PESHAWAR: The back-to-back detection of vaccine-derived polioviruses in Khyber Pakhtunkhwa has posed a challenge to the government, which is struggling to deal with the P3 type of the virus.

On Sunday, five more VDPV2 cases, including four from Khyber and one from Nowshera in Khyber Pakhtunkhwa and one from Rawalpindi were reported that brought the total number of cases to nine in 2020. In 2020, KP has recorded eight polio cases of the countrywide nine cases.

Last year, a total of 22 VDPV2 cases were recorded that included 16 from KP, four from Gilgit-Baltistan, one each from Islamabad and Gujranwala. The Khyber Pakhtunkhwa, which is in limelight due to detection of P3 cases, has been the worst-affected province for vaccine derived P2 that is likely to infect more children due to poor routine vaccination programme.

Pakistan tested 146 children positive for P3 virus in 2019 that included 92 from Khyber Pakhtunkhwa while it accounted for 10 cases of the recorded 18 in 2020 so far.

Experts say that indications are that both the viruses would continue to haunt children due to poor vaccination. Trivalent oral polio vaccine (containing all three strains immunity) now obsolete and bivalent has only p1 and 3 antigens.

Polio has 3 strains, 1, 2 and 3. Type 2 was eradicated in 1999 and vaccine switch from OPV, for three viruses, to OPV (P1 and 3) was conducted in April 2016 globally but it was believed that the routine immunisation through injectable polio vaccine (IPV) would sustain the required immunity. However, owing to poor routine immunisation that immunity was not sustained.

When vaccine derived p2 got imported to Gilgit-Baltistan then Kohistan reported CVDPV2 case last year. It has now spread all over the country. Case response campaigns against VDPV2 were carried out in the specific districts. Since then, the government is conducting case response campaign in the affected districts.

The IPV is being administered to children at Expanded Programme on Immunisation (EPI) centres at public sector hospitals but the coverage has been extremely low due to which the immunity level of children couldn’t be scaled up.

Sources in health department said that VDPV2 cases were reported last year in August but the World Health Organisation didn’t notify the same and the case response campaigns were launched when those cases were reported in the press.

Had the WHO, responsible for monitoring and surveillance, notified the cases in time, prompt response would have arrested its widespread, they said.

Pakistan has been facing issues with regard to polio vaccination. The government is blamed for new cases but the programme is run by the UN agencies, including WHO and Unicef, unlike other countries that have eradicated the virus because they played lead role while the UN organisations played second pedal to the government, according to sources.

They said that both the agencies were involved in polio-related operations directly or through third parties while it was government’s mandate to run the programme and take technical inputs from the agencies.

Sources said that there was a tussle between the then WHO team leader Dr Abdi and Babar Bin Atta, former PM’s focal person on polio, that affected the whole programme. “Now that government has removed Babar, the same treatment should have been meted out to the WHO team leader but he has given promotion to the Geneva office; a reward strange to the normal rule of business,” they added.

Experts say that the polio programme needed an urgent reset via neutral expert forums and government should take full control of the programme before it was too late.

WHO Pakistan chief didn’t respond to telephone calls and messages to seek his version.

Published in Dawn, February 24th, 2020