IMB urges Pakistan to quickly deal with remaining issues

ISLAMABAD: The Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative has exhorted Pakistan to build a programme that is truly capable of stopping polio by “dealing fast with the major dysfunctions that remain” because “the time to stop polio is now.” The global polio watchdog has made it crystal clear that it will expect nothing less when it next reviews Pakistan’s programme.
A forewarning to this effect is enshrined in the just-released 11th report of the IMB, which believes that while recent gains in the fight against polio should be applauded, they should not be a source of triumphalism until the crippling disease is totally eradicated.
“Time is absolutely of the essence. Pakistan was supposed to stop polio transmission by the end of 2014, and failed to do so. It has now established a new timeline, of stopping polio by May 2016. For some, this is too far away. There is no room for relaxing into a leisurely pace. The time is now,” the report emphasises.
In making Pakistan-specific recommendations, the report has urged the National Task Force to resolve, within the next four weeks, issues that are resulting in front-line workers not being properly paid.
However embarrassing it may be for Pakistan, the IMB has minced no words in highlighting that the country’s polio programme “does not pay its frontline workers reliably.” Its report states that the country’s polio programme has ideas to boost the morale, engagement and status of its all-important vaccinators, “but this will be wishful thinking unless the serious demotivator - not being paid in full and on time - is properly done away with. This must be resolved - and urgently,” the report highlights.
Secondly, the IMB has recommended that the National Task Force should meet at least on a monthly basis until polio transmission is stopped, to oversee strict implementation of the National Emergency 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.