Global body concerned over ‘inadequate’ polio eradication efforts

Updated November 19, 2018

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In this photograph, a Pakistani health worker marks a child's finger after administering polio drops outside her house during a door-to-door polio immunization campaign.—AFP/File
In this photograph, a Pakistani health worker marks a child's finger after administering polio drops outside her house during a door-to-door polio immunization campaign.—AFP/File

ISLAMABAD: The independent monitoring board of the Global Polio Eradication Initiative (GPEI) has expressed its greatest concern that Pakistan has not been able to demonstrate success in clearing even one of the three traditional reservoirs of wild polioviruses.

The board in its sixteenth report, titled ‘How to cut a long story short’ says there is a regular isolation of wild poliovirus from Karachi, Quetta block and Peshawar. A critical mass of children is being missed in vaccination campaigns.

Pakistan’s failure to address variations in the quality and general inconsistency in performance of polio vaccination rounds is coming home to roost. Too many children, particularly in high-risk mobile populations, are being missed, something that the board has expressed serious concern in previous reports.

GPEI report says there is regular isolation of wild poliovirus from Karachi, Quetta and Peshawar

A review team of the independent board carried out visits to Pakistan and Afghanistan for 10 days and went deep into the field to some of the most challenging areas where the poliovirus has thrived.

The report says that the percentage of positive environmental samples in Pakistan is at the same level as this time last year. Worse five sites that were clear in October 2017 are now testing positive, indicating circulation of infection.

The polio programme in Pakistan has been seriously disrupted by the recent general elections. The pre-election assurances given to the board that there was political all-party agreement on retaining the national leadership arrangements for polio proved completely unsound.

In private conversation with senior government figures, the underlying belief has been evident that the polio problem is coming from Afghanistan, and that the situation in Pakistan is under control.

However, the report says ‘this is just not true’. Polio must be seen as the challenge of one Afghanistan and Pakistan epidemiologic zone to which serious weaknesses in both countries program­mes are contributing wild polioviruses.

For some years, the polio programme has viewed the situation in Pakistan and Afghanistan as one epidemiological block, even though the management of polio-related activities is based on cooperation between the countries rather than a unified governance structure.

The northern corridor runs from Nangarhar, Kunar and Nuristan provinces in Afghanistan to Khyber Pakh­tunkhwa in Pakistan, extending across to Islamabad, Rawalpindi and Lahore. The southern corridor covers Helmand, Urozgan and Kandahar in the south of Afghanistan and extends through to the Quetta block in Balochistan.

The report says that outside the corridors, poliovirus continues to circulate in central Pakistan — eastern Balochistan, northern Sindh and southern Punjab. There is also intense circulation of the poliovirus within and surrounding the core reservoir in Karachi, demonstrated by recurrent positive environmental samples. There are substantial population movements to every province in Pakistan, and parts of Afghanistan, making persistent transmission.

In its findings, the review team found a strong link between abysmal development indicators and the persistence of the poliovirus. In such communities, very poor health services frequently co-exist with no access to water, nutrition and sanitation or other basic public services. Neither are there real opportunities for work or education, such is the profound impact of multiple deprivations. The team saw a major opportunity for governments and partner organisations to target funding to the most deprived and at-risk communities.

Rumours and anti-polio sentiments posted on social media have infiltrated communities in Pakistan and Afgha­nistan, and turned some people against the polio vaccine. The review team heard propaganda in all three countries — Pakistan, Afghanistan and Nigeria — that the vaccine is harmful to children.

Many parents in Pakistan and Afghanistan still refer to the Abbottabad incident, believe that the vaccine is ‘haram’ and have been persuaded that polio eradication is a western or international agenda that will not benefit local people.

It shocked the review team that delays and rejections of travel authorisations and visas in Pakistan have been a great hindrance to polio programme monitoring and quality improvement activities. The review team was concerned about pressures from the GPEI to reduce budgets, which were forecasted to range from 12.5 per cent in Afghanistan and Pakistan to as much 15pc to 20pc in Nigeria.

The GPEI is currently working to review this strategy and prepare a new document for the January 2019 WHO Executive Board meeting. The review will assess whether the current strategies, functions and activities in the existing strategy continue to be valid and sufficient to achieve the eradication goal and if new approaches are required.

Published in Dawn, November 19th, 2018