WHO’s body upset over polio vaccinations at airports

Islamabad :The Emergency Committee of the International Health Regulations (IHR) has shown dissatisfaction over quality of Polio Vaccinations administered at all International airports of the country and has recommended another three-month extension in temporary international travel restrictions on Pakistan, where 72 cases of polio have been confirmed.

These recommendations are in place since 2014 when the same committee of the World Health Health had announced travel restrictions on travellers leaving the country for international travel.

“The Committee is gravely concerned by the significant further increase in wild poliovirus (WPV1) cases globally to 73 in 2019 to date, in Pakistan,” reads the statement of the 22nd meeting of the Committee, which was convened on the call of the Director General of the World Health Organization (WHO) on September 16, 2019 at the WHO Headquarters.

The Committee believes that the risk of international spread of poliovirus still remains a Public Health Emergency of International Concern (PHEIC).

“In Pakistan, transmission continues to be widespread, as indicated by both AFP (acute flaccid paralysis) surveillance and environmental sampling, although the Khyber Pakhtunkhwa province was of particular concern. The increasing refusal by individuals and communities to accept vaccination is a serious setback to eradication. The Committee was very concerned about the current status of the polio programme in Pakistan but understood that steps are being taken to get the programme “back on track,” reads the statement.

Highlighting these concerns, the Committee noted that based on sequencing of viruses, there were new and recent instances of international spread of viruses from Pakistan to Afghanistan, in addition to the earlier reported exportation of virus to Iran (but without further transmission). “The resumption of WPV1 international spread between Pakistan and Afghanistan suggests that rising transmission in Pakistan correlates with increasing risk of WPV1 exportation beyond the single epidemiological block formed by the two countries,” the statement points out.

The Committee noted the continued coordination between Afghanistan and Pakistan, particularly in reaching high-risk mobile populations, and welcomed the all-age vaccination now being taken at key border points between the two countries. It was concerned that after five years of vaccinating travelers as a means to limit the risk of international spread, there was some evidence of complacency about this aspect of the programme, particularly at airports, and this must be addressed to prevent further international spread.

The committee noted that as the risk of international spread of WPV1 was the highest since 2014, the risk of exportation events from Pakistan and Afghanistan through air travel was also greater than in recent years and urged both countries to ensure adequate funding and monitoring of airport and travel vaccination was in place. “While travel vaccination may not be a major priority in terms of impact on the control of WPV1 in the two countries, it represents a critical control point in preventing international spread,” the statement reads.

The Committee considered the following factors in reaching this conclusion: WPV1 exportation in 2019 from Pakistan to Iran and to Afghanistan; ongoing rise in the number of WPV1 cases and positive environmental samples in Pakistan; the urgent need to overhaul the programme in Pakistan, which although already commencing, will take some time to lead to more effective control of transmission; increasing community resistance to the polio programme; and possible fatigue in implementing traveler immunization at airports increasing the risk of international spread beyond Pakistan and Afghanistan.

The recommendations require Pakistan to ensure that all residents and long-term visitors (i.e. > four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel; to ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure; ensure that such travelers are provided with an International Certificate of Vaccination to serve as proof of vaccination; and restrict the international travel of any resident lacking documentation of appropriate polio vaccination.

The recommendations also require further intensification of cross-border efforts by improving coordination to substantially increase vaccination coverage; and efforts to increase routine immunization coverage. Pakistan is required to maintain these measures until at least six months have passed without new infections.