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2019 a horrible year for anti-polio prgramme in Pakistan: report

November 20, 2019
2019 a horrible year for anti-polio prgramme in Pakistan: report

Photo: AFP

The year 2019 has been a horrible year for the polio programme in Pakistan and the world and a year of triumph for the poliovirus, said the Independent Monitoring Board, a body that assesses progress made across the globe on efforts to eradicate polio.

The IMB has raised concerns about the rising number of polio cases being reported in Pakistan in a report published in November 2019. It noted that while the public message of “nearly there”, “one final push” and “polio at a historical low” was being pushed, it found several contradictions in Pakistan.

It noted that there is

  • Widespread hostility to and rejection of the oral polio vaccine in many communities
  • Weak emergency culture not commensurate with the present stage of the eradication process
  • Oppressive top-down demands stifling local creativity and ingenuity and creating a climate of fear at the frontline
  • Top performing staff not being identified or sent to the most difficult places
  • Action to raise essential immunisation levels unconvincing and inadequate
  • A programme inundated with excessive amounts of data and weak in using insights to improve quality
  • Widespread environmental samples and community mistrust in the Pakistan Programme were not being given proper attention

The number of cases of wild poliovirus in Pakistan stood at 77 on 29 October 2019 and at 19 in Afghanistan. Last year, there were only six cases in Pakistan and 19 in Afghanistan.

“In Pakistan, 15,000 babies are born every day. The comparable figure for Afghanistan is 3,000. This is a formidable accumulation of susceptibles every day, if there are insufficient women vaccinators and monitors, especially in remote areas, getting into the houses to check the newborns,” it noted in its report.

“Polio in Pakistan began its resurgence in the third quarter of 2018, and intensified in the second quarter of 2019, with a record number of cases (38) in that quarter alone. This was followed by 30 cases in the third quarter of 2019,” read the report. It noted “major outbreaks” across Khyber Pakhtunkhwa (57 cases) and “intense virus circulation” in parts of Punjab, Sindh and Balochistan.

“The pattern of poliovirus-positive environmental samples is another indication of the depth of the problem. Within the core reservoirs of Peshawar, Karachi and Quetta block, 69% of samples were reported to be positive in 2019. This is compared to only 29% of samples in total in 2018,” it said. “Outside core reservoirs, there has been entrenched transmission in Lahore (88% of 2019 environmental samples were positive); indeed, three sampling sites out of five were reported as 100% positive. Within the core reservoirs (Peshawar, Karachi and Quetta block), transmission has been most intense in Karachi; all 11 environmental sampling sites have reported positive for wild poliovirus,” noted the IMB in its report.

It noted that the polio virus is spreading and 25 districts have reported polio cases in 2019 so far. In 2018, this number was at five. The number of infected districts, having either polio cases or positive environmental samples, has almost doubled, it added.

It said that the Pakistan Polio Programme’s performance has gone from bad to worse: the most recent vaccine rounds in Islamabad, Punjab, and Sindh scored 44%, 64%, 56% against a benchmark of 90%

Though the government has made strong statements in support of the polio programme, the IMB noted that polio is still rising.

In a depressing statement, the IMB said that its technical advisory group for Pakistan has always made “helpful and constructive criticisms of the polio programme in Pakistan” but its reports have always been “rather encouraging, with a tendency always to see light at the end of the tunnel”.

“However, the most recent report of this committee made a searing and devastating condemnation of the state of polio transmission in the country,” it said. It gave an example of this as well. “The programme in KP has shifted from being an example to the country as a whole to becoming an emblem of the national programme’s current crisis. KP has re-assumed its position as a major global barrier to polio eradication,” it said. “Transmission in Karachi is now everywhere,” said the report, adding “Signs of programme deterioration are everywhere [in Punjab].”

It has blamed the sorry state of the polio programme on

  • Absence of political unity
  • Dysfunctional teamwork
  • Alienated and mistrustful communities
  • Suboptimal technical performance

The IMB said the situation is “grave and of very deep concern”.

“Pakistan has reported more than 80% of the total global polio cases this year, with 90% of them reported outside the traditional core reservoirs. The September 2019 campaign reported the highest number of missed children in Pakistan, ever,” it said.

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Polio, pakistan polio, imb, independent monitoring board
 
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