LAHORE: Upset over frequent outbreak of vaccine-derived poliovirus type 2 (cVDPV2) in all provinces and alarming surge in Wild Poliovirus Type 1 (WP1) cases, the World Health Organization (WHO) has extended travel restrictions on the country for another three months.

The WHO has recommended that there is an urgent need to overhaul the entire leadership and strategy of the anti-polio programme in Pakistan.

The decision of extending travel restriction was taken on the recommendations of the Emergency Committee of International Health Regulations (IHR) and conveyed to Islamabad a couple of days back.

In 2019, Pakistan documented 134 wild poliovirus cases and this count in the country was just 12 in 2018. The situation was worse in Punjab and Khyber Pakhtunkhwa for reporting a large number of children missed out and polio cases.

The WHO expressed serious concern over the pathetic state of affairs. “The progress made in the recent years appears to have reversed, with the committee’s assessment that the risk of international spread is at the highest point since 2014.”

Afghanistan and Nigeria are the other countries facing the travel restriction.

According to the IHR, the transmission continues to be widespread in Pakistan as indicated by both AFP (acute flaccid paralysis) surveillance and environmental sampling.

“The Khyber Pakhtunkhwa province continues to be of particular concern,” reads the report of the IHR.

Added pressure on the programme was due to confirmation of detection of circulating vaccine-derived poliovirus type 2 (cVDPV2) in several provinces, it further stated.

“The committee noted that based on sequencing of viruses, there were recent instances of international spread of viruses from Pakistan to Afghanistan and also from Afghanistan to Pakistan,” said the IHR.

The recent increased frequency of WPV1 international spread between the two countries suggests that rising transmission in Pakistan and Afghanistan correlates with increasing risk of WPV1 exportation beyond the single epidemiological block formed by the two countries.

“The continued cooperation and coordination between Afghanistan and Pakistan, particularly in reaching high risk mobile populations that frequently cross the international border and welcome the all-age vaccination now being taken at key border points between the two countries,” the committee recommends.

It further stated that Pakistan is among seven new countries which has recently reported multiple outbreak of cVDPV which were earlier being reported in four WHO regions (African, Eastern Mediterranean, South-east Asian and Western Pacific Regions).

The WHO’s key areas of serious concerns are: the WPV1 exportation in 2019 from Pakistan to Iran and to Afghanistan, and more recently spread from Afghanistan to Pakistan; ongoing rise in the number of WPV1 cases and positive environmental samples in Pakistan, and to a lesser extent Afghanistan; the quickly increasing cohort of unvaccinated children in Afghanistan, with the risk of a major outbreak imminent if nothing is done to access these children; the urgent need to overhaul the leadership and strategy of the program in Pakistan, which although already commenced, is likely take some time to lead to more effective control of transmission and ultimately eradication.

After this declaration the head of state or government would have to declare the interruption of poliovirus transmission a national public health emergency and implement all required measures to support polio eradication. The emergency status should be maintained as long as the response is required, declares the WHO.

“It would have to ensure that all residents and long­-term visitors (i.e. four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel,” according to the declaration.

It would have also to ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of poliovaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers.

The state would provide the traveler with an International Certificate of Vaccination or Prophylaxis in the specified form of the IHR to record their polio vaccination and serve as proof of vaccination.

The resident would not be allowed international travel for lacking documentation of appropriate polio vaccination.

These recommendations would be applied to international travelers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea).

Improved coordination of cross­-border efforts should include closer supervision and monitoring of the quality of vaccination at border transit points, as well as tracking of the proportion of travelers that are identified as unvaccinated after they have crossed the border.

Published in Dawn, January 10th, 2020