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Towards a Polio-Free Pakistan in 2021: Aiming to consolidate gains

By Dr. Rana Muhammad Safdar
Coordinator, NEOC (The National Emergency Operations Centre of the Pakistan Polio Eradication Programme) and EPI (Expanded Programme on Immunization)

2020 has come to an end!! It is a year that will be remembered for the enormous challenges it brought to global public health and to our lives. Like other nations around the globe, Pakistan had no choice but to focus on and address the most pressing and immediate needs of the hour – mounting the best possible response to control the COVID-19 pandemic. While the battle is still on, the resilience and courage demonstrated by the Pakistani nation thus far has been exemplary. All of Government and many private sector and civil society stakeholders made enormous contributions to the battle against COVID-19. But perhaps the most critical contribution came from the national Polio Eradication Programme. By using all available resources, the disciplined team of the Polio Eradication Programme has made remarkable contributions in building COVID-19 surveillance and data management systems and raising awareness among people.

While Pakistan has been applauded globally as a great example of a nation successfully tackling the pandemic, questions have also been raised as to why our country has been unable to eradicate Polio so far. Pakistan and Afghanistan are the only two countries left where the wild polio virus continues to threaten the health and wellbeing of children. This underlines the urgency with which all of us must work to eradicate the disease and deliver a polio free world.

Our surveillance system stays highly sensitive as total of 84 wild polio cases have been detected from 38 districts of Pakistan in 2020 to date. Amidst COVID-19, it represents 43 per cent decline over the 147 cases reported in 2019. Nevertheless, environmental surveillance does indicate widespread presence in different geographical zones of the country. As part of the single epidemiological block, Afghanistan also recorded 56 cases of polio during 2020 in comparison with 29 reported in 2019.

Our efforts to eradicate polio suffered immensely in 2019 and thereby ushered in a new era of hard work for the country team. In the wake of persistent challenges in ensuring optimal essential immunization coverage, the slip in programme oversight in 2019 was enough to impact the vaccination campaign performance to the extent of generating marked immunity gap across the country. Meanwhile, vaccine hesitancy soared due to the spread of totally false negative propaganda against the Programme and the polio vaccine, especially over social media platforms. High rates of malnutrition, poor basic healthcare and poor water, sanitation and hygiene services in some communities further kept on providing an environment rife for increased poliovirus transmission.

Learning from these challenges, in 2020, the Programme identified the ways by which it could bring communities along, improve operational performance, and in turn contain the spreading poliovirus. A comprehensive structural transformation was initiated and has been rigorously implemented in 2020 to retain the best performing staff, improve management structures and enhance the utility of data collected across the country for decision making.

The reinvigorated Programme promoted Polio eradication as a shared priority across all political divides and across all segments of the society. The ‘One Team’ approach was quickly revived, and a fresh battle initiated from Dec 2019, conducting two high-quality nationwide campaigns and a subnational door to door campaigns in three months’ time, before COVID-19 forced yet another suspension of immunization activities. While the Programme had to be suspended, it’s strengths and capacities were successfully diverted to COVID-19 surveillance and response.

Sensing risks associated with the disruption of essential immunization activities as well as the supplementary immunization campaigns, the Programme made a bold undertaking to resume campaigns in July, using revised operating modalities for the COVID-19 context. Since then, six high-quality campaigns have been successfully conducted, and there are several remarkable things worth noting about this effort. Just like in the COVID-19 response, there has been outright national ownership with engagement of leaders at all levels ensuring successful implementation of door-to-door campaigns. The Armed Forces and security arms of Government continue their support, including but not limited to facilitating access and security for frontline workers vaccinating children in remote and challenging areas. Vaccinators were also trained on COVID-19 preventative measures, while strict rules were put in place to minimize any chance of spreading COVID-19 infection amongst vaccinators, parents and children they interact with, and the community.

Additionally, essential immunization services which are important for eradicating polio were heavily affected due to the lockdown at the beginning of the pandemic. With strong advocacy and community support, services were resumed, and we have since implemented enhanced outreach activities taking our coverages above the pre-COVID-19 times with special focus on populations living at distances from the health facilities.

We are highly confident about the processes the Pakistan Polio Programme has taken in 2020 to re-think, re-strategize and innovate like it had never done before. Comprehensive reviews of operations, programme structures and staff, as well as forensic and detailed analysis of available data has been conducted, and this has ultimately helped the Programme launch its battle against polio afresh, with renewed and reinvigorated energy. We are also on track putting in place structures that are fit for purpose and positioning the best people where they are needed most. We are implementing a revamped communication strategy to support high levels of vaccine acceptance. Further investments through the priority community engagement strategy are underway to cater for all communities having similar risk factors related to vaccination in general, thus ensuring a holistic approach.

2021 presents a unique opportunity to leverage the gains made in 2020 despite the pandemic. We look forward to sustaining the high levels of leadership support across the political divide and society segments, consolidating and further strengthening programme structure change, better engagement with priority communities, reinforcing essential immunization, delivering Integrated services to underserved communities, and coordinating with our Afghanistan colleagues for synergy in campaigns and operations in order to manage the spread of the polio virus across the shared epidemiological block. Through its highly committed frontline workers, the programme will aim to restrict the geographic scope of polio circulation to historical reservoir areas and get closer to the goal of eradication in 2021!

We thank all polio frontline workers, our heroes, whose dedication has contributed to the progress in 2020. We also thank all partners who have supported us in the polio eradication efforts. Above all, we acknowledge and thank all parents and caregivers, and urge them to support their neighbors and communities to vaccinate all children in 2021 for a polio free Pakistan!