they insist.
While attributing a published comment on the subject to an official from the World Health Organisation, Unicef's media focal person for polio eradication Michael Coleman said, "The programme is not seeing related evidence in the reasons for refusal on the ground, meaning few if any refusals are being linked with this issue at all." The recent Taliban-imposed ban on anti-polio campaigns in North and South Waziristan is now being dubbed as an issue of 'access' rather than one related to refusals or the dented credibility of the initiative. "Clearly, the ban in North and South Waziristan is having an impact on the programme and on efforts to reach every child with vaccination so in this sense, of course it has affected the programme from an access point of view," Michael added.
Is it not a folly to ignore the fact that almost 250,000 children in North and South Waziristan have been deprived of polio vaccine as a result of large-scale refusals by the Taliban, followed by the grand local elder jirga's decision to support the Taliban's stance? Is the ban on campaigns then really an issue of access or refusals? "The grand local elder jirga, which represented almost the entire population of the area, was constituted by the governor of Khyber Pakhtunkhwa and the polio eradication authorities to convince the Taliban to lift the ban on polio immunisation in North and South Waziristan. However, the Taliban ended up convincing the jirga members in favour of their decision," confided a high-ranking official of the provincial anti-polio programme in Peshawar.
Requesting anonymity, the official blamed misplaced strategies for the current state of affairs. "Instead of taking corrective steps to restore public confidence in the anti-polio drive in the wake of the Shakeel Afridi episode, millions of dollars have been pumped on mass media campaigns, which are now being perceived with greater suspicion because the actual sore point (Shakeel Afridi incident) remains unattended and untreated," he pointed out. The official clarified that while there is no denying the value of mass media campaigns, the government should have given priority to handling the actual crisis before embarking on a multi-million campaign that seeks to amend public mindset.
Unicef obviously has its own set of reasons to justify spending of $700,000 on the recent Shahid Afridi mass media campaign for polio eradication. "With each campaign, we reach 110 million people and geographically about 95% of the country, with a special emphasis on high-risk districts and messaging in virus sanctuaries," said Micheal, emphasising what a massive and costly undertaking it is, given the wide outreach that is resultantly obtained. "The campaign has been produced in five languages. Campaign materials were carried on 35 TV stations, 50 radio stations and in about 30 key regional newspapers. The public service announcements were broadcast over 20,000 times nationwide and in five languages. In the July campaign, nearly all radio stations in Fata were engaged to deliver the messages of the campaign. And approximately 40 per cent of the outdoor resources were dedicated to Karachi, Quetta Block and Fata/KP due to their critical position in virus movements. There were 10,000 large format banners, over 150 billboards, over 700,000 campaign cards, 10 location brandings, 15 inter-city bus brandings, 1,000 streamers and 30,000 sq. ft. of wall paintings," Michael counted. With reference to the cost factor, he took pride in having managed to hold costs to an average of around 6/10 of a US cent (0.006 cents) per person reached during National Immunisation Days campaigns.
How far the Shahid Afridi campaign has actually altered the behaviour and mindset of the 110 million people who have been reached, is yet to be ascertained. One can only hope that a parameter other than a KAP study, which has a limited set of respondents and cannot be extrapolated to the entire target population, is used to gauge the actual impact of the campaign.
Responding to a query on media coverage of polio as a health issue, Michael informed that "a standard global set of indicators" is used to monitor print and electronic media coverage on a daily basis. All coverage is then categorised according to whether the overall tone of the article is positive, negative or neutral.
The said indicators, it is learnt, place 20 per cent of polio coverage in Pakistan under the category of 'negative media' and 80 per cent under 'positive media.' Explaining the rationale, Michael said, "The category of negative media might include indicators such as misreporting and biased reporting, but more importantly, it includes tracking coverage of things like operational failures, community or religious opposition or an inaccurate linkage between child sickness and the vaccine." He clarified that the indicators are not used for an evaluation of the media or diagnosis of the programme, but rather "as a useful tool to provide a snapshot of how the programme is seen and being discussed in the public sphere."
If the hundreds of media reports focusing on official statements and photographs taken at polio campaign inaugurations can fall into the 'positive media' category, then it would be fair to expect that reports highlighting operational failures, community and religious opposition, or an inaccurate linkage between child sickness and the vaccine be tagged for action against 'incompetent officials' rather than being labelled as 'negative media.' Food for thought, Unicef!