KARACHI, Feb 21: Pakistan and Nigeria represent the gravest risks to global eradication of polio.

According to a review body of the Global Polio Eradication Initiative (GPEI), there are six sanctuaries for polio virus, four in Pakistan — Quetta, the districts of Qila Abdullah and Pishin and Karachi — and two in Nigeria.

A relatively tiny proportion of the world posed a disproportionate risk to the likelihood of success for the entire globe, the GPEI noted.

A recent report of the independent monitoring body convened at the request of the World Health Assembly to monitor and guide the progress of GPEI’s 2010-12 Strategic Plan said there were 10 months to go to the assembly’s goal of stopping global polio transmission by the end of 2012, but the eradication programme was not on track to meet the goal.

It said success in India — one of the four polio endemic countries — showed that unswerving political commitment, outstanding public health leadership, clear lines of accountability, intolerance of weak performance and systematic enforcement of best practices could stop polio.

Pakistan ended last year with 198 polio cases, followed by Afghanistan with 80, Nigeria, 60, and India, one (reported in January 2011).

In all, 649 cases — 339 in endemic countries and 310 in others — were reported during the year. The strategic plan’s milestones for past two years have been missed.

The number of polio cases actually increased in four of the six persistently affected countries. Nigeria’s 2011 emergency plan had no meaningful impact.

Pakistan has deep problems but has recently strengthened its approach, while Afghanistan has not got to grips with how to reach enough children in insecure areas.

According to the report, the reason that polio will not be eradicated on the programmes’ present trajectory is that performance is of variable quality and consistently falls below best practices in all the affected areas.

The fate of Afghanistan is intertwined with that of Pakistan and it cannot just wait for Pakistan to improve, it says.

The monitoring body said the two countries must join hands in response and work for the re-establishment of a cross-border vaccination mechanism which was common in the past when access was easier. It noted that Pakistan’s polio programme progressed strongly over its first 12 years. In 2005, it reported just 28 cases against 20,000 cases per year in the early 1990s.

But transmission was never stopped and the country has seen cases increase for the past three years in succession.

Balochistan had six times as many cases in 2011 as in the previous year.

The new national emergency action plan has been considerably revised and is stronger, but there is no demonstrable impact on polio transmission.