ISLAMABAD: The Indepen­dent Monitoring Board (IMB), an international institution which assesses progress towards the attainment of a polio-free world, has expressed concern about potential disruption to the Pakistan Polio Programme before, during and after forthcoming national elections.

It said that shifts in political landscape, overall rates of immunisation, poor sanitary conditions and insecurity are factors behind complexity of the polio situation in Pakistan.

The IMB said that Global Polio Eradication Initiative (GPEI) and Pakistan government leaders, who attended the IMB meeting held in July this year, gave strong assurances that they have taken steps to secure the continuity of programme operations during the election period and as part of the government’s transition arrangements.

The IMB meeting was held in July this year in Geneva, Switzerland, and it was attended by then Sindh chief secretary Sohail Rajput, Pun­jab chief secretary Zahid Akhtar Zaman, KP chief secretary Nadeem Aslam Chaudhry, Baloch­istan chief secretary Abdul Aziz Uquaili and National Emergency Operations Centre for Polio Eradication Coordi­nator Dr Shahzad Baig.

Shifts in political landscape, rates of immunisation and insecurity termed factors behind complexity of polio situation

The low transmission of poliovirus season starts in September and ends in May. It is believed that the polio virus remains inactive during the low temperature due to which cases are hardly reported, but during the last low transmission season Pakistan continued reporting cases.

The report of the meeting, available with Dawn, stated that stopping transmission in Khyber Pakht­unkhwa will be tough even in 2024.

“The IMB cannot yet see a convincing path to interrupting transmission in this province. If it is to happen, then the security disruptions and constraints, as well as the frequency of campaign boycotts in south KP, will have to be reduced. These issues arise because the oral polio vaccine is prominently associated with the ‘wants’ of the Pakistan government and the international world. Too many communities see polio vaccination as something being imposed upon them rather than a service provided for their benefit. It, therefore, carries massive bargaining power in the eyes of key communities and interest groups.

“The integrated delivery design is being used to try and insulate the oral polio vaccine from this hostile reaction and if it can achieve the necessary coverage and reach, this could be the answer,” the report said.

“The IMB was told that a standardised approach to integration does not work in Pakistan. It is an approach that should be customised and applied to different places in different ways. In Karachi, where the infrastructure is better developed, a package of measures, delivered through outreach, worked very well. In Khyber Pakhtunkhwa province, health camps had more impact because the infrastructure is not well developed there,” it stated.

The body has not shown full confidence in the resilience of the Balochistan Polio Programme. However, it stated that making interruption of wild poliovirus transmission in 2024 was feasible by strengthening of the performance of the Polio Programme in the province.

It stated that the Polio Programme in Pakistan has benefited from a recent period of very strong political support and involvement, but now it can be hampered during the interim government’s tenure.

“In Pakistan, polio eradication has had the personal and direct leadership of the Prime Minister. In the past, national elections in the country have broken the continuity of leadership and derailed progress. Elections are scheduled for late in 2023. The IMB was assured that political commitment and consensus will be steadfast, but this will be a worrying period for the Polio Programme.

Problems are likely to come from the loss of, or reduction in, security support for polio vaccination in high-risk areas,“ it stated.

The report stated that poliovirus cases were restricted to only seven districts of south KP province in Pakistan and to one province of east Afgh­anis­tan. However, there were environmental detections in Kara­chi and Lahore in 2023 (though no re-established transmission) and, in Afghanistan, also in Kunar, Kandahar, and Balkh (data as of 31 July 2023).

The IMB has suggested that more polio vaccination rounds should be carried out in the final quarter of 2023 in the endemic countries than currently planned and better coordination between the two countries.

Published in Dawn, September 12th, 2023

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