The fight against polio in Pakistan also means fighting criticism from activists, writes Tahmina Rashid.
The incidence of polio cases has tripled in Pakistan in 2014, despite national and global programs to eradicate polio, while the inner turmoil adds new obstacles to Pakistan's efforts to eradicate the disease.
This raises serious concerns for the health of children, and signs of a failure to reach the global polio eradication approved by the World Health Assembly (WHA) in 1988.
Health professionals are unanimous in saying that even an infected child is a serious risk of children contracting polio. Health economists estimate that the eradication of polio would save at least US $ 40-50 billion over the next 20 years, especially in low-income countries. It would also mean that children never suffer the terrible effects of the paralysis of polio for life.
Of particular concern is that the virus is emerging in countries previously free of the disease, such as Syria, Somalia and Iraq, and in light of the civil war and instability in these regions, any effort to arrest would be a challenge.
If polio is not stopped in these areas can potentially cause about 200,000 new cases each year in 10 years. In May 2014, the World Health Organization (WHO) has imposed travel restrictions on Pakistan over its failure to control the spread of the virus and many countries have ordered the vaccination against poliomyelitis for travelers from Pakistan.
WHO defines Polio is a highly infectious disease caused by a virus that invades the nervous system and cause total paralysis in hours.
There is no cure for polio, the prevention by a vaccine, if given to children under five, protects for life. As the virus could pass through human contact through the fecal-oral contaminated water or through food, and remains a serious threat to global health.
Pakistan lack adequate wastewater drainage system pollution incidents are common in urban areas, while rural communities have almost no system in place.
Monitoring programs for the eradication of polio in 1997 and the monitoring system set up working in provincial and national, district and remains a cornerstone of strategies to identify and eradicate polio exists.
In recent years it has been used to confirm the diagnosis of polio isolation and identification of faeces of poliovirus. WHO has helped to establish laboratories to provide this service, and these laboratories play a key role in polio cases certification and verification of the absence of wild poliovirus circulation.
Since 2009, Pakistan has conducted environmental monitoring to detect poliovirus in sewage in strategic locations in the main cities of the four main provinces. The plan of the National Plan of Action Emergency (PNA) in 2014 to eradicate polio was a response to the alarming increase in cases of polio.
Vaccination against polio is a high-risk work and there have been several attacks on health workers militias aligned with the Taliban. In the last two years, over 56 people of the polio workers killed in various provinces.
Religious radicals have always opposed immunization programs in Pakistan, even declaring polio vaccine not only a "Western conspiracy" and a "Judeo-Christian plot" to make children sterile, but also against the principles of Islam.
These religious dignitaries and supporters continue to campaign against vaccination, and tensions were further fueled when it emerged that the CIA (Central Intelligence Agency) used a vaccination campaign against polio conducted by Dr. Shakil Afridi for collect information which he led to the 2011 military operation that killed the leader of Al Qaeda, Osama bin Laden.
polio statistics highlights the problems associated with access to the vaccine; the lack of security for health team workers; access to the remote area; and the lack of accurate data on displaced persons, particularly in the area administered by the federal government (in North and South Waziristan).
Polio cases in the last six years show a strong connection between the security situation, militancy, the military operation against the Taliban and internal displacement in 2010 and 2014, so it is not surprising that polio cases have arisen in urban centers such as Karachi, but also in remote areas of Punjab during this period.
Internal migration is another critical factor, as people move to other areas with children who are not immunized because of activists waiting in the tribal areas.
To eradicate polio, Pakistan needs financial support through the WHO and UNICEF to continue the implementation of the vaccination program in the coming years.
Internally, Pakistan needs to have an efficient and hygienic living vaccine campaign, involving religious leaders and dignitaries, to fight effectively against the orthodox Islamic propaganda.
Iran is successfully religious clerics involved in population planning programs, providing a model for the effective use of mosques for the formulation of public policies.
In Pakistan, local authorities could be used effectively in these programs remained almost disappeared since 2008 (with the exception of Baluchistan, where elections were held in late 2013).
Local authorities should be administrative and financial authority to provide these basic services. The government should make a serious effort to provide safe drinking water and adequate sewage to contain the polio virus.
More importantly, you have to make a sustained effort to curb militancy and maintain law and order in all jurisdictions, including the tribal areas.
This is the key to keeping safe the world's children from polio.
Vaccination campaigns against polio face a challe