*‘아시아엔’ 해외 필진 기고문 한글요약본과 원문을 게재합니다.
파키스탄에서 소아마비가 급증하고 있다. ‘글로벌 소아마비 퇴치 계획’에 따르면 작년의 28건에 비해 올해 166건의 소아마비 사례가 발견되며 급증했다. 가장 피해가 큰 지역은 무장단체들이 예방접종을 가로 막는 연방정부 관할의 부족민 거주 지역과 카이버 팍툰카와 주다.
파키스탄은 전세계적으로 소아마비 퇴치가 가장 어려운 지역으로 꼽힌다. 소아마비 바이러스가 창궐하는 지역에는 복잡한 부족 문화, 접근의 어려움, 폭력사태, 잘못된 정보 등 병세를 확산시키는 악재들로 가득하다.
이에 더해 인구가 이동하면서 바이러스가 빠르게 퍼져나가는 것으로 파악된다. 40만명의 어린이들이 분쟁 지역으로부터 옮겨오면서 예방접종을 받았으나 아직 역부족이다. 지속적으로 발생하는 홍수도 질병의 위험을 증가시킨다.
보건 관계자들에 의하면 예방접종을 거부하는 이들의 수는 6월 초 4,200명에서 6월 말 12,000명으로 대폭 증가했다. 하지만 유니세프는 예방접종 거부자의 수가 급격히 감소했고, 질병에 대한 대중의 경각심을 일깨우는데 성공했다고 발표했다.
6월 초 파키스탄 정부는 모든 출국자들이 소아마비 예방접종 확인서를 제출해야 한다는 세계보건기구의 권고를 받아들였다. 중국, 시리아, 이집트, 이스라엘 및 팔레스타인 등지에서 파키스탄에서?발생한 것으로 추정되는 바이러스가 발견됨에 따라 파키스탄은 ‘소아마비 바이러스 수출국’이란 불 명예를 얻게 됐다.
당국이 공항에서 예방접종 여부를 확인하더라도 전적으로 신뢰할 수 있는 것도 아니다. 실제로 많은 여행객들은 예방접종 없이 출국하며 사태를 악화시키고 있다.
Polio cases surge in Pakistan
Pakistan is heading for one of its worst years for polio in recent times. According to figures from the Global Polio Eradication Initiative (GPEI), 166 cases of polio have been verified this year, compared to 28 at the same time last year, says a report released by United Nations Integrated Regional Information Network (IRIN).
This puts the country at significant risk of crossing the 199-mark officially recorded in 2000, or the 198 seen in 2011. It is a major setback for a country that as recently as 2005 saw just 28 cases, with everything seemingly on track for polio eradication. Last year there were 93 cases in the country, according to the GPEI.
The worst affected areas, according to State Minister for the National Health Service (NHS), Saira Afzal Tarar, are the Federally Administered Tribal Areas (FATA) and Khyber Pakhtunkhwa Province (KP), where militants often prevent vaccination.
“Pakistan presents one of the most complex polio eradication environments in the world,” Ban Khalid Al-Dhayi, spokesperson for UN Children’s Fund (UNICEF), was quoted as saying by IRIN. “In the areas that remain with poliovirus, there is inaccessibility, violence, misconcept ions and misinformation that circulates every day, along with intricate tribal and cultural norms and systems.”
“Massive dai ly populat ion movements” were also described as a major problem by UNICEF.
Al -Dhayi sa id the r e c ent movement of more than one million internally displaced persons (IDPs) following the military operation in North Waziristan Agency had raised fears of the virus spreading to areas which had not previously seen infections. More than 400,000 children were vaccinated at transit points as they moved out of the conflict zone in FATA and settled in host communities in KP, Punjab and Sindh.
IDPs who settled in parts of Punjab due to ongoing floods could also increase risks. While KP health officials based at the Provincial Polio Control Room (PPCR) in Peshawar agree the IDP influx poses a polio risk, they disagree, according to media reports, that refusals (those refusing to be vaccinated) are declining, and blame UN communications authorities for this.
According to PPCR data, the number of refusals increased from 4,200 during the polio vaccination drive carried out between 6-8 June, to 12,043 during the vaccination campaign run from 23-25 June. UNICEF, however, says they have separately seen a sharp fall in the rate of refusals, and claim successes for social mobilization and awareness raising.
IDPs themselves appear keen to receive the drops: “I was desperate for my three young children to get them, and queued up with many others when vaccinators got here,” said Aziz Dawar, who fled North Waziristan in mid-June. He told IRIN his three children aged 8-2 had not yet received any vaccinations.
Weak prevention systems
On 1 June Pakistan enforced a WHO recommendation – seen as draconian by some – that anyone travelling overseas from Pakistan had to produce certification that they had received polio drops, to prevent the export of the virus.
Prior to this move, the emergency coordinator for polio eradication in Pakistan, Elias Durry, explained to IRIN that Pakistan had “informally been labeled” as an “exporter of polio” when strains of the virus originating from the country were found in China, Syria, Egypt, Israel and Palestine.
“There needs to be no more import/ export of polio virus for at least six months,” Durry said.
While officially polio teams are set up at airports to administer vaccination drops, in reality implementation has been reportedly patchy, with travelers saying they had been able to travel without receiving the drops.
“It’s all just on paper. No one really bothers with drops or certificates in reality,” an official who asked not to be named told IRIN from Lahore Airport.
Shortages of vaccines have also held back anti-polio campaigns. Responding to this, NHS minister Saira Afzal Tarar told: “A loan from the Islamic Development Bank that I had been campaigning for has now been obtained, so we should be able to deliver drops more efficiently.” The minister said the precise loan details, including the amount, were still being finalized.
“Our approach is not right,” Anita Zaidi, head of pediatrics at Karachi’s Aga Khan Hospital, told IRIN. She said the lone focus on polio had had a negative effect, and that the vaccine should be given alongside others.
At ground level, the message is still struggling to be heard. “Why don’t we do something to stop our children from being crippled by this terrible disease?” asked Azra Bibi in Bannu, whose cousin’s infant son caught polio five years ago and can now barely walk.
“We keep hearing of more and more cases.” She said she herself had to battle her parents-in-law to get her two daughters vaccinated. “They said the drops would make them sterile, but I spoke to doctors and also school teachers who are educated, and I know this is a lie,”
said Azra, who now regularly visits an IDP camp to encourage mothers to vaccinate against polio. “I want to keep our children safe,”she said.