ISLAMABAD: The Technical Advisory Group (TAG) on Polio, which visited Pakistan last week, recommended involving security departments in planning of polio campaigns and offering incentives to polio workers.

The TAG emphasised the importance of utilising the low transmission season which lasts until May.

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TAG appreciated the Khyber Pakhtunkhwa (KP) government’s programme ‘Sehat Ka Ittehad’ and suggested that the model be replicated in other areas of the country. The KP programme involves taking numerous stakeholders such as army and community on board for day long, frequent polio campaigns.

Day-long campaigns to be launched in 126 high-risk union councils

International experts make up the TAG, which reviews progress on polio eradication throughout the world by assessing implementation of past recommendations.

In its presentation, available with Dawn, TAG suggested that the health departments benefit from the low transmission season, which begins in November and ends in April. The virus becomes less active in lower temperatures and hence easier to eradicate.

TAG noted that Pakistan has the highest number of annual polio cases reported during the last decade and known reservoirs of polio exist in the country.

Experts expressed concern over outbreaks in Quetta and South Khyber Pakhtunkhawa because these areas were once polio free. They also said central Pakistan could be a possible hide-out for the poliovirus.

TAG’s panel of experts appreciated the establishment of the Emergency Operation Centres (EOCs) with accountability mechanisms, at the national and provincial levels. But the panel also noted that improved accountability for the EOC requires political support.

TAG noted that with circulation of poliovirus in the country, Karachi may become the most dangerous polio reservoir with potential to amplify and export the virus unless urgent steps are taken.

The experts said that children in some areas of Karachi could still not be vaccinated because of security problems. They said that operational and security plans have not been synchronised, because of which three supplementary immunisation activities (SIAs) were missed in parts of Karachi since November 2014.

In Karachi, like other parts of the country, security and communication plans should aim to produce an enabling environment on the ground for vaccination teams, they said.

Discussing Punjab’s polio campaign, the panel recognised the enhanced commitment from provincial leadership at the highest level but expressed concern over persistent detection of poliovirus in environmental samples in Lahore, indicating missed population pockets.

The panel suggested that urgent steps be taken to ensure all high risk and migrant communities are included in the Union Council Micro Plans in Lahore and Rawalpindi.

While talking about KP, TAG again appreciated the commitment shown by political leadership and said the opportunity to reach populations in North Waziristan has been utilised well through targeted campaigns.

The experts said that the initiative ‘Sehat ka Ittehad’ provides a good platform for synchronised implementation in Federally Administered Tribal Areas (Fata) and could be used to improve community support.

The panel noted with concern that the implementation of the Low Season Plan has not kicked off in the Khyber Agency (Bara and parts of Jamrud in particular).

The advisory group said although poliovirus has been reported in Balochistan, the province has demonstrated the capacity to stop poliovirus transmission in the past, managing to control it twice.

A Ministry of National Health Services (NHS) official, requesting anonymity, said that TAG was invited by the health department in the hope that it would suggest that the day-long campaigns of Sehat Ka Ittehad programme are not required in other areas.

The official said that the ministry is opposed to the day-long campaigns preferring the less frequent, three-day long campaigns.

“However, the advisory group suggested the Sehat ka Ittehad programme be replicated because it is the only way to eradicate polio from Pakistan,” he said.

The EOC head, Dr Rana Safdar, told Dawn that TAG was invited to discuss the government’s plan regarding polio eradication and inform the group regarding progress in Karachi and Waziristan.

“They were informed that we have been focusing on problem zones and day-long campaigns will be held in 126 high-risk union councils of Fata, KP and Karachi,” he said.

Dr Safdar said TAG suggested implementation of plans made for low transmission season.

“TAG also suggested taking security departments on board and involving them in planning to achieve maximum results. Moreover, it was suggested that greater incentives be offered to polio workers because they have been working in very difficult circumstances,” he said.

“We have decided to launch four major polio campaigns and a number of smaller campaigns all over the country, during low transmission season,” he added.

Published in Dawn, February 23rd, 2015

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