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 Polio Eradication Initiative

 

 

Updated on polio eradication in Pakistan

Pakistan is one of the four remaining polio-endemic countries in the world and as such is a priority country for the Global Polio Eradication Initiative. Since the start of the polio vaccination campaign in 1994, the country made substantial progress towards polio eradication. There was lucid evidence of increasing geographical localization of transmission indicating progress. However in 2008, the program faced set back due to sharp upsurge of polio cases mainly due to re-infection of previously polio free areas This reintroduction of the virus seems to be due to population influx from several key areas due to deteriorating security situation. However, the technical Advisory Group reaffirmed that Pakistan is well positioned to reach the goal of poliomyelitis eradication if recommended strategies are implemented effectively.     

The Government of Pakistan remains committed to achieving the global targets and to ensure poliovirus transmission is stopped. Prime Minister of Pakistan personally inaugurated 3 polio campaigns after taking the oath in 2008, reinforcing polio as a priority at the highest levels. The Government of Pakistan also released a three-year plan of activities for 2008-2010, and committed to providing the funds for Oral Polio Vaccine (OPV).  

In 2009, Pakistan has conducted 4 rounds of NIDs and 4 additional rounds were conducted in each of high risk areas. Additional efforts have been intensified to strengthen the routine immunization programme (EPI), with the support of the polio infrastructure.  The key challenge to interrupting ongoing poliovirus circulation in known active transmission zones indicates a persistent immunity gaps. One of the main reasons behind the persistent circulation remains the inconsistency of campaign quality at the sub-district level and continuing suboptimal routine EPI coverage.  On the other hand, inaccessibility to children in security compromised areas (NWFP & FATA) and pockets of refusals have also contributed to the inability to reach children and hence the persistence of circulation in NWFP/FATA. In addition, the movement of over 400,000 internally displaced persons from active conflict areas of NWFP and FATA which have both non-immune and under-immune children because they are inaccessible or refusals resulted in a significant disturbance in the epidemiological situation and contributed to an upsurge in cases in NWFP and FATA, Islamabad and Punjab.  

The Federal EPI Cell, Ministry of Health has not only been analyzing the situation but also is providing technical guidance and necessary logistics support to the provinces following consultation with the international experts. Key reasons contributing to this upsurge are as under:

  • Inconsistent quality of vaccination activities in few key reservoir areas mainly due to weak supervision and monitoring.

  • Compromised access due to the serious security situation

  • High population movement within the country and across the border with Afghanistan

  • Frequent transfers of Provincial EPI Managers and Executive District Officers (Health)

  • Injudicious distribution of vaccinators at union council level.

  • Improper utilization of resources in few key districts and towns

  • Selection of inappropriate/incompetent volunteers/vaccination staff during the campaign. e.g. deployment of minor children as volunteer and/or those who can’t speak local language

  • Non-existence of regular outreach EPI activities

  • Political influence which in turn compromise accountability

  • lacking of institutionalized mechanism to translate the high level  political commitment into action at operational level resulting in lack of ownership of the programme 

:: Steps taken to address the challenges

  • Maintaining high level of political commitment and promoting government ownership of the program at district levels.

  • There are early signs of accountability demonstrated by taking actions against persistently poor performing district leadership i.e., Kila Abdullah

  • Launch of the Prime Minister Action plan focusing on inter-sectoral collaboration

  • Polio widely covered subject in the media

  • Establishment of the inter-ministerial Inter Provincial Committee on Polio (IPCP), chaired by the Federal Minister for Health. Overall two meetings held and district specific plans launched

  • Technical consultations continued; one TAG meeting and two NITAG meetings conducted in 2009.

  • Strengthening the program management in all the known zones of poliovirus transmission through close coordination with district and provincial leadership;

  • Mobilizing resources of WHO and other partner agencies to the highest risk areas;

  • Strengthening cross border coordination with Afghanistan by regular cross border meetings.

  • Targeting specific training in areas with weak performance to improve the quality of work;

  • Implementing program activities in security compromised areas by recruiting local human resources and adopting opportunistic immunization outside the planned rounds, whenever there is ease in the security situation;

  • Reaching children on move and nomads, mapping their movement, establishing transit points on their route. Special focus given to moving population in their areas of concentration by establishing special teams backed –up by extensive monitoring.

  • Addressing chronic performance gaps in few key districts by improving district health management, improving service delivery through revising training modules and methodologies.

  • Regular feedback including recommendations based on the field evidence & letters for cases and inadequate performance are shared with the highest authorities of all the provinces.

  • Developing specific plans to vaccinate children on the move and marginalized communities;

  • Adopting local approaches for local problems and recruiting local vaccinators to overcome cultural barriers;

  • Developing a proactive communications plan to avert the consequences of misconception about the safety of oral polio vaccine and improve accessibility in insecure areas. Locally appropriate communications activities were also developed to overcome the relevant challenges involving local leaders

  • Regular desk and field surveillance reviews and feedback to have a sensitive AFP surveillance system with performance indicators reaching the international standards (field and laboratory surveillance)

:: Achievements and improvements 

  • Highest level advocacy

  1. The Prime Minister of Pakistan and Health Ministers has launched the National Immunization Days thrice since 2008 while reiterating commitment of the government to polio eradication & urged district leadership to provide oversight to vaccination activities. 

  2. The Health Minister since taking over his responsibility has been personally involved in several key activities including chairing an inter-ministerial health ministers’ meeting on polio eradication and immunization; visit to Motorway Toll Plaza for vaccination of children on the move and taking calls from the community in Control Room established by PTV & private television channels

  3.  The Chief Minister Balochistan directed high risk districts’ leadership to ensure high quality vaccination campaigns. He issued a separate letter in this regard, as well.

  4.  The Chief Minister Punjab himself inaugurated the NIDs in 2008 and chairman of his task force has mostly inaugurated the campaigns in 2009. The Chief Minister committed to provide all resources to stop polio and declared that no negligence in this regard will be tolerated.

  5. The Governors and Chief Ministers launched the campaigns in their respective provinces. District Coordination Officers and Executive District Officers  (Health) were realized accountability for poor performance in special and routine vaccination activities

  • Development of province specific plans with more innovative and effective approach in 2009.

  •  4 rounds of NIDs, 4 SNIDs and 6 case response vaccination activities have been conducted in 2009 so far. 

  • Special posts were established to vaccinate IDPs form insecure areas at the exit points.  During SIAs, special focus was made to indicate these populations in the plans and vaccinate them.

  • Regular feedback on performance in vaccination campaign and AFP surveillance to abridged reports and weekly, monthly and quarterly reports.

  • Independent international panel visited Pakistan to look for barriers to polio eradication.

 :: Way forward 

  • The President has acceded request to kindly launch the October nation wide campaigns

  • Ensure trickling-down of the Prime Minister Action Plan for polio eradication

  • Advocate with the provincial governments for ensuring high political commitment translated in to effective interventions at the operational levels

  • Quarterly inter-ministerial meeting of the Inter-provincial Committee on polio chaired by the Federal Minister for Health

  • Continue vaccination activities to have high population immunity in general and transmission zones in particular

  • Maintain high performance of AFP surveillance system

  • Efficient health management at district level to improve vaccination activities – routine & campaigns

:: Upcoming events

  • N. Waziristan case response ((9-11 September, 2009)

  • EPI review meeting (11-12 September, 2009)

  • Immunization month in October, 2009.

  • National Immunization Days (12-14 October, 2009)