ISLAMABAD: The Independent Monitoring Board (IMB) for Polio in its latest report has expressed concerns over the quality, reliability, capacity and authenticity of surveillance data in areas across the whole polio programme. It recommended to the countries to revisit the Global Polio Eradication Initiative (GPEI) to identify the gaps.

The board claimed that the number of children “not available” for vaccination in Pakistan whilst away from home elsewhere in the union council or district was far too high. Pakistan should urgently review and enhance local micro planning, it said.

The report, available with Dawn, states that the number of so-called “guest children” regularly moving with their families from place to place across Pakistan and Afghanistan was huge. The number of those among the “guest children” who do not receive the polio vaccine even after catch-up immunisation activities is in the hundreds of thousands. Both countries should establish a new strategy to address this issue.

The IMB works on behalf of the international donor agencies and issues reports on the performance of countries after every six months. In November 2012, the IMB recommended that travel restrictions should be imposed on Pakistan and finally the direction was implemented on May 5, 2014.

Independent Monitoring Board (IMB) says number of children away from home and “not available” for vaccination is far too high

The last meeting of the IMB was held on May 2-3 in London. During the meeting, teams from Pakistan, Afghanistan and Nigeria briefed the board about their performances.

The report of the meeting, chaired by Chairman IMB Sir Liam Donaldson, claimed that all available sources of data showed that the levels of routine immunisation in the polio-vulnerable areas of Pakistan and Afghanistan were very poor despite substantial investments by the Global Alliance for Vaccines and Immunisation (Gavi). “It is recommended that a special task force be assembled to bring about a major transformation in performance within the next six months.”

The report, “Every last virus” recommended that a system of innovation hubs should be established in Pakistan and Afghanistan. They should seek the input of local people, individuals entirely outside the public health field, and young people who are not used to working in formal organisational structures.

However, at the same time, improvements were appreciated. “The IMB continues to be deeply impressed with the overall commitment, dedication and courage of frontline staff and their leaders in each of the three endemic countries. Many crucial areas of these countries are beset by insecurity, danger and complexity on a scale that is truly extraordinary in the delivery of public health programmes.”

The most recent case of wild poliovirus in Pakistan was reported on February 13, 2017, but virus-positive environmental samples are still being found in all three of the major polio reservoirs.

However, the report said, cases of wild poliovirus associated with paralysis in Pakistan and Afghanistan in 2017 had been halved compared to the same period a year ago, with cases in fewer districts and less viral diversity.

The report claimed that in reviewing Pakistan the IMB had gained strong impression of a high-performing programme. “The polio programme in Pakistan is continuing to benefit from exceptional political leadership.”

An important and recent innovation in programme governance has been the engagement of the divisional level – below that of the province. Over the last year, this has substantially improved.

“The impression of strong programme performance seems to be backed up by data. Pakistan has had two cases of paralytic polio associated with wild poliovirus in 2017. Both were outside the endemic reservoirs. The cases have been subject to very aggressive response. However, there are still extensive environmental positive samples in the Quetta block and Killa Abdullah. In several locations, this has been happening consistently for the past two years – for example in Shaheen Town, Peshawar, and in Surpal, Quetta. There are also recurrent positives in Karachi,” said the report.

“However, it has to be said that the current scale of environmental sampling is unprecedented. There are now 53 active surveillance sites in Pakistan. This provides a higher resolution focus on virus circulation than ever before. India only began environmental sampling at the very end of its eradication effort. In India, the environment continued to be poliovirus-positive for several months after the last case,” it said.

The report expressed concerns over missed children during immunisation rounds, particularly large numbers are missed even after subsequent catch-up activities have been completed. In Pakistan, even after attempts to go back to communities to find the children who had been missed, the approximate numbers unvaccinated were: 767,000 (low season 2016); 760,000 (high season 2016); 858,000 (low season 2017), the report adds.

Published in Dawn, June 16th, 2017