Pakistan accounted for 86% of the global wild poliovirus (WPV) case count in 2014. Pakistan is the only country to have reported a dramatic increase in cases last year. In 2014, polio affected forty-four districts (23 in 2013) from three provinces/areas.
There was some spill over in all provinces with no or minimal viral establishment. Environmental samples tested positive for WPV in Peshawar and DI Khan (KP), Lahore and Rawalpindi (Punjab), Quetta block (Balochistan), Sukker, Larkana, Hyderabad and Karachi (Sindh), and most recently Islamabad. To date in 2015, there are 21 confirmed WPV cases. The majority of WPV cases continue to appear in the known reservoir areas. Although reported cases have risen, access breakthroughs in North and South Waziristan give some cause for optimism. The large-scale displacement of populations afforded opportunities to vaccinate at transit points and in host communities.
Against this background, the Government of Pakistan and its partners began intense preparations for the low transmission season in September 2014, resulting in national and provincial low seasons strategic plans. In November 2014, during a three-day consultative workshop in Bhurban, details for the reservoir areas expanded upon these plans. The plans provided milestones for the low season, focusing on key issues, such as, improving the quality of vaccination campaigns, improving the performance and morale of frontline workers, increasing the security measures for protecting health workers, developing special strategies for reaching mobile populations, expanding innovations, and using inactivated polio vaccine (IPV) in areas with difficult or irregular access.
Polio eradication continues to be a national emergency with the renewed commitment of the Government at all levels.
The Polio Eradication Initiative (PEI) recognizes that quality and coverage of polio campaigns are too low, with significant pockets of continuously missed children. Furthermore, the PEI recognizes inefficient selection, payment, training and supportive supervision of front line workershas negatively affectedthe quality of polio activities. In addition, the level of independent monitoring is too low to assure adequate program performance management and accountability. Finally, routine polio vaccination coverage is too low.
The goal of the NEAP 2015-16 remains to interrupt transmission of wild poliovirus in Pakistan. Key elements and strategies of the plan are in this document, in detail, which includes both refinements of existing strategies and the incorporation of innovative approaches. The underlying assumption of the 2015 Pakistan NEAP is that “all children anywhere in the country can be reached”
The strategic approach will be to stop poliovirus transmission in all reservoirs in Pakistan by the end of 2015; in addition, to detect, contain and eliminate poliovirus from newly‑infected areas, as well as to maintain and increase population immunity against polio throughout Pakistan through vaccination campaigns and routine vaccinations. The NEAP details specific objectives, targets, milestones and indicators that will guide and drive the program to its goal.
The NEAP 2015-16 will have a strategic focus on:
• Increasing quality of all polio eradication activities; including campaigns, AFP Surveillance and routine immunization
• Increasing programmatic access and reach, with a focus on tracking and vaccinating continuously missed children
• Placing frontline workers at the centre of the polio eradication initiative
• Expanding continuous community-protected vaccinations • Ensuing integration of planning and implementation of Operations, Security and Communications through Federal and Provincial EOCs and District Polio Control Rooms/Teams
• Monitoring of performance and increased accountability at all levels
• Reviewing and enhancing AFP Surveillance sensitivity and quality
• Enhancing seroconversion through targeted IPV introduction and expansion
• Implementing the outbreak response strategy
The oversight and review of program implementation, as per the emergency plan, will continue through:
the Prime Minister’s Task Force and the Prime Minister’s Focus Group for Polio Eradication, as well as the National Steering Committee headed by the Prime Minister’s Focal Person for Polio Eradication at the national level
the Provincial Task Forces headed by the Chief Secretaries and Security Coordination Committees at the provincial level
• the District Polio Eradication Committees headed by the Deputy Commissioners (Civil Military Coordination Committee headed by Political Agent in FATA).