“Nigeria has been declared Ebola free by WHO” was the headline flashed by most global media channels on October 20. This came as a pleasant surprise to many. Just about a year ago, Nigeria was reported to be a success story as there had been a 50 per cent drop in the number of polio cases reported there. Having worked in Nigeria and being familiar with the economic, security and health systems in the country, I have read these stories with interest and admiration. Nigeria has been running one of the world’s most innovative polio eradication campaigns, using the very latest satellite-based, cutting-edge GPS technologies to ensure that no child misses out on polio vaccines. With only one reported case of polio in 2014, the country is well on track to eliminate the disease by the end of the year. When the first Ebola case was confirmed in the country in July, health officials immediately repurposed polio technologies and infrastructures to conduct Ebola case-finding and contact-tracing. They have also brought down the case fatality of Ebola to 40 per cent from the global rate of 70 per cent.
On the other hand, the dismal state of the polio eradication programme in Pakistan is well known. A lot has been written about the plethora of problems that this programme is facing so I will not get into the details here. What I would like to point out is that unlike Nigeria, Pakistan will not be able to learn from the experiences of its polio eradication programme to prepare for countering Ebola, as the programme has ostensibly failed so far.
The health ministry has only now started to think about the risk of Ebola in Pakistan and is trying to prepare an emergency plan for it. The highlight of this plan appears to be the setting up of Ebola counters on airports, establishing temporary clinics and special wards. I would like to point out that the manner in which health counters were set up in the past (e.g. for H5N1, yellow fever, etc.) is a model that should not be followed. Having these counters towards one side of the arrival lounge does not ensure that every arriving passenger will be screened and there is a risk of skipping an Ebola carrier. For example, a person who has travelled from Sierra Leone, takes a three-day break in Dubai and arrives in Karachi. He will write in his embarkation card that he travelled from Dubai. So, it is likely that this person will be skipped by the routine checking system and can become a potential risk.
To ensure that every person coming into the country is screened, health officials should be placed on the immigration counter, sitting parallel to the immigration officer. While passports are being stamped by the immigration officer, the health official can obtain the traveller’s travel and health history. There are questions that must be asked directly, as well as be included on the health card to assess any risk: i) have you been near anyone with a confirmed Ebola virus disease; ii) have you cared for anyone with a severe illness recently, or for someone who has died of an unknown cause; iii) have you been vomiting or do you feel generally unwell; and iv) have you had any contact with dead bodies or have been to any funerals recently?
It is essential that the health ministry and the immigration department work together closely on this issue. Otherwise, the risk of an Ebola epidemic hitting Pakistan cannot be ruled out.
Published in The Express Tribune, October 22nd, 2014.