Polio in Pakistan

 

Pakistan is one of only three countries in the world with ongoing wild poliovirus transmission, alongside Afghanistan and Nigeria. In the last stage of polio eradication, Pakistan has made tremendous progress towards poliovirus transmission interruption and eradication.

Two years ago, transmission of the wild poliovirus was widespread. In less than 24 months, a reinvigorated programme has been able to first stem the tide of uncontrolled transmission and then tackle the more chronic underlying challenges that have proven obstacles to virus interruption and eradication.  

The number of children paralysed by the wild poliovirus has dropped progressively from 306 in 2014 to 54 in 2015 to 20 in 2016 and 2 cases in 2017 so far. Eradication efforts have begun to close the immunity gaps and the programme is on track to reaching the goal of interrupting the transmission of polio in Pakistan. 

To accomplish the eradication of the poliovirus, Pakistan Polio Eradication Programme refocussed its goal from “coverage” to “no missed children”. This paradigm shift has driven programme operations with very encouraging results. The proportion of children recorded as “missed” during campaigns and remaining unvaccinated after each campaign has declined to approximately 4% in the 2016 low transmission season.

Today, the genetic picture for Pakistan provides basis for optimism especially if the gains achieved so far are sustained and intensified in the remaining areas of residual wild poliovirus transmission. 

At the moment, the virus is cornered in just three remaining sanctuaries – the Khyber-Peshawar corridor, Karachi and the Quetta block. However, the risks to Pakistan span beyond these areas and a determined focus on delivering high quality campaigns that ensure finding and vaccinating every missed child is critical to stop virus circulation. 

The target of the National Emergency Plan (NEAP) 2016-17 is to stop transmission in the core reservoirs and maintain or increase population immunity against polio in the rest of the country. To achieve this goal, the programme has set up a multi-pronged strategy with a robust work plan to ensure all children are vaccinated and any circulating virus is detected quickly and responded to immediately.

The polio eradication effort in Pakistan enjoys full government support across party lines as well as the support of parents, communities, religious leaders, professionals, paediatricians.

The program is now driven by high-quality data and comprehensive, real-time risk assessment to reach and vaccinate all children with particular focus on those children who have been missed amongst the 37 million target under 5 population. 

The programme now has access to almost all children in Pakistan thanks to a number of innovative approaches including community based vaccination, high risk mobile population strategy to catch children on the move and the support of the Pakistan Army who enabled access to almost half a million children who were previously unreached by vaccination teams in North Waziristan. 

A dedicated network of 250,000 Sehat Muhafiz (Health Protector) are at the centre of the effort. They have been selected from their local communities and trained to motivate communities around polio immunization activities in Pakistan.

The vast majority of parents in Pakistan accept the polio vaccine: less than 0.05% refuse vaccination in the highest risk areas.

The programme is using a combination of inactivated polio vaccine (IPV) and Oral Polio Vaccine (OPV) to boost individual immunity of children (aged 4-23 months) in all Tier 1 districts and as many Tier 2 high risk districts as possible. Combining OPV and IPV provides stronger protection against polio.  IPV strengthens immunity in the blood while OPV strengthens immunity in the gut.