.

The Karakoram Highway cuts a rugged path through the high black mountains that separate China from Pakistan, where mirror-like lakes reflect the snowy peaks and azure sky. The highway runs 800 miles, connecting the Gilgit-Baltistan region of Pakistani Kashmir with Kashgar, a city in the Xinjiang Uyghur Autonomous Region of China. It is the only land link between the two countries, and it follows an ancient caravan trail that was once part of the Silk Road.

Today, the highway belongs to the China-Pakistan economic corridor. It is at the center of a multi-billion dollar project to join China with Pakistan’s other roadways leading to the Gwadar port, west of Karachi on the Arabian Sea, a future hub for the trans-shipment of critical oil and natural gas from the Persian Gulf.

The Karakoram corridor represents the future of Sino-Pak trade, but it could also put China at risk. Pakistan’s recent failure to stem the spread of polio has reminded Beijing of the corridor’s potential to become a gateway for the importation of the crippling disease into a country that now prides itself on being polio-free.

Global efforts to stamp out polio, a highly infectious and incurable viral infection, have been hampered for decades by the transmission of the poliovirus across international borders. The World Health Organization (WHO) estimates that 60 percent of polio cases around the world can be traced to travelers who have carried wild poliovirus from one country to another.

As recently as 1988, polio killed or paralyzed as many as 350,000 people worldwide every year. Spread through contact with saliva or feces, the poliovirus enters the body through the mouth, multiplies in the gastrointestinal tract and then moves into the bloodstream. It can invade the central nervous system, destroying the motor neuron cells and causing irreversible paralysis in one out of every 200 cases, usually in the legs. Among those paralyzed, five to 10 percent die when their respiratory muscles shut down.

Over the past three decades, global immunization campaigns have saved five million people from being crippled by polio, according the UN Foundation’s Polio Eradication Initiative, and today the world is closer than ever to being polio-free.

But the disease remains endemic in three countries: Nigeria, Afghanistan, and Pakistan. Pakistan reported 91 cases last year. During the first four months of 2014, it reported 59 of the world’s 79 cases—40 of those in the country’s northeastern region.

The region’s proximity to China is cause for worry. Even though Pakistan’s health ministry has ordered immunization counters set up at airports and border crossings, the remote Karakoram corridor remains vulnerable.

In 2011, China experienced its first polio outbreak in more than a decade—the result of wild poliovirus (type 1) being carried through the Karakoram corridor into southern Xinjiang. The virus paralyzed 21 people, including 10 young children, and caused two deaths.

When the virus was first detected in Xinjiang in 2011, China’s health ministry coordinated a massive response to prevent it from spreading. It dispatched more than 500 experts to the region to train and direct 1,000 health specialists, and enlisted 500,000 volunteers, health workers and government officials. The outbreak was curbed in only four months, and over a seven-month period, more than 43 million doses of oral poliovirus vaccine (OPV) were administered to children and adults under 40.

Pakistan’s inoculation campaigns have met with less success. In many areas, they have suffered from logistical challenges, as well as from attacks by Pakistani Taliban militants and other extreme Islamist groups who claim that Western countries use the vaccine to contaminate Muslims or make them infertile. More than 50 people, including health workers and their security escorts, have been killed in attacks in Pakistan since December 2012. When Pakistan began its latest inoculation drive in May, concentrating on the semi-autonomous tribal areas along the Afghan border, officials said that militancy and resistance to immunization would likely prevent the vaccine from reaching 369,039 children. Other challenges exist, as well. Some NGO workers allege that the government is deliberately dragging its heels so as to sustain the millions of dollars it receives each year from the World Bank and other international organizations. From 2012 to 2014, Pakistan drew $249.64 million in loans from the World Bank, Islamic Development Bank and other countries to help eradicate polio, with some of these funds said to be providing regular income to high officials, a claim Islamabad denies.

Historically, poliovirus has been endemic in China, but gradually it has been brought under control by the introduction of OPV. China developed an effective OPV in the 1950s, and by 1963, the vaccine was being administered in mass inoculation campaigns each winter. It was included in the WHO’s newly-mandated Expanded Program on Immunizations in 1978.

After a polio epidemic between 1989 and 1991, which paralyzed some 10,000 people, China finally saw its last indigenous case in 1994. The country was declared polio-free in 2000, 21 years after the United States.

Today, OPV is manufactured in China in sufficient quantities each year to cover all newly born children. In 2013, 145 million doses were released.

In accordance with the WHO’s global Polio Endgame Strategic Plan, China’s National Health and Family Planning Commission is now working to phase in the inactivated (killed) poliovirus vaccine (IPV). Unlike OPV, it does not pose a risk of paralysis, and it is expected to supplant OPV in the coming years.

While imported IPV became available in China in 2009, its supply is limited and costly. Last year, only 8.3 million doses of IPV were released in the country. That prompted private pharmaceutical companies to apply for licenses to manufacture and distribute the vaccine domestically.

Nevertheless, China’s anti-polio campaign still faces serious challenges, especially in Xinjiang, which is predominantly Muslim. Increasingly, the Taliban and other fundamentalist groups in Pakistan are leading Muslims to believe that polio vaccination is un-Islamic or haraam (forbidden). Some observers fear that such notions could easily take hold in Xinjiang, which for years has been undergoing an Islamic revival. And even if inoculation were to reach full coverage in the region, there is no guarantee that all children would acquire full immunity to the virus.

As China expands its trade and investment ties with Pakistan—already it has pledged $52 billion to infrastructure and energy projects over the next five years—it will have to revisit the pledges it made last year to provide Pakistan with polio eradication assistance.

Intercountry and interregional collaboration will play a crucial role in immunization and monitoring efforts. And health authorities will have to become move vigilant in tracking travelers passing through the Karakoram corridor as workers, technical consultants and business people move in ever greater numbers to and from regions most at risk of harboring the disease.

This article was originally published in the Diplomatic Courier's July/August 2014 print edition.

Photo: The Gates Foundation (cc).

About
Paul Nash
:
Toronto-based Correspondent Paul Nash is a frequent China commentator.
The views presented in this article are the author’s own and do not necessarily represent the views of any other organization.

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Polio’s Backdoor Into China

July 14, 2014

The Karakoram Highway cuts a rugged path through the high black mountains that separate China from Pakistan, where mirror-like lakes reflect the snowy peaks and azure sky. The highway runs 800 miles, connecting the Gilgit-Baltistan region of Pakistani Kashmir with Kashgar, a city in the Xinjiang Uyghur Autonomous Region of China. It is the only land link between the two countries, and it follows an ancient caravan trail that was once part of the Silk Road.

Today, the highway belongs to the China-Pakistan economic corridor. It is at the center of a multi-billion dollar project to join China with Pakistan’s other roadways leading to the Gwadar port, west of Karachi on the Arabian Sea, a future hub for the trans-shipment of critical oil and natural gas from the Persian Gulf.

The Karakoram corridor represents the future of Sino-Pak trade, but it could also put China at risk. Pakistan’s recent failure to stem the spread of polio has reminded Beijing of the corridor’s potential to become a gateway for the importation of the crippling disease into a country that now prides itself on being polio-free.

Global efforts to stamp out polio, a highly infectious and incurable viral infection, have been hampered for decades by the transmission of the poliovirus across international borders. The World Health Organization (WHO) estimates that 60 percent of polio cases around the world can be traced to travelers who have carried wild poliovirus from one country to another.

As recently as 1988, polio killed or paralyzed as many as 350,000 people worldwide every year. Spread through contact with saliva or feces, the poliovirus enters the body through the mouth, multiplies in the gastrointestinal tract and then moves into the bloodstream. It can invade the central nervous system, destroying the motor neuron cells and causing irreversible paralysis in one out of every 200 cases, usually in the legs. Among those paralyzed, five to 10 percent die when their respiratory muscles shut down.

Over the past three decades, global immunization campaigns have saved five million people from being crippled by polio, according the UN Foundation’s Polio Eradication Initiative, and today the world is closer than ever to being polio-free.

But the disease remains endemic in three countries: Nigeria, Afghanistan, and Pakistan. Pakistan reported 91 cases last year. During the first four months of 2014, it reported 59 of the world’s 79 cases—40 of those in the country’s northeastern region.

The region’s proximity to China is cause for worry. Even though Pakistan’s health ministry has ordered immunization counters set up at airports and border crossings, the remote Karakoram corridor remains vulnerable.

In 2011, China experienced its first polio outbreak in more than a decade—the result of wild poliovirus (type 1) being carried through the Karakoram corridor into southern Xinjiang. The virus paralyzed 21 people, including 10 young children, and caused two deaths.

When the virus was first detected in Xinjiang in 2011, China’s health ministry coordinated a massive response to prevent it from spreading. It dispatched more than 500 experts to the region to train and direct 1,000 health specialists, and enlisted 500,000 volunteers, health workers and government officials. The outbreak was curbed in only four months, and over a seven-month period, more than 43 million doses of oral poliovirus vaccine (OPV) were administered to children and adults under 40.

Pakistan’s inoculation campaigns have met with less success. In many areas, they have suffered from logistical challenges, as well as from attacks by Pakistani Taliban militants and other extreme Islamist groups who claim that Western countries use the vaccine to contaminate Muslims or make them infertile. More than 50 people, including health workers and their security escorts, have been killed in attacks in Pakistan since December 2012. When Pakistan began its latest inoculation drive in May, concentrating on the semi-autonomous tribal areas along the Afghan border, officials said that militancy and resistance to immunization would likely prevent the vaccine from reaching 369,039 children. Other challenges exist, as well. Some NGO workers allege that the government is deliberately dragging its heels so as to sustain the millions of dollars it receives each year from the World Bank and other international organizations. From 2012 to 2014, Pakistan drew $249.64 million in loans from the World Bank, Islamic Development Bank and other countries to help eradicate polio, with some of these funds said to be providing regular income to high officials, a claim Islamabad denies.

Historically, poliovirus has been endemic in China, but gradually it has been brought under control by the introduction of OPV. China developed an effective OPV in the 1950s, and by 1963, the vaccine was being administered in mass inoculation campaigns each winter. It was included in the WHO’s newly-mandated Expanded Program on Immunizations in 1978.

After a polio epidemic between 1989 and 1991, which paralyzed some 10,000 people, China finally saw its last indigenous case in 1994. The country was declared polio-free in 2000, 21 years after the United States.

Today, OPV is manufactured in China in sufficient quantities each year to cover all newly born children. In 2013, 145 million doses were released.

In accordance with the WHO’s global Polio Endgame Strategic Plan, China’s National Health and Family Planning Commission is now working to phase in the inactivated (killed) poliovirus vaccine (IPV). Unlike OPV, it does not pose a risk of paralysis, and it is expected to supplant OPV in the coming years.

While imported IPV became available in China in 2009, its supply is limited and costly. Last year, only 8.3 million doses of IPV were released in the country. That prompted private pharmaceutical companies to apply for licenses to manufacture and distribute the vaccine domestically.

Nevertheless, China’s anti-polio campaign still faces serious challenges, especially in Xinjiang, which is predominantly Muslim. Increasingly, the Taliban and other fundamentalist groups in Pakistan are leading Muslims to believe that polio vaccination is un-Islamic or haraam (forbidden). Some observers fear that such notions could easily take hold in Xinjiang, which for years has been undergoing an Islamic revival. And even if inoculation were to reach full coverage in the region, there is no guarantee that all children would acquire full immunity to the virus.

As China expands its trade and investment ties with Pakistan—already it has pledged $52 billion to infrastructure and energy projects over the next five years—it will have to revisit the pledges it made last year to provide Pakistan with polio eradication assistance.

Intercountry and interregional collaboration will play a crucial role in immunization and monitoring efforts. And health authorities will have to become move vigilant in tracking travelers passing through the Karakoram corridor as workers, technical consultants and business people move in ever greater numbers to and from regions most at risk of harboring the disease.

This article was originally published in the Diplomatic Courier's July/August 2014 print edition.

Photo: The Gates Foundation (cc).

About
Paul Nash
:
Toronto-based Correspondent Paul Nash is a frequent China commentator.
The views presented in this article are the author’s own and do not necessarily represent the views of any other organization.