Upshot of Pakistan’s war on polio hangs on Gadap Town

The emergence of the latest polio case in the notorious UC-4 of Karachi’s Gadap Town has set alarm bells ringing in health circles from Islamabad to the WHO headquarters in Geneva and the Unicef head office in New York City.

The Gadap union council in question has become the epicentre of the polio virus, which is transmitted not only across Karachi but also to other parts of Sindh, to southern Punjab and Quetta, and to Kandahar and other Afghan cities.

On Wednesday Pakistan’s authorities had confirmed the emergence of two polio cases: one in Gadap’s UC-4 and the other in KP’s Landi Kotal tehsil, saying that the virus was detected in two girls, but both of them escaped paralysis due to repeated vaccinations during special polio drives.  

Why UC-4?

Twenty polio cases have emerged in Gadap’s UC-4 during the past decade, with at least 10 of them having been confirmed in the last five years.

While health experts and authorities around the globe are trying to understand why the union council continues to be the epicentre of the virus, they all agree that winning the war against polio in UC-4 is crucial to declaring Pakistan polio-free.

Hazrat Gul, an Afghan pushcart vendor residing in a Sohrab Goth shanty town, which is part of UC-4, told The News that he hides his three children whenever health workers visit their area to administer oral polio vaccine (OPV).

“I don’t know why these people send their women door to door to give these drops to children when they can’t even give us simple painkillers and common medicines.” But he is not the only one. Thousands of people, mostly Afghans and Pakistani Pashtuns, do not allow health workers to administer OPV to their children or hide them from the vaccinators, which has become a serious cause of concern for the authorities.

Sindh Chief Minister Syed Murad Ali Shah was recently informed that 118,557 parents had refused to get their children vaccinated in Karachi during the last anti-polio campaign, while over 96,000 kids were apparently not at home when the health workers had arrived on their doorsteps.

“The issue of UC-4 is very complex,” Emergency Operation Centre National Coordinator Dr Rana Safdar told The News. “It’s an extremely deprived locality, the most neglected part of the city where sanitary conditions are very poor.”

Dr Safdar said the union council has no health facility except a dispensary that was recently revamped, but the people there are less educated, extremely sceptical and demoralised due to their socio-economic conditions.

He said that due to abject poverty, neglect and other problems, community resistance is very high in UC-4, making it very hard to eradicate the virus from the environment. Uncooperative parents make it difficult to vaccinate every child, he added.

“With unhygienic environmental conditions and the absence of potable water, children there have poor nutritional status. When they get less or no vaccine, their weak immunity cannot protect them from the virus. Due to a want of health facilities, routine immunisation is negligible.”

Local experts and paediatricians said UC-4 has become a challenge for the country’s polio eradication initiative, because the virus is being transmitted from here to other parts of Karachi through the sewerage system.

People of this locality regularly travel to and from Quetta, other Pashtun areas of Balochistan, the interior parts of Sindh, southern Punjab, various areas of the tribal belt and many cities of Afghanistan, they added.

An official associated with polio eradication in Karachi said the movement of people with unvaccinated children to other parts of the country and Afghanistan is the real issue. “They are not keen on cooperating with the authorities, and so this has become a serious cause of concern for health officials in Islamabad, Geneva, New York and Washington.”

But Dr Safdar is hopeful about eradicating the polio virus from its epicentre in Karachi, saying that they have decided to go door to door and talk to people refusing vaccination. “We are working on setting up more health facilities there, improving their living conditions and increasing their awareness about these issues. We can do that and wipe out polio from our land once and for all.”