ISLAMABAD: Confir­ming the worst fears about the spread of poliovirus from Pakistan across the globe, the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative has labelled the country’s efforts to combat the disease as a ‘disaster’ and recommended that “the polio programme in Pakistan should be put in the hands of the National Disaster Management Authority (NDMA)”.

The IMB works on behalf of international donor agencies and issues reports regarding the performance of countries in combating the poliovirus after every six months. In Nov 2012, the IMB recommended that travel restrictions should be imposed on Pakistan. These recommendations finally came into effect on May 5 this year.

At the IMB’s last meeting, held in the United Kingdom on Sept 30, National Health Services (NHS) Minister Saira Afzal Tarar and the Prime Minister’s Focal Person for Polio, MNA Ayesha Raza Farooq, represented Pakistan.

Board recommends more travel restrictions to stem export of Pakistani strain of poliovirus

The report is a damning indictment of Pakistan’s track record in fighting the curse, frequently referring to the strain of poliovirus being exported from the country as “Pakistan polio virus”.

The report also suggests that the expert committee of the World Health Organisation’s International Health Regulations recommend that all countries receiving travellers from polio-infected countries should ensure that they have a valid vaccination certificate, as a condition of entry and asks for this to be implemented urgently.

Commenting on the report, an official from the Ministry of National Health Services told Dawn that if the IMB recommendations were implemented, it would severely limit the ability of Pakistanis to travel abroad.

“The polio vaccination certificate will become just as important as a passport and other countries will not allow travellers from Pakistan to enter without one,” he added.

According to the report, Pakistan is home to 80 per cent of the world’s polio cases this year. “Pakistan’s polio programme... continues to flounder... as its virus flourishes,” it says in no unclear terms. “The principal victims are the children of Pakistan who are left vulnerable and unprotected by their government,” it maintains.

Threat to neighbours

Pakistan is also deemed a threat to its neighbours. The report states that Afghanistan, the Middle East as well as Syria and Iraq have all reported deaths and paralysis caused by the Pakistani strain of the poliovirus.

The report states, forebodingly, “No one whom the IMB spoke to had anything but gloomy predictions about polio eradication in Pakistan. It is clear that the level of political commitment... engagement of regional and local leader, quality of public health leadership and management, and the involvement of civil society are totally inadequate.”

Making specific recommendations, the IMB calls on Pakistan to implement a programme similar to the one that has been widely successful in Nigeria. It suggests that a strengthened Emergency Operations Centre (EOC) be established under the NDMA to perform intelligence and coordination functions.

Making an emotional appeal, the report calls on the government to ensure that courageous frontline polio workers’ hard work and sacrifices do not go in vain.

“Over the last two years, one intractable element in Pakistan has been polio circulation in North Waziristan, where a Taliban ban left a quarter of a million children unvaccinated. On June 19, 2014, a window of opportunity opened. The Pakistan Army launched a major operation and took control of North Waziristan. Warned in advance, almost all families and children fled, enabling the programme to vaccinate previously inaccessible children at temporary transit posts. Inaccessibility in this area is no longer a valid excuse.”

Rejecting both insecurity and inaccessibility as valid excuses for the spread of the virus in the country, the report argues that since the army operation in North Waziristan, many children fleeing from the area have now become accessible.

However the report says that insecurity also cannot explain the polio cases that have occurred in Punjab or excuse those that have occurred in numerous districts of Karachi.

Furthermore, the discovery of cases in the main port city of Karachi makes it “a real threat to surrounding countries and the wider world”.

Meanwhile, an official statement issued by the Ministry of NHS stated that a number of measures mentioned in the report – such as the strengthening of the EOC – have already been taken since the IMB meeting was held in September.

According to the statement, Pakistan has finalised a plan to introduce Injectable Polio Vaccine (IPV) for routine immunization from 2015, in compliance with IMB recommendations.

Published in Dawn, October 26th, 2014