Towards a polio-free Pakistan

The year 2020 has (finally) come to an end. The year will be remembered for the 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 need 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 the government’s 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 a total of 84 wild polio cases have been detected from 38 districts of Pakistan in 2020 to date. Amidst Covid-19, it represents a 43 percent decline over 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, Afghani- stan also went on recording 56 cases of polio during 2020.

Our effort to eradicate polio suffered immensely in 2019 and thereby ushered in a new era of hard work for the country’s anti-polio 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 gaps 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 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 the political divide and across all segments of society. A ‘One Team’ approach was quickly revived, and a fresh battle initiated from Dec 2019, conducting two high-quality nationwide campaigns and subnational door-to-door campaigns in a three-month time before Covid-19 forced yet another suspension of immunization activities. During these times, the programme’s strengths and capacities were successfully diverted towards Covid-19 surveillance and response.

Sensing the 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 in 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 other security arms of government continue their support, including but not limited to facilitating access and security to 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 the Covid-19 virus 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 coverage above the pre-Covid-19 times, with a special focus on populations living at larger distances from 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 have 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 with similar risk factors related to vaccination in general, thus ensuring a holistic approach.

The year 2021 presents a unique opportunity now to leverage the gains made in 2020, despite the pandemic. We are looking forward to sustaining the high levels of leadership support across the political divide and society segments, consolidating and further strengthening the programme structure, 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 historically reservoir areas and get closer to the goal of eradication in 2021.

We thank all polio frontline workers, our heroes, whose dedication contributed to the progress in our efforts in 2020. We also thank all our 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.

The writer is the coordinator of the National Emergency Operations Centre for Polio Eradication and EPI.