Conflict and Disease an Analysis of Endem Ic Polio in Northern Pakistan

CONFLICT AND DISEASE AN ANALYSIS OF ENDEM IC POLIO IN NORTHERN PAKISTAN Master of Arts in Law and Diplomacy Capstone Project Submitted by Randall Quinn December 15, 2015 © 2015 Quinn http://fletcher.tufts.edu Quinn The Fletcher School of Law and Diplomacy Conflict and Disease An Analysis of Endemic Polio in Northern Pakistan Randall M Quinn Graduate Thesis 12-15-2015 1 Conflict and Disease Quinn Abstract Polio is a disease that held a profound impact on much of the world’s population for the first half of the 20th Century. Today it is barely an afterthought throughout the developed world, as vaccines invented in the 1950’s greatly reduced the disease burden, gradually at first and then precipitously with the onset of the Global Polio Eradication Initiative in 1988. Despite great progress, there is one remaining reservoir of wild poliovirus that remains in the world today and prevents any declaration of victory against the disease. The reservoir is centered in northern Pakistan and frequently infects populations on both sides of the Afghanistan-Pakistan border. A number of factors have contributed to this being the last global holdout. This paper aims to explore those factors and project potential policy solutions. Given the highly infectious nature of the disease and the frequent movement of people in and through this region, all of the elements are there for a global resurgence, highlighting the importance of resolving the issue as quickly and efficiently as possible. 2 Conflict and Disease Quinn Table of Contents Acronyms ..................................................................................................................................................... 4 Introduction ................................................................................................................................................. 5 Figure 1 – Polio Summary .................................................................................................................... 5 Figure 2 – Polio Crisis Dimensions ...................................................................................................... 7 Figure 3 – Global Wild Poliovirus Cases, 2000-2015 .......................................................................... 8 Part I: Poliovirus ....................................................................................................................................... 10 Symptoms and Modern History .............................................................................................................. 10 Global Polio Eradication Initiative ......................................................................................................... 14 Figure 4 – GPEI Progress ................................................................................................................... 14 Current Infections ................................................................................................................................... 15 Polio in Pakistan Today .......................................................................................................................... 16 Figure 5 – Polio in Pakistan Today ..................................................................................................... 16 Part II: Ethno, Religious and Social Tension ......................................................................................... 21 Introduction ............................................................................................................................................. 21 Figure 6 – Ethnic Makeup of Afghanistan and Pakistan .................................................................... 21 Mujahedeen and the Afghan Taliban ...................................................................................................... 23 Tehrik-i-Taliban ...................................................................................................................................... 26 Policy Divisions ...................................................................................................................................... 30 Part III: Political Discord ......................................................................................................................... 34 Figure 7 – Mughal Empire .................................................................................................................. 34 History of Pakistan .................................................................................................................................. 34 Figure 8 – Pakistani Heads of State .................................................................................................... 40 Political Ostracism .................................................................................................................................. 41 Musharraf, 9/11, Devolution and the Bargaining Chip of UBL .............................................................. 45 Sharif and Impasse .................................................................................................................................. 50 Part IV: Conflict Dimensions and Threat Management ....................................................................... 56 Introduction ............................................................................................................................................. 56 The Specter of bin Laden ........................................................................................................................ 57 Understanding Force Options ................................................................................................................. 59 Figure 9 – Pakistani Military Escalatory Options ............................................................................... 62 Figure 10 – TTP Escalatory Options .................................................................................................. 64 Multi-Threat Management ...................................................................................................................... 66 Part V: Designing Policy Solutions .......................................................................................................... 72 3 Conflict and Disease Quinn Lynchpins and Equilibrium ..................................................................................................................... 72 Best Practice, Best Failure ...................................................................................................................... 73 Stakeholder Analysis............................................................................................................................... 76 Figure 11 – Stakeholder Background ................................................................................................. 76 Figure 12 – Stakeholder Analysis ....................................................................................................... 78 Figure 13 – Support/Opposition Spectrum ......................................................................................... 79 Potential Policy Options .......................................................................................................................... 80 Characteristics of Low Resource Environments ..................................................................................... 80 Broad Stakeholder Inclusion ................................................................................................................... 81 Evidence .................................................................................................................................................. 81 Figure 14 – Map Wild Poliovirus Cases, 2014 ................................................................................... 85 Constructing Alternatives ....................................................................................................................... 86 Selecting the Criteria ............................................................................................................................... 88 Projecting the Outcomes ......................................................................................................................... 89 Confronting Tradeoffs ............................................................................................................................. 96 Sensitivity, Decisions and Telling the Story ........................................................................................... 97 Conclusions ............................................................................................................................................. 99 Figure 15 – Outcome Projections ..................................................................................................... 101 Part VI: Beyond Polio ............................................................................................................................. 102 Lessons Learned .................................................................................................................................... 102 What is Security? .................................................................................................................................. 103 Bibliography ............................................................................................................................................ 105

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