PESHAWAR: The poor polio vaccination campaigns in Khyber Pakhtunkhwa have worried the UN agencies, which have been supporting the province’s immunisation programme, according to sources.

The province has recorded 60 cases of the nationwide 276 cases. “There will be no let up in polio cases as the campaigns aren’t up to the mark,” the relevant officials said.

The donor agencies see no hope of eradicating the childhood ailment in the near future until the administrative problems with regard to immunisation are addressed. Officials said that the polio immunisation programme suffered from chronic problems that were never addressed.

“Polio vaccination has never been a success since its onset in 1994 in Fata and Khyber Pakhtunkhwa not because of violence but owing to administrative problems on the part of health department and lack of coordination with UN agencies,” officials said. Fata has recorded 169 polio cases in the current year.

Donors see no hope of eradicating the childhood ailment in near future owing to administrative problems

The incidents of violence related to anti-polio campaigns began in June 2012 when two vaccinators were killed in Charsadda. A total of 57 people, including 26 health workers and 31 security men, have been killed in the country allegedly by Taliban. Documents show that 31 persons also sustained injuries in polio-specific attacks.

In the attacks on vaccinators, 24 persons, including nine health workers and 15 policemen, were killed while in Fata 17 persons, including 14 security men and three health workers, were killed. Nine health workers were killed in Karachi while in Balochistan seven persons, including five health workers and two security personnel, were killed in attacks on anti-polio teams.

The attacks by Taliban on polio workers are cited as a reason for the health department’s inability to ensure good quality campaigns. Similarly, the anti-vaccine propaganda is also advanced as argument for soaring refusal cases against the OPV. However, documents show that the country continues to record cases on regular basis. The country had recorded 103 polio cases in 2003, 53 in 2004, 28 in 2005, 40 in 2006, 32 in 2007, 117 in 2008, 89 in 2009, 114 in 2010, 198 in 2011, 58 in 2012 and 72 in 2013.

As far as a single polio case exists, there is no possibility of virus eradication, according to World Health Organisation.

During all these years, the three main partners, including WHO, Unicef and health department failed to make a coordinated effort to do away the vaccine-preventable childhood disease.

Mobilisation, one of the three components of anti-polio campaign meant to create demand for vaccine and convince parents to get their children immunised, is responsibility of Unicef. The WHO extends technical assistance to the campaign besides supplying vaccines and devising macro and micro plans for the drives whereas the most important task of vaccinating children lies with the health department.

All the three components are interlinked and aimed at vaccinating at least 95 per cent of the target children to eradicate the disease as part of Pakistan’s international commitment.

However, lack of coordination among WHO, Unicef and health department has been hampering quality anti-polio vaccination, sources say.

Most of the campaigns carried out in Fata and Khyber Pakhtunkhwa didn’t fulfil the desired criteria owing to which the children were tested positive from areas where vaccination had been carried out.

The last week’s one-day polio vaccination is such an example which was launched hurriedly to vaccinate 654,383 in 97 union councils. Only 65 per cent of the 8,866 workers turned up as many stayed away owing to nonpayment for the past campaigns while others couldn’t be contacted on a short notice.

For each immunisation campaign, the union council polio eradication committees are required to hold meeting fortnight ago and district polio eradication committee 10 days ago in line with the guidelines set forth in the National Polio Action Plan. However, the drive was launched on a notice of 24 hours.

The health department is required to chalk out plans for vaccination which included registration of all immunisable children in certain neighbourhoods.

The vaccinators should be aged above18 years with priority to local workers with a ratio of 80:20 (female: male) after providing them training on standard module to scale up their know-how about vaccine administration but those protocols aren’t followed usually.

Sources said that under-age and untrained vaccinators were recruited who didn’t carry out immunisation to a desired level. The vaccinators, who should have been convincing the defiant parents to vaccinate their children, didn’t take pain to do so, they added.

Officials said that 33,635 children weren’t vaccinated in three-day campaign conducted in 21 districts of the province owing to refusal by parents last week. Majority of the refusal cases could have been covered but the vaccinators didn’t make any effort, they said.

The health department has often been complaining that Unicef and WHO ignore it in making important appointments for the campaign. During the past few years, the health department had sent written complaints against Unicef for not taking it on board in recruitment of social mobilisation officers, who were supposed to address refusal against the OPV.

The WHO and Unicef are unsure of any breakthrough in polio eradication till the quality of vaccination is not improved.

Published in Dawn, December 8th, 2014