ISLAMABAD: The Independent Monitoring Board for Polio has said that Pakistan has made considerable improvement in the fight against polio.

A meeting of the board, presided over by IMB Chairman Sir Liam Donaldson, was held in London on Oct 5 and 6.

In a report released after the meeting, IMB declared the Peshawar valley and the Federally Administered Tribal Areas (Fata) as a ‘conveyer belt’ of polio transmission and noted that this was possibly the last reservoir of wild poliovirus left in the world.

The IMB works on behalf of international donor agencies and issues reports on the countries’ performance after every six months.

In Nov 2012, it recommended that travel restrictions be imposed on Pakistan and finally those recommendations were implemented on May 5 last year.

Also read: ‘Zarb-i-Azb helped decrease polio cases’

The report says whilst security is a barrier to reaching children in some areas, there is no excuse for outright poor programme performance. In some areas, supplementary immunisation activity remains substandard – notably in Quetta and Karachi. This year has also seen cases of wild poliovirus in Sindh, away from areas of previous concern.

Whilst there needs to be vigilance and polio eradication activity across all areas of Pakistan, it is Peshawar and surrounding regions of the country that must receive the greatest attention in this low season if polio transmission is to be interrupted.

According to the report, throughout history the road that links Peshawar to Jalalabad – through the mountains along the Khyber Pass – has been of great strategic importance. It was a significant trade route along the Silk Road, a critical military corridor in many conflicts down the ages.

The IMB said the cities, towns and villages along this road and in the surrounding Peshawar Valley – and the transient flows of people that moved through them to the border and Fata – were at the heart of a great reservoir of the wild poliovirus. “Once again, in the polio story, it has become a focus of attention around the world – the poliovirus’ heartland, and a ‘conveyor belt’ of onward transmission.

The report said although this was one epidemiological block, it spanned two sovereign countries. The continued presence of cases in the Peshawar Valley, and on both sides of the Afghanistan-Pakistan border between these two key cities, showed a need for intense focus and eradication effort. “The fact this disease reservoir sits on two sides of a national border and across different Pakistani administrative regions adds complexity.”

According to the IMB, the programme needed to work harder to track down unvaccinated populations in such a mountainous and varied country. It also needed to understand when its processes were imperfect. Understanding, for example, that when ‘No Team’ was given as a reason for missing children, then this was a programmatic failure that must be escalated to the provincial secretary level and corrective action taken.

“There is only one more low season to get it right before the new 2016 deadline and before the $1 billion a year consequences of failure are upon the programme. To succeed, there can be no more excuses, no more postponements, and no more distractions.”

The report said an unremitting focus must be placed on Peshawar and its vicinity. “It is the key to success and to failure in Pakistan. If polio can be eliminated in this part of Pakistan during the low season then there is an excellent chance that the country will have interrupted transmission during 2016. If the programme comes out of the low season in Peshawar with cases still occurring, then the polio ‘conveyor belt’ will spring into life and there will almost certainly be a substantial outbreak in the high season.”

It said other areas of Pakistan must also receive robust attention. There was an unnerving comparison with Nigeria. A year before Nigeria interrupted transmission there were fewer reservoirs than in Pakistan. On this basis, Pakistan was not yet on the right trajectory for 2016.

The Minister for National Health Services, Saira Afzal Tarar, welcomed the report and said she was encouraged by its findings.

In a statement, she attributed recent gains in the programme to “an exemplary political commitment” at federal and provincial levels.

The Prime Minister’s Focal Person for Polio Eradication, Senator Ayesha Raza Farooq, said the Pakistan programme now had all the ingredients required to finish the job in areas pointed out by the IMB.

Head of National Emergency Operation Centre Dr Rana Safdar told Dawn that although the IMB had given some suggestions it also praised the performance of the polio programme in Pakistan.

An official who works against polio said that in Afghan provinces of Kunar, Nangarhar, Paktika and Khost a breakaway group of the Taliban, which called itself the self-styled Islamic State, has banned all health activities, including anti-polio campaigns.

Talking to Dawn, Fata’s Law and Order Secretary and Coordinator for Polio, Shakil Qadir Khan, said that he totally agreed with the IMB’s findings.

“If poliovirus is controlled in Fata and some areas of Afghanistan, it will be eliminated. But since people belonging to the same tribes live on both sides of the border, it is technically difficult to stop their movement,” he said.

Published in Dawn, November 13th, 2015