LAHORE: Risks within Pakistan’s political and economic landscape present steep challenges to the polio eradication effort even in 2024, the Global Polio Eradication Initiative (GPEI) has warned.

In a recent report, the GPEI linked complete eradication of the crippling disease from the world with the coordinated efforts of Pakistan and Afghanistan — the two countries that are still reporting the cases, with bleak chances of making them polio-free even in 2024.

While WPV1 (Wild Poliovirus type 1) transmission has been limited to Afghanistan and Pakistan, epidemiological challenges demand new approaches to address the long tail of transmission, states the report, a copy of which is available with Dawn.

The GPEI is a public-private partnership led by national governments with six partners — the World Health Organisation, Rotary International, the US Centers for Disease Control and Prevention, Unicef, Bill & Melinda Gates Foundation and Gavi, the vaccine alliance. Its goal is to eradicate polio.

Disease outbreak in southern Afghanistan can spill over into Pakistan, warns GPEI

The cross-border transmission threatens each endemic country’s capacity to sustain gains, as neither state can achieve WPV1 eradication until they both succeed, it said.

According to the report, the coordination across the epidemiological block includes a range of collaborative actions the country programmes are taking to address this risk.

Underscoring the threat

The report said that a WPV1 isolate was detected in an environmental sample collected in Pishin on Sept 4, 2023. The virus was matched to a WPV1 detected in Kandahar in May, representing a new importation from Afghanistan.

“The endemic countries of Afghanistan and Pakistan show considerable progress despite unprecedented difficulty,” reads the report.

However, Pakistan faces intense economic instability, political uncertainty, and rising insecurity.

“In Afghanistan, the world’s largest humanitarian crisis has intensified, contributing to setbacks across the country’s health sector,” notes the GPEI.

Despite these challenges, both programmes have not only remained operational but have also achieved success in key areas, including a resumption of house-to-house (H2H) campaigns.

The virus remains endemic in seven of 164 districts in Pakistan and just four of 34 provinces in Afghanistan.

Progress in jeopardy

However, several challenges place this progress in jeopardy when both country programmes face uncertainty as WPV1 survived the 2022–2023 low-transmission season.

There is still no agreement for H2H campaigns in southern Afghanistan, and the history of disruption of H2H campaigns throughout the country has contributed to potential pockets of susceptibility in children 5-10 years old.

“The positive samples in Kandahar suggest the potential for a large outbreak in southern Afghanistan that could potentially spill over into Pakistan,” warned the GPEI.

The deteriorating security context in both countries, with low-intensity violence in southern Khyber Pakhtunkhwa, may further impede access to high-risk populations.

Illustrative of the severity of risks, it said, the International Monitoring Board (IMB) highlights the number of boycotts within KP, where communities leveraged polio vaccination to get the government to meet their demands for a range of issues, such as a lack of healthcare, electricity, or water supply.

Pakistan was able to resolve these boycotts through the efforts of provincial chief secretaries. Because of their critical role in resolving boycotts and the amount of time required to achieve a resolution, the IMB goes so far as to suggest that chief secretaries “will define the course of Pakistan’s struggle to eradicate polio”.

Published in Dawn, December 18th, 2023