2013 rotary media coverage report

If there is one spot on earth where polio may make its last stand, it is a cramped slum called Shaheen Muslim Town No. 1 in Peshawar, a hotbed of anti-Western militancy. Since sampling began, its sewers have never tested negative for the virus.

It is a neighborhood of migrant Pashtun families who rent rooms briefly and move on, looking for menial jobs picking fruit or making bricks. On a recent sunny afternoon, its alleys were full of carts drawn by donkeys whose faces were decorated with the red prints of hands dipped in henna. Many women wore the full burqa popular in Afghanistan.

In this part of the world, virtually all those with polio are from the Pashtun tribe, in which resistance to vaccination is highest. It is Afghanistan’s largest ethnic group and the wellspring of the Taliban, but a minority in Pakistan. Pakistani Army sweeps and American drone strikes have driven many Pashtuns from their mountain valleys into crowded cities.

Peshawar worries even Dr. Elias Durry, a normally optimistic polio specialist with the W.H.O. “You can get 90 percent vaccine coverage, and come back a few months later, and it’s 50 percent,” he said. “People just move so quickly.”

Shaheen’s sewers are concrete trenches about a foot deep, into which wastewater, rendered milky white by dish soap, flows from pipes exiting mud-brick houses. A child reaching into one for a stick to play with showed how easily the virus, carried in fecal matter, could spread.

Though the area has clean water from a well, the steel pipe it flows through at times dips inside the sewerage trench. It has dents where trucks have banged it, and it is pierced by connectors, some attached just to rubber hoses.

“Piped water with sewage mixed in is worse than no piped water,” said Dr. Bhutta of Aga Khan. “Sometimes rural populations have it better. They carry water from the river, and they defecate in open fields, so there’s no mixing.”

Pakistani children suffer diarrhea so often that half the country’s young are stunted by it. Polio immunity is low, even in vaccinated children, because other viruses crowd the gut receptors to which the vaccine should attach.

At the clinic in Shaheen, the doctor running the polio drive, an ophthalmologist, complained that he got too little police help.

“I have 28 teams, so I requested 56 constables,” he said. “I was given 12.”

He said the underpaid officers inevitably knocked off at midday because their station house serves a hot meal.

The same problem was echoed in Gadap Town, a Karachi neighborhood where vaccinators were killed in December. As a team worked its way from house to house with a reporter, it had every reason to feel secure: because the visit was arranged by an official, six officers with AK-47s came along.

But another team passing by was guarded only by an aged sergeant with a cudgel.

“Yes, we have a security problem,” Dr. Syed Ali, a local official, said quietly on a side street. “What is a stick in front of a gun?”

The isolation and poverty of the Pashtun tribe underlie its resistance. Many of its imams are from Islam’s fundamentalist Deobandi sect, which emerged in the 19th century as a reaction to the British conquest.

Many Pashtun neighborhoods receive few government services like health clinics, paved streets or garbage pickup, but get shiny new billboards trumpeting the polio fight paid for by Western donors.

“People tell us, ‘We need schools, we need roads, we need housing, and all you bring our children is polio, polio, polio,’ ” said Madiha, a black-veiled Gadap vaccinator.

In the middle of last year, it became known that in 2011, the C.I.A. had paid a local doctor to try to get DNA samples from children inside an Abbottabad compound to prove they were related to Bin Laden.

Even though the doctor, Shakil Afridi, who is now serving a 33-year sentence for treason, was offering a hepatitis vaccine, anger turned against polio drops.

Leaders of the polio eradication effort could not have been more frustrated. They were already fighting new rumors that vaccinators were helping set drone targets because they have practices like marking homes with chalk so that follow-up teams can find them. Now, after years of reassuring nervous families that the teams were not part of a C.I.A. plot, here was proof that one was.

“It was a huge, stupid mistake,” Dr. Bhutta said.

Anger deepened when American lawmakers called Dr. Afridi a hero and threatened to cut off aid if he was not released. The W.H.O. and the Unicef, afraid of offending the United States, did not protest publicly. Unicef’s executive director, Anthony Lake, is a former White House national security adviser, which put the agency in an awkward position, an agency official said on the condition of anonymity because of the sensitivity of the issue.

But the deans of a dozen top American public health universities wrote a letter of protest to the Obama administration. Mr. Gates said he endorsed it, though he was not asked to sign. He also said he discussed the issue with Tom Donilon, the former national security adviser, though he would not give details of the conversation.

New opposition has forced the adoption of new ground tactics.

Dr. Qazi Jan Muhammad, the former deputy commissioner of Karachi East, called his approach “a mix of carrots and sticks.”

Whole apartment buildings were missed, he discovered, because Pashtun watchmen were shooing away vaccinators.

“I had the police tell them: ‘Either you let them in, or you go behind bars,’ ” he said.

He had traffic circles blocked so teams could approach each car, and he led some teams himself holding fistfuls of rupees, worth about a penny each.

“I saw a girl, about 11, carrying her 2-year-old sister,” he said. “I gave her a 10-rupee note and said, ‘Will you allow me to give drops to your sister? You can get sweets for yourself.’ ”

“She told all the children, ‘A man is giving away 10 rupees,’ and they all came rushing. I vaccinated 400 kids for only 4,000 rupees.”

The sewers of his district, which has several million inhabitants, are now virus-free.

At the Front Lines Again

The country’s new determination has also brought Rotary International back to the front lines.

The club, founded in Chicago in 1905, started the global polio eradication drive in 1988. It has had chapters in what is now Pakistan since 1927, and is now led by Aziz Memon, a hard-driving textile magnate.

Mr. Memon, 70, and other Rotary-affiliated executives have used their money and political connections to keep the pressure on. They compensated the killed vaccinators’ relatives and held news conferences at which the families urged others to continue fighting.

Rotarians also work in places that terrify government officials. In an industrial neighborhood in Karachi, where both gangs and the Taliban hold sway after dark, Abdul Waheed Khan oversaw a Rotary polio clinic in his school, Naunehal Academy. A big, gregarious man, he angered the Taliban by admitting girls to his academy and offering a liberal arts education instead of only Koran study. His only security was local teenagers who ride motorcycles beside his car to keep anyone from pulling up alongside.

In March, he hosted Dr. Robert S. Scott, the 79-year-old Canadian chairman of Rotary’s polio committee, who flew in to vaccinate children to prove that the fight would go on despite the December killings.

“I had a fatwa put on my head,” Mr. Khan said in April as he led a tour of the clinic. “They said I was Jewish. I had a friend issue a counter-fatwa saying I was a good Muslim.”

On May 13, Mr. Khan was killed by gunmen who also wounded his 1-year-old daughter.

His clinic will not close. “No one can replace Waheed, but life has to go on,” Mr. Memon said.

‘This Is Good Work’

Rotary also sponsors a tactic used to reach children from areas too dangerous for home visits: “transit point” vaccinating.

At a tollbooth on the highway into Karachi, Ghulam Jilani’s team takes advantage of an army checkpoint. As soldiers stop each bus to search for guns, Rotary vaccinators hop aboard. On a typical day, they reach 800 children.

Yes, Mr. Jilani said, the soldiers’ presence may intimidate some resistant families into complying. Also, he added brightly: “We scare them a little. We say, ‘You are entering a city with the disease. Don’t you want your children safe?’ ”

About 90 percent comply, he said, sometimes after a public argument between a father who believes the rumors and a mother, outside their home and at times backed by other women on the bus, insisting the children be protected.

Near the Afghan frontier, where thousands of children live in valleys under Taliban control, teams do the same at military roadblocks. At hospitals, which are usually guarded by soldiers, nurses will pack extra doses of the vaccine on ice for families willing to smuggle it to neighbors.

Some frontier clan chiefs have lost their government stipends for opposing vaccination, and officials have threatened to deny national identity cards to their clans. But the chiefs are in a bind; the Taliban have assassinated many for cooperating with the government.

Mr. Memon of Rotary opposes what he called “these coercive gimmicks.”

“We can’t twist arms,” he said. “We want to win them over with love and affection.”

Among hundreds of men wearing turbans and topees at Karachi’s main train station, Muhammad Arshad stood out in his blue baseball cap with Rotary’s bright yellow gearwheel.

Threading his way through the crowd squatting on Platform 1, he picked out children under age 5.

“What a nice boy,” he said to Sohail Ameer, chucking his infant, Abadur Rahann, under the chin. “May I give him drops against polio?”

Mr. Ameer agreed, and it was over in seconds. Abadur looked nervous, but he did not howl and squirm like some.

After the December killings, Mr. Arshad worried briefly, he said. “But then I thought: This is good work, and God will protect me.”

Friendly strangers came up to the Rotary table to suggest he play it safe and quit. He replied that the railroad police would protect him.

His wife tried the hardest.

“But I told her,” he said. “If a man has to die, he can die even at home. I’m going back to work.”

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‘Good Wife’ Star Joins the Fight Against Polio

Emmy award-winning actress Archie Panjabi is on a mission to help make sure all children get the polio vaccine. She's signed up with Rotary International to help spread the word and has even learned to administer oral vaccinations. This Associated Press video was picked up by several outlets, most notably USA TODAY, Yahoo!, and the Globe and Mail.

Rotary International and the Bill & Melinda Gates Foundation have renewed a fundraising partnership they hope will inject millions of new dollars into the final push to eradicate polio, a goal both say is closer than ever.

Only 69 cases of polio were reported globally so far this year as of June 19, and an independent board monitoring the global eradication effort recently said halting transmission of the disease by the end of 2014 is "a realistic prospect." The number of cases has declined substantially from 1,352 reported in 2010, and the virus is endemic in pockets of only three countries: Pakistan, Afghanistan and Nigeria.

But the war on the final vestiges of polio is tough. Polio vaccinators have been shot and killed in recent months in Nigeria and Pakistan. An eradication goal was missed last year. And the virus appears to be resurging in the Horn of Africa, with more than one-third of the cases so far this year in Somalia and Kenya—two countries that had been largely polio-free.

Under the agreement, the Gates Foundation said it will match two to one every new dollar that Rotary commits to polio eradication up to $35 million a year over five years. That could total $525 million, including $175 million from the Rotary Foundation and $350 million from the Gates Foundation for polio immunization programs, the organizations said.

The fundraising is part of a six-year drive to raise $5.5 billion for a "polio eradication and endgame strategic plan" led by Rotary International, the Centers for Disease Control and Prevention, Unicef and the World Health Organization to wipe out the virus by 2018. Governments, nongovernmental organizations and individual philanthropists such as New York City Mayor Michael Bloomberg have pledged $4 billion of that amount. The Gates Foundation has committed $1.8 billion of that amount, which it says will include its matching funds for Rotary.

Nigeria is ground zero for the reemergence of polio. The country was making surprising headway in 2010 against the crippling disease, in part thanks to an unlikely meeting of two leaders: Microsoft mogul Bill Gates and the Sultan of Sokoto, the spiritual leader of Nigeria's 70 million Muslims. WSJ's Rob Guth reports.

Rotary launched its first fundraising campaign for polio in 1985, prodding a World Health Organization resolution to eradicate the disease. It has contributed $1.2 billion since then toward eradication, raised through donations from Rotarians as well as their communities, and thousands of Rotary volunteers have helped immunize children in multiple countries.

Over the past year, volunteers have vaccinated people in mobile clinics and at toll plazas in Pakistan, met with religious leaders, and implemented lessons learned from India, which successfully stopped transmission of polio with programs like health camps that offer nutrition training and other health services along with polio vaccine.

"Rotarians are spending not only money out of their pockets and raising money in the community, but they've also spent a considerable amount of their own money and time to go to these countries and help with the vaccination efforts," said John Germ, vice chairman of fund development for the Rotary International PolioPlus Committee.

The amount Rotary is seeking to raise is less than approximately $228 million it raised during a recent five-year campaign, in which the Gates Foundation also matched funds. Part of the reason is concern about "donor fatigue," Mr. Germ said. But mainly, he said, Rotary's goal now is to persuade major donors such as governments and corporations to give more for the final eradication push. "We need to reach out and get money from those who have not given," he said.

And, he said, Rotary is likely to raise more than the $35 million a year. "Rotary's got a history of exceeding its goals," he said.

"We both want to maintain the momentum," said Gates Foundation CEO Jeff Raikes, adding that the new endgame strategy has plans and resources for quelling outbreaks like the one in the Horn of Africa. "We're very excited about what can be done here."

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Sir Emeka Offor, a wealthy Nigerian oil baron, has donated $1 million to PolioPlus, an international polio eradication programme promoted by Rotary International, Nigeria’s Vanguard newspaper has reported.

Offor, who is the founder and Executive Vice Chairman of Chrome Group, a Nigerian conglomerate with interests in oil trading, biofuels, dredging and logistics, made the donation on Sunday during the ongoing 2013 Rotary International Convention taking place in Lisbon, Portugal.

“Polio should have no place in our world. Therefore, today I am giving an additional $1 million to PolioPlus,” he said, during the convention in a video available here.

This is not the first time the Nigerian tycoon is donating to Rotary’s PolioPlus initiative, which provides funding for the Global Polio Eradication Initiative (GPEI). Last year, he gave $250,000 to the program.

Nigeria, Pakistan and Afghanistan are the few remaining areas in the world that are still affected by Polio.

“Considerable effort is being made to eradicate polio in Nigeria, but at times progress is slow. In 2011, we had 62 documented cases of polio. In 2012, that number increased to 122. This year 26 cases have been documented so far,” Offor explained while announcing the donation.

According to Offor, ignorance, difficulty in accessing affected rural areas and various myths surrounding polio vaccines, particularly in Africa were major obstacles hampering the success of immunization campaigns and efforts by international aid agencies.

“Many parents simply refuse immunizations for their children because they fear that some evil motives are at play or even fear perceived bad side effects,” he complained. “An additional problem is reaching the nomadic and remote populations that are often strongholds for the disease. Even in the best of times, Government capacity to reach these “hidden populations” is severely limited.”

According to report, since the inception of PolioPlus, members of Rotary International have contributed more than $160 million to polio eradication in Nigeria.

Sir Emeka Offor is one of Nigeria’s emerging philanthropists and one of the West African country’s successful men. His Chrome Group which is a Nigerian leader in oil trading, biofuels, dredging and logistics has an annual turnover of over $1 billion according to sources at the company. His Sir Emeka Offor Foundation which he solely funds supports causes in education and health. In May, he donated $600,000 to Books For Africa, a non-profit organization in St. Paul, Minnesota, USA which provides educational books to children in Africa. The foundation also gives aways millions annually in scholarships to underprivileged Nigerian students.

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Following a walk through nearly empty hallways, there is no receptionist at Thomas Frieden’s outer office. Just a ring-for-service sign. The director of the Centers for Disease Control and Prevention (CDC) is trying to manage a partial shutdown at an institution where nearly everything is ultimately a matter of life or death. “The longer it goes,” he said, “the more complex it is. What isn’t an imminent threat to health on Day Four is on Day 10.”

A ‘shutdown’ that changed Russia forever: Twenty years before today’s American crisis, a president and a congress battled to the end. Russian Federation President Boris N. Yeltsin had a few challenges familiar to President Obama today, writes Emory political scientist Thomas F. Remington, but the results of that confrontation still reverberate in Moscow. Here’s Remington on what happened.

As of now, eight of 10 global disease detection centers — the field offices where outbreaks are identified and countered — are closed. No processing of blood samples for parasitic diseases is taking place. No testing of counterfeit malaria medicines.

Fortunately, the CDC’s polio eradication effort has been largely exempted from the shutdown. It is part of one of the most ambitious medical enterprises in history — attempting to eliminate a highly contagious virus from the wild. This has been achieved only twice before, with smallpox and rinderpest. The end of polio transmission is a few hundred yearly cases away. Even a brief pause would risk losing ground.

Poliovirus — which destroys neuron cells controlling swallowing, breathing and the use of limbs — was once a source of seasonal panic in the United States. Epidemics (usually arriving in summer) sometimes caused states to close their borders, with inspectors demanding certificates of health for children younger than 16. American infections peaked at nearly 58,000 in 1952. (Sen. Mitch McConnell and Rep. Steve Cohen were both infected as children.) As late as 2004, dozens of Americans still lived in iron lungs.

But the use of the Salk and Sabin vaccines has chased the virus across the planet. The last American infections were in 1979 (among Amish who resisted vaccination). This was also the year that Rotary International started a campaign to eliminate polio transmission in the Philippines, beginning a global eradication movement that now includes the World Health Organization, UNICEF, the Gates Foundation and the CDC. In 1999, type 2 poliovirus (of three types) was eliminated in the wild. India has been polio-free since 2011 — an important proof of concept. (If polio can be eliminated in northern India — with its dense population and poor sanitary conditions — it can be defeated anywhere.)

More than 99 percent of poliovirus transmission has been stopped over the past few decades. But the final bit is the hardest.

In 2011, an independent review panel questioned whether the opportunity for polio eradication was being squandered. It lit a fire under the movement. Partners increased their commitments. Frieden moved his effort into the CDC’s Emergency Operations Center — a high-tech amphitheater in which the disease is minutely tracked in maps and charts.

There are two regions where wild polio transmission has never been eradicated: in the tribal areas along the Afghanistan-Pakistan border and in northern Nigeria. In Afghanistan, efforts by the ministry of health have been innovative and successful. There have been only six cases so far this year, all of which (when the CDC examined the genetic fingerprints of the viruses) originated in Pakistan. In Pakistan, infections are largely confined to North Waziristan, where the local Taliban commander has banned vaccination. In Nigeria, the government has recently improved the management of its program and infections are down. But the terrorist group Boko Haram — which rejects everything Western, including vaccines and education — is suspected of being responsible for the murders of nine polio workers this year. Polio is a killer that finds allies among killers.

Now a virus originating in Nigeria has caused an outbreak in Somalia, which has spread some cases to Kenya and Ethiopia. Health authorities in Mogadishu responded with surprising celerity, beginning immunizations four days after the first reported illness. But the problem persists in less-populated areas controlled by the jihadist group al-Shabab. Somalia, which has ended polio transmission twice before, must do it a third time.

Polio eradication is an enterprise now conducted at the frontiers of medicine and war — introducing vaccination into places that have never seen Western medicine and sometimes requiring negotiations with warlords and militias. In some places, the challenge is management; in others, security. The complexity can be frustrating. “It is like finishing a marathon,” one CDC expert told me, “and being told you have an extra mile to run.”

But these are struggles near the finish line of a landmark scientific achievement. And for those who doubt that any purpose of government can be essential, the daring, humane work of the CDC is a corrective.

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