Action Plan (NEAP). “The Task Force should particularly ensure that a monthly meeting of each chief secretary with their deputy commissioners goes ahead without exception, and with full attendance, to tightly oversee implementation of NEAP in each province,” it states.
The IMB’s third recommendation emphasises the need for the prime minister to receive a monthly briefing on stopping circulating vaccine-derived polio virus in the country to ensure that it does not stand in the way of the planned global withdrawal of trivalent oral polio vaccine.
The global polio watchdog has also called for an urgent global polio summit being convened on the subject of persistently missed child. This summit should be charged with the task of producing a plan that will cut the number of such children by 50% within six months.
Pakistan, the report states, “must not duck out of facing up to the fundamental barriers to reaching children, nor must it continue to reach for tired and unimaginative solutions that have failed in the past.” Whilst the majority of Pakistan is free from polio, the challenge of eradicating polio from a small number of geographical areas where it persists is formidable. “In most of the country, children are being reliably vaccinated against polio. But in too many, children are being persistently missed,” it states.
Pointing to other dysfunctions that remain, the report states that in some areas, half of all micro-plans used in campaigns are out of date; whole settlements that were previously being missed by vaccinators are being discovered; and most of the provincial Emergency Operating Centres have only been properly established in recent weeks.
Presenting a province-wise analysis, the report states that “in the whole of Pakistan, Peshawar tops the IMB’s list of concerns.” Terming the ‘United For Health’ initiative “a strong step in the right direction,” the IMB has called for urgent strengthening of the programme in Peshawar, with strong leadership and new ideas.
With reference to Fata, the report states that as displaced people start to return in coming months, good plans are in place to ensure that vaccination continues.
Khyber agency is now the greatest concern in Fata. “In two of its three subdivisions - Bara and Jamrud - both security and campaign quality are serious barriers to progress. The programme in Fata is well led, but the highest level of military and political support is required to close the remaining gaps in its polio eradication programme,” the report highlights.
With reference to Sindh, the report expresses concern about campaigns being delayed, virus regularly spread from Karachi to other parts of Pakistan, and violence being endemic and threatening to disrupt even the best-planned campaigns. “Strong programme leadership must be sustained in Karachi or all will be lost,” the report warns.
The Quetta block - Quetta, Killa Abdullah and Pishin - stopped polio transmission in 2013, but has since become re-infected. “The quality indicators show poor campaign performance that must be turned around,” the report states.
Punjab, the report states, has the best routine immunisation coverage in Pakistan, generally strong campaigns, and little problem with polio. “The province is innovating, using technology to track and support vaccinators’ work. But bordering the Northern Sindh outbreak, and with substantial movement between provinces, Punjab must retain the highest level of vigilance against polio,” it warns.
The key message of the report is that while Pakistan has established a more positive trajectory for its polio eradication programme, a great deal of change is still needed to translate this early positive momentum into meaningful progress against polio.