LAHORE: One of the major reasons behind emergence of a polio case in the provincial capital after a gap of seven years or so is said to be the mushroom growth of unplanned urban slums, undocumented families and the scarcity of small hospitals to address their health issues.

The massive population influx in the recent years constitutes approximately 30-40 per cent of the total population of the city and mostly the polio cases or environmental samples are reported positive in these localities.

While demanding a budget to the tune of Rs8 billion to improve services in eight bordering districts of Punjab to fight poliovirus and for the management of massive population movement, the health department has also assigned task to experts to prepare another special proposal for Lahore and Rawalpindi as well.

Since a majority of the poor people reside in the urban slums, settlements and temporary shelters of the provincial capital, the health department is also preparing a proposal for Lahore too, says Punjab Emergency Operation Coordinator for Polio Eradication Dr Munir Ahmed.

Speaking to Dawn about the possible factors behind the poliovirus circulation and detection of a case in Lahore, he said a vast majority of the families were residing in urban slums in the surroundings of Bund Road, Shahdara, Ravi Road, Thokar Niaz Baig, Raiwind, Ferozepur Road, Johar Town etc.

“It is matter of grave concern that we have no government hospital alongside the Lahore Canal from Thokar Niaz Baig to Bahria Town to address the health issues of the people residing there,” he said. The massive population movement from villages to the city was going on and the resources were same as were provided years back to face the growing challenges of health needs, he said.

“We need at least 24 more dispensaries for the people living in the areas identified by the health experts in Lahore,” Dr Munir said. He lamented that no new mega teaching hospital had been constructed in the provincial capital during the last 20 years or so.

He further said the poliovirus resurgence in Punjab and other parts of the country posed a big challenge for the health authorities.

“We moved a proposal to the Punjab government demanding funds, medicines, human resource and other related services for eight bordering districts of the province,” Dr Munir said. These include DG Khan, Attock, Hafizabad, Mianwali, Lodhran and Kasur.

He said the government had been requested to provide facilities to the health department to provide health services for 24 hours against the present practice of seven hours from 8am to 7pm at these high-risk districts.

He said 12 polio cases were reported in 2018 all over the country and in the first two months of the current year, the number of cases reached eight.

“We are also preparing a draft proposal for Lahore and Rawalpindi, the two most high-risk districts for poliovirus,” he said.

Meanwhile, a health expert has pointed out flaws in the policy of the health department in respect of urban immunization. He said the immunization in urban slums had been emphasized by the international organizations as the next big challenge.

“The scale of this problem is evident in the continuous polio positive environmental samples in Lahore, Rawalpindi and Faisalabad,” he said.

He said Lahore and Rawalpindi had seen large-scale urban slums and the unplanned urban migration into the slums and undocumented births leave huge gaps in immunization as a result most families in these areas remained undocumented or under documented.

“The immunization coverage rates in these mega cities, when evaluated by independent surveys, emerge much less than the overall average of the province,” he said, adding that Punjab’s overall average had exceeded 80 but these mega cities remain less than this ratio.

He pointed out another important issue of routine immunization, saying the polio vaccine in injectable form is administered after 14 weeks of childbirth but the vaccine in this form is served only in routine immunization and not in campaigns.

“The results of the IPV have been very encouraging as Pakistan has been able to control polio circulation in Fata and tribal areas by its massive use,” the expert said. “When IPV was used in Fata, the polio cases dropped from 179 in 2014 to just two in 2016 and no case was reported next year in 2017,” he said and added that this activity was officially documented in a recent meeting in Islamabad.

He said the IPV had been the game changer and no polio case with IPV dose had been reported.

Published in Dawn, February 16th, 2019