The meeting of the Technical Advisory Group in Pakistan has highlighted important progress made in the fight against polio, and outlined the battles still to be faced.
The world has never been in a better position to eradicate polio, yet Pakistan and Afghanistan face a daily battle to protect children against the virus. Pakistan, the single greatest challenge to global eradication, is getting back on track to stop transmission of polio in 2015, concluded the Technical Advisory Group (TAG) at their meeting in Islamabad on 4 and 5 June.
In 2014, Pakistan reported 85 % of the world’s polio cases. This year has seen 26 children paralysed by polio, 72% less than we had seen by this time in 2014. This drop in cases is evidence that, despite major challenges and remaining hurdles in greater Peshawar, Khyber Agency, the Federally Administered Tribal Areas (FATA), and the central Pakistan block, Pakistan is taking steps forward towards a polio-free future.
Every missed child
Key to improvements over the last few months has been the shift in focus to finding and vaccinating every missed child – rather than focusing on the numbers of children reached and vaccinated. The TAG was encouraged by the fact that the number of persistently missed children had significantly declined in all major areas including South Waziristan, parts of Peshawar and Karachi. Similarly, the exodus from North Waziristan due to military campaigns in 2014 was grabbed as an opportunity to vaccinate longstanding un-reached and unvaccinated populations. Ongoing innovations specific to each area and enhanced community engagement are the key tools being used to bring those numbers of missed children down to zero.
Pieces of the puzzle
Since the most recent consultation in February, the TAG recognised that significant progress has been made, especially through the adoption of innovations such as the use of the inactivated polio vaccine (IPV) in supplementary immunization activities, measures to protect the safety of health workers, and the health camps to reach children with vaccines alongside other health measures.
Pakistan has all the tools it requires to stop transmission of polio. It remains crucial that these tools are utilised to ensure that the final pieces of the puzzle come together in practice to see concrete change over the current high season for transmission. These essential aspects are an accountable government at all levels, community trust and health worker safety, engaged community leaders, the continued use of innovative solutions and ensuring that the programme are using the right vaccines in the right places, such as the inactivated polio vaccine (IPV) in campaigns in hard to reach areas to build immunity more rapidly.
Insecurity in certain areas remains the biggest obstacle to polio eradication in Pakistan, resulting in delayed or missed campaigns. Combatting this is where non-traditional tools, such as female community volunteers and health camps, have proved most valuable. “We cannot allow conflict and politics to get in our way because at the end of the chain, behind that door, stands a mother or a father who wants to protect their child,” argued Dr Hamid Jafari, Director of Polio Operations and Research at WHO.
The National Emergency Action Plan for Pakistan has outlined an action plan to stop transmission as soon as possible by detecting, containing and eliminating the virus, maintaining and increasing immunity, and strengthening routine immunization to help sustain protection once transmission is stopped. The plan aims at reaching every child with multiple doses of the vaccine between September 2015 and May 2016. The programme is strengthening and preparing to stand absolutely ready for high quality implementation by mid-August. The programme will also have to ensure it continues to coordinate with Afghanistan, following spread of viruses across the border in both directions. Along the 2450 km border, temporary vaccination points are in place to coincide with movement of seasonal workers, pilgrims and those forced to leave their homes due to extreme weather conditions.
“The recent progress in Pakistan is very promising. We may be looking at months- months, not years- before we eradicate polio in this country,” stated Dr Jafari. If all elements of the polio programme are accountable for reaching and immunizing every child in polio vaccination campaigns, Pakistan can take the world over the finishing line for polio eradication.