LAHORE: The Independent Monitoring Board (IMB) has declared that the epidemiological situation in Pakistan is extremely worrying and disappointing, stating that particularly the outbreak of the wild poliovirus in the southern part of Khyber Pakhtunkhwa (KP) province continues alongside the core reservoirs of Karachi and Quetta.

The IMB provides an independent assessment of the progress being made by the Global Polio Eradication Initiative (GPEI) in the detection and interruption of polio transmission globally.

The top global health body fears that beyond the traditional reservoirs, transmission is expanding to previously polio-free areas of Pakistan. A major outbreak of vaccine-derived poliovirus cases is also besetting Pakistan, reads a report of the IMB (a copy is also available with Dawn).

“If no mass vaccination activities take place, there will be many more polio cases than were expected, pre-Covid-19, by the end of the year”.

“The numbers could go into hundreds,” the report said while making more stunning revelations about pathetic response of the country towards achieving the targets to stop transmission of the poliovirus at a time when the World Health Organisation declared Africa polio-free.

Even Africa had recently been declared polio-free

According to the report, the IMB remains deeply concerned about the prospects for polio eradication in Pakistan.

“There is every possibility that Pakistan will be the last place on Earth to harbour this terrible disease,” reads the report.

The then health minister Mirza spoke at the IMB meeting on behalf of the government about their plans for “transformation”, it said. The health minister and senior officials from the four polio-affected provinces had spoke knowledgably and authoritatively about the action needed in their cities and smaller communities.

The Pakistan Polio Programme that needs transformational change was a good control programme in 2017 and 2018, the IMB said.

“The polio situation in Pakistan is very grave. There have been 61 wild poliovirus cases so far in 2020 (31 July data) compared to 56 by this time in 2019. The surge in vaccine-derived polio cases in Pakistan is shocking. They represented almost a third of the entire world’s such cases at the end of July 2020,” reads the IMB report.

While discussing disturbing situation in some main cities of the country, the Board stated that the outbreak of wild poliovirus in southern Khyber Pakhtunkhwa (KP) has not stopped.

In Punjab, the authorities have not even been able to stop transmission in Lahore, the main city of the province, it said while declaring Karachi a long-standing power base of the poliovirus where the Sindh government was unable to find effective medical officers to lead the polio response.

In Quetta some of the long-standing problems are associated with persistent or repeated poliovirus infection are yet to be addressed comprehensively, reads the report.

“Border vaccination of large numbers of children that cross the Chaman border daily is yet to be optimised. An added complexity for the Polio Programme is the inability of international staff to move and to monitor programme implementation,” it said.

The board said that given the epidemiological situation, there is great urgency to resume regular polio vaccination campaigns in Pakistan.

In 2019, according the IMB, Pakistan’s health minister had announced the establishment of a high-level National Strategic Advisory Group as part of the transformation agenda on polio eradication and essential immunisation.

“This group has not met. This sent a confusing message about the government’s ability and determination to create an unambiguous and non-partisan commitment to everything necessary for success in polio eradication,” reads the report.

Key provinces

According to the report, all the provinces in Pakistan are facing the acute challenge of Covid-19 that is disrupting their polio eradication programmes, essential immunisation, and virtually all public services in most areas.

Punjab

According to the IMB report, Lahore has had circulation of wild poliovirus for about 15 months. It has been a key polio-affected area many times in the past, but circulation was interrupted in 2014, 2015 and 2016.

“The representative of the province who attended the IMB told us that, in those days, there were many more campaigns than now. Supplementary National Immunisation Days happened every month. There were occasions when the intra-campaign gap was only 25 days,” reads the report.

In Punjab these days, out of 2,000 approved vaccinator posts, nearly 700 are vacant. The Punjab team that attended the IMB meeting, stated that, compared with 2019, it felt in a slightly better position.

Khyber Pakhtunkhwa

The province has had persistent wild poliovirus isolations in its southern districts during 2019 and 2020, with transmission of vaccine-derived poliovirus detected initially in one district, in November 2019, and later in others.

The report stated that overall the province has had widespread transmission of both wild and vaccine-derived polioviruses.

In 2019, it accounted for 63% of all wild poliovirus cases in Pakistan. While the poliovirus was isolated from all the parts of the province (central, southern and northern) in 2019, 86 per cent were from the south and about three quarters were specifically from Bannu Division (Bannu, Lakki Marwat, North Waziristan districts).

By the end of July 2020, no wild poliovirus cases had been detected outside the south of the province.

Sindh

After the initial successes in 2017 and 2018, the performance of the province went downhill in 2019, the report said. The drop has been continuing into 2020. There were only four wild poliovirus cases by July 31, 2019. So far in 2020 there have been 20 cases,19 of which were outside Karachi (July 31 data). Cases have occurred across all tiers of the district classification.

The proportion of environmental positive isolates in 2019 increased to 73pc and it has further increased to 85pc in Karachi in 2020 (July 31 data).

Other divisions of Sindh are not doing any better. The number of “still missed” children is a big cause for concern, especially in Karachi where the number does not meet the national benchmark.

“Analysis of the reasons for “still missed” children shows that the biggest is misconception-related refusals,” reads the report.

It unveiled shocking figures that between 30,000 and 40,000 children are being missed, especially in Karachi.

Balochistan

In the province, the wild poliovirus transmission has been re-established since May 2019 in the known polio hotspots within the Quetta Block, comprising parts of Quetta City, Chaman tehsil in the Killa Abdullah district, and Pishin district.

The Quetta Block is an important contributor to the southern cross-border poliovirus corridor connected with southern region of Afghanistan.

Published in Dawn, August 29th, 2020