KARACHI, Dec 26: Despite tall claims made and targets set by national and provincial immunisation functionaries as well as local and foreign health managers, the spread of polio in Sindh as in other provinces of the country could not be halted even this year.

Planners of anti-polio campaigns are now pinning all their hopes on the “National Emergency Action Plan 2011”, which is being finalised on a directive of President Asif Ali Zardari.

With 136 polio cases reported in 2010, Pakistan is one of the only three Asian countries, the other two being India and Afghanistan, where polio is endemic.

However, the convenience of postponement of deadlines in the “knock out polio game” has never come as a surprise during the 16 years of polio eradication activities in the country.

The irony of the entire child inoculation during the years is that nobody — right from foreign experts to volunteer vaccinators — is ready to learn from mistakes and reach at least their own-set goals.

Mass vaccination with a “trivalent” form of the vaccine aimed at all three viral subtypes helped reduce the number of countries with endemic polio from 125 in 1988 to four in 2010.

In April 2003, country representative of the World Health Organisation Dr Azmoudeh stated that Pakistan was likely to achieve the status of a polio-free country by the end of that year.

Similar hopes were pinned on immunisation campaigns in 2005. Since then, the provincial government, international health organisations and the NGOs working in the province for the eradication of polio have been claiming that the “coming year will be a polio-free year” in Sindh. According to experts, things were achievable as the province of Sindh in no way underwent a situation of having inaccessible localities such as the strife-hit areas of Khyber-Pakhtunkhwa and federally administered tribal areas (Fata).

However, the year of much-awaited achievement has never come. The gravity of the situation can be understood from the fact that polio cases has increased by 117 per cent this year as compared to last year.

Polio that afflicts children mainly under five is caused by a virus that invades the nervous system and can cause total paralysis or death. The anti-polio oral vaccine works by infecting children with a benign form of polio and giving them immunity to the virulent strain.

As per official figures, this year has witnessed a six-year high number of polio cases. Of the total 26 new cases, 12 cases were reported in Ghotki, three each in Karachi and Kambar, two each in Sanghar and Khairpur, and one each in Jacobabad, Hyderabad, Kashmore and Sukkur.

The year's first case of polio in Sindh was reported in January, following which no case was reported till the mid of August. However, with the beginning of the high-risk months (August to November), the number of polio cases started climbing almost every week. At present, the figure is just two short to equal 28 cases, which were reported in 2004.

High-risk districts In Sindh, the crippling virus infected a total of 209 children, including 56 cases detected during the last three years, since 2001. Of the 56 cases, 13 were reported in Karachi, followed by 12 in Ghotki, five in Jacobabad, four each in Sanghar, Kambar and Khairpur, three in Hyderabad, two each in Shikarpur, Naushehro Feroze and Tando Allahyar, and one each in Dadu, Mirpurkhas, Sukkur, Shaheed Benazirabad (Nawabshah) and Kashmore.

While most of these districts have now been declared high risk districts, which need better anti-polio campaigns in line with specific plans, other districts where no case was reported this year are also required to continue vaccination to eliminate the chances of reemergence of polio cases in future.

Of course the challenging task requires innovative solutions, renewed zeal and determination under a well-committed leadership and depoliticised administrative arms.

Field officers and health experts cite the devastating floods in the interior of Sindh and the subsequent displacement of a large number of people for the increase in polio cases this year. Similarly, low routine immunisation rate due to seasonal migrants, low socio-economic status, low literacy rate, environmental issues, poor sanitary conditions, managerial issues and unwilling workers is also blamed. According to the official data based on finger-marking of the children vaccinated against polio disease during various rounds this year, about 10 districts and towns across the province failed to ensure 95 per cent coverage of their target population.

However, the fact that six of the 26 children, who were infected and had the onset of paralysis this year, aged between five and 12 years and had the history of routine vaccinations and supplementary vaccinations against polio speaks a lot about the style and efficiency of the prevailing expanded immunisation programme in the province.

Leads to improve immunisation Comments of Ghotki's executive district officer (health) Dr Ayaz Ali Jumani sought on the reemergence of polio cases in the district some weeks back provide some leads to improve immunity level of children at risks. He had expressed dissatisfaction over the prevailing environmental conditions and the sewerage system and questioned how children could be protected if they consumed sewage-mix water. Besides, malnutrition and prevalence of diarrhea in children are also needed to be addressed, according to him.

He highlighted the need for conducting a titre (a measurement of the amount of concentration of substances in a solution) of the polio vaccines delivered to Ghotki and administered to the children there.

The issues of poor environment, sanitation, and drinking water, diseases, children's vulnerability to diseases due to inadequate food intake, and the fear that oral polio vaccines some time turn ineffective in preventing the virus due to improper handling and faulty cold-chain system are needed to be addressed by both foreign and local health experts who have frequently visited other countries for study and training.

There have also been reservations against those who do the micro-planning, the monitors who are supposed to identify the loopholes and the vaccinators. It is said about many of those engaged for the jobs under political considerations that they rarely find themselves answerable to their superiors.

Public health organisers and their foreign counterparts stationed in the province despite attending workshops and evaluation conferences abroad have been unable to ensure optimum immunity level in children that is required to achieve the target of polio-free Sindh.

The situation certainly demands from the international health agencies and donor bodies that they should revisit strategies regarding monitoring and technical management and social mobilisation and advocacy. There is a need to assess the output of their experts and the field workers deployed in the province.

Efforts should be made to let anti-polio campaigns work in an environment that guarantees a system of management, monitoring and accountability of all those involved — right from top officials of the federal and provincial health departments to the field workers at the union council level.