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Islamabad
Only a year ago, the International Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) had described Pakistan’s polio programme as ‘deeply dysfunctional.’ A year on, the programme has raised its game with a 67% reduction in the number of cases so far in 2012, as compared to the same period last year. Yet, in recommending actions for 2013, IMB’s latest report points to numerous weaknesses and gaps that Pakistan needs to surmount in order to prevent a surge another surge in polio cases.
The report describes Khyber-Pakhtunkhwa (KP) as a ‘super sanctuary’ for poliovirus transmission in Pakistan, and terms ‘inconsistent performance at the Union Council level, poor implementation of the migrant strategy and a failure to conduct additional vaccination passages in the low transmission season’ as the core contributors to this unwelcome scenario.
KP experienced an upsurge of polio in the second half of 2012. The province accounts for over 40% of all Pakistan’s polio cases and 46% of Pakistan’s infected towns and districts this year. Worryingly, 50,000 children were missed during the September campaigns. A lot now depends on the quality of campaigns scheduled in December. “These must be of a significantly higher quality if they are to have the desired effect,” the report points out.
The report expresses concern over the fact that even though KP has agreed to increase the frequency of campaigns, the provision of financial resources to support these has yet to be confirmed. On a positive note, it welcomes the proposal to double the salary of frontline workers and to award bonuses for good performance. It also recommends working closely with the community if the lid is to be put back on the recent surge in cases.
In the Federally Administered Tribal Areas (FATA), the report urges the polio programme to maximize the civil-military partnership, which has led to a decrease in the number of missed children in Bara Tehsil of Khyber Agency — from over 46,000 in January 2012 to less than 18,000 in September 2012.
In Fata, the lives of 203,000 innocent children have been put in danger by the actions of anti-government groups that have banned polio vaccinators from South and North Waziristan. “The protection of Pakistan’s most vulnerable children should be a universal cause,” the report states.
The programme in Fata must not lose sight of the need to improve other aspects of campaign preparation and implementation. “Efforts to gain increased accessibility will be wasted if campaigns are poorly executed or mothers refuse the vaccine,” the report warns. Analysis shows that Fata parents are 40% more likely to refuse OPV than parents in any other part of the country.
With reference to the Quetta Block (Pishin, Killa Abdullah and Quetta city), the report expresses concern over the recent detection of cases of vaccine-derived polio. “These cases point to continuing deficiencies in vaccination coverage,” it states. The Board has applauded government authorities for matching GPEI funding of vaccinators and the ongoing involvement of the chief secretary and other senior officials.
According to the report, Gaddap Town, particularly Union Council 4, remains a thorn in the side of polio programme in southern Pakistan. “It is deeply frustrating that such a small geographical area can offer such succour to the polio virus. Environmental samples in the area continue to test positive,” it says. The report pays tribute to the District Commissioner and his team for ensuring that vaccination campaigns continued following a security incident in July 2012 after which Gaddap was declared a no-go area for UN staff. “The programme in Karachi appears to have a talent for community engagement from which other parts of Pakistan could learn,” the report states.
In presenting a national analysis, the IMB report recollects that just a year ago, the polio programme in Pakistan was deeply dysfunctional and required a fundamental change in its approach. “Case numbers were spiralling. Its action plan was more ‘plan’ than ‘action’. A year on, the picture is very different, with more children being reached by vaccination rounds, a decline in vaccine refusals, and an improvement in surveillance.
However, the report calls for further improvements in vaccination coverage and surveillance. Environmental surveillance shows transmission in Punjab and Sindh, where cases had not been spotted. Virologic analysis confirms that surveillance gaps persist. Too many children, particularly Pashtun children, are still being missed by vaccinators.
With reference to programmatic advances, the report commends the government for taking a $227 million loan from the Islamic Development Bank to fund eradication activities; for increasing the pay of vaccinators in some key areas; and for establishing a direct payment mechanism to ensure that they receive the money due to them.
In recommending further actions for polio-endemic countries, the report draws attention to country plans that are impressive, but unclear with reference to priorities. It terms the ongoing low transmission season as a golden opportunity, and calls upon country programmes to list no more than five priority goals that they will achieve by end of April 2013 and communicate these to all their staff.
The report also proposes efforts to increase parental demand for vaccine. It further suggests that polio vaccine be paired with other benefits because many communities see polio vaccination as an imposition with no benefit: yet they are in desperate need of other services.
The report reminds the GPEI of the hard fact that despite its promise to stop polio transmission globally by 2012, it has failed to do so. “The 2013-18 Endgame Strategic Plan must tackle the challenges that stand in way of eradication. It must be a once-in-a-generation plan if it is to fulfil a once-in-a-generation opportunity,” the report concludes. Vital to this plan will be a convincing case for a US $5.5 billion investment that is based on evidence and sets out the full benefits that polio eradication will bring.
Only a year ago, the International Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) had described Pakistan’s polio programme as ‘deeply dysfunctional.’ A year on, the programme has raised its game with a 67% reduction in the number of cases so far in 2012, as compared to the same period last year. Yet, in recommending actions for 2013, IMB’s latest report points to numerous weaknesses and gaps that Pakistan needs to surmount in order to prevent a surge another surge in polio cases.
The report describes Khyber-Pakhtunkhwa (KP) as a ‘super sanctuary’ for poliovirus transmission in Pakistan, and terms ‘inconsistent performance at the Union Council level, poor implementation of the migrant strategy and a failure to conduct additional vaccination passages in the low transmission season’ as the core contributors to this unwelcome scenario.
KP experienced an upsurge of polio in the second half of 2012. The province accounts for over 40% of all Pakistan’s polio cases and 46% of Pakistan’s infected towns and districts this year. Worryingly, 50,000 children were missed during the September campaigns. A lot now depends on the quality of campaigns scheduled in December. “These must be of a significantly higher quality if they are to have the desired effect,” the report points out.
The report expresses concern over the fact that even though KP has agreed to increase the frequency of campaigns, the provision of financial resources to support these has yet to be confirmed. On a positive note, it welcomes the proposal to double the salary of frontline workers and to award bonuses for good performance. It also recommends working closely with the community if the lid is to be put back on the recent surge in cases.
In the Federally Administered Tribal Areas (FATA), the report urges the polio programme to maximize the civil-military partnership, which has led to a decrease in the number of missed children in Bara Tehsil of Khyber Agency — from over 46,000 in January 2012 to less than 18,000 in September 2012.
In Fata, the lives of 203,000 innocent children have been put in danger by the actions of anti-government groups that have banned polio vaccinators from South and North Waziristan. “The protection of Pakistan’s most vulnerable children should be a universal cause,” the report states.
The programme in Fata must not lose sight of the need to improve other aspects of campaign preparation and implementation. “Efforts to gain increased accessibility will be wasted if campaigns are poorly executed or mothers refuse the vaccine,” the report warns. Analysis shows that Fata parents are 40% more likely to refuse OPV than parents in any other part of the country.
With reference to the Quetta Block (Pishin, Killa Abdullah and Quetta city), the report expresses concern over the recent detection of cases of vaccine-derived polio. “These cases point to continuing deficiencies in vaccination coverage,” it states. The Board has applauded government authorities for matching GPEI funding of vaccinators and the ongoing involvement of the chief secretary and other senior officials.
According to the report, Gaddap Town, particularly Union Council 4, remains a thorn in the side of polio programme in southern Pakistan. “It is deeply frustrating that such a small geographical area can offer such succour to the polio virus. Environmental samples in the area continue to test positive,” it says. The report pays tribute to the District Commissioner and his team for ensuring that vaccination campaigns continued following a security incident in July 2012 after which Gaddap was declared a no-go area for UN staff. “The programme in Karachi appears to have a talent for community engagement from which other parts of Pakistan could learn,” the report states.
In presenting a national analysis, the IMB report recollects that just a year ago, the polio programme in Pakistan was deeply dysfunctional and required a fundamental change in its approach. “Case numbers were spiralling. Its action plan was more ‘plan’ than ‘action’. A year on, the picture is very different, with more children being reached by vaccination rounds, a decline in vaccine refusals, and an improvement in surveillance.
However, the report calls for further improvements in vaccination coverage and surveillance. Environmental surveillance shows transmission in Punjab and Sindh, where cases had not been spotted. Virologic analysis confirms that surveillance gaps persist. Too many children, particularly Pashtun children, are still being missed by vaccinators.
With reference to programmatic advances, the report commends the government for taking a $227 million loan from the Islamic Development Bank to fund eradication activities; for increasing the pay of vaccinators in some key areas; and for establishing a direct payment mechanism to ensure that they receive the money due to them.
In recommending further actions for polio-endemic countries, the report draws attention to country plans that are impressive, but unclear with reference to priorities. It terms the ongoing low transmission season as a golden opportunity, and calls upon country programmes to list no more than five priority goals that they will achieve by end of April 2013 and communicate these to all their staff.
The report also proposes efforts to increase parental demand for vaccine. It further suggests that polio vaccine be paired with other benefits because many communities see polio vaccination as an imposition with no benefit: yet they are in desperate need of other services.
The report reminds the GPEI of the hard fact that despite its promise to stop polio transmission globally by 2012, it has failed to do so. “The 2013-18 Endgame Strategic Plan must tackle the challenges that stand in way of eradication. It must be a once-in-a-generation plan if it is to fulfil a once-in-a-generation opportunity,” the report concludes. Vital to this plan will be a convincing case for a US $5.5 billion investment that is based on evidence and sets out the full benefits that polio eradication will bring.
Posted in: Islamabad
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