LAHORE: Frustrated by the performance of Pakistan’s Polio Programme, the Independent Monitoring Board (IMB) has declared that the number of missed children in 2021 vaccination rounds all over the country is still higher than it was in 2018 and 2019.

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.

In its recent report on Pakistan’s Polio Programme, the global body has marked Punjab as a ‘poor performer’ compared to other provinces.

The IMB says that “still missed” children have spread alarmingly across the province with majority in Lahore and Rawalpindi.

IMB report says missed children in 2021 rounds all over country still higher than 2018-19

The report cites the government officials as telling the IMB that the problem is mostly because of the non-availability of the children. Refusals are mainly in Rawalpindi where there is a large Pashtun population, it says.

The IMB’s 20th report on Pakistan’s Polio Programme released a week back has presented an overview of polio vaccination status all over the country.

It states that when the IMB had its meetings with the provinces in mid-May 2021, in most cases, there had been no vaccine round since March 2021 to assess progress (a gap of nearly three months).

For this reason, the IMB held back the draft of its report until it had early sight of the June 2021 vaccination campaign data.

“The latest data on vaccination campaign quality and “still missed” children has been added to our account of progress in this, the final, version of the report,” the IMB says.

Showing its serious concerns over the rising number of missed children, the report states that it was somewhat surprising for the IMB to hear that certain technical programmatic basics were deficient.

For example, simple things like the cold chain, the vaccine-carriers, the ice packs, were not in place everywhere that they were needed, it says.

Some vaccinators did not have [vaccine] carriers and were transporting doses in bags of their own with a few accompanying ice cubes.

“The polio programme has had to supply 75,000 vaccine-carriers. Having remedied this problem, the National Emergency Operations Centre found gaps in the availability of freezers and the absence of some electricity supplies and dealt with them too,” reads the report.

There were also populations missing from micro-plans. In some provincial teams, vaccinators have huge workloads and so cannot finish their work until late afternoon.

Polio programme in Punjab

In Punjab, previous polio problems have tended to be concentrated in the south of the province, whereas recent outbreaks were in the vicinity of Lahore.

The June 2021 vaccination campaign quality data showed rates were struggling to reach 80pc in Faisalabad, Lahore and Rawalpindi. The problems in these areas must be sorted out quickly.

“In particular, if Lahore does not stop transmission in the next three or four months, it will sit alongside Karachi as a very serious concern,” reads the IMB report.

It was a surprise to see Punjab entering the grim ranks of the worst performers, reads the report adding that it is perhaps a lesson to all, at this crucial point in the history of polio in Pakistan, of the dangers of complacency.

When the June 2021 vaccination campaign quality assessment data became available, it showed a variable picture, sometimes at odds with the compelling statements of progress made at the IMB meeting.

Sindh

The IMB declares that the vaccination campaign quality data has again shown weak performance in Karachi.

Quality declined from an already low base of 60 per cent in March 2021 to 50pc in June 2021. Problems in quality are affecting all districts. Positive environmental samples have broadly matched geographically this pattern of low campaign quality.

“Karachi is a big place. People from everywhere come there. It is a longstanding endemic area, but also a major hub and distribution point for the polio virus. This means that the demands on polio programme quality in Karachi are surely the highest of anywhere in Pakistan,” reads the report.

Balochistan

The last two IMB reports highlight several specific concerns about the provincial polio programme in Balochistan, including gaps in campaign quality in Quetta city and pockets of vaccine refusal there; an inability to control security and local elements in Killa Abdullah; the need to stop virus carriage across the border in Chaman district; and restriction on international staff movement.

Three high-risk districts - Quetta, Killa Abdullah and Pishin - have been a constant cause for concern, reads the report.

The numbers of “still missed” children went up in each of these districts between the March 2021 and the June 2021 vaccination rounds, the increase doubling in Quetta.

The June 2021 campaign quality data showed more encouraging results in Killa Abdullah (90pc) and Pishin (100pc), but Quetta fell short (79pc).

Khyber Pakhtunkhwa

In the KP province, the Peshawar and Khyber [Agency] results were good (in the 85-100pc range) but in the south of this province, the Swat district, largely inhabited by Pashtun people, scored 30pc, Lakki Marwat was 60pc and there were no results for Bannu.

“The IMB follow-up suggests that, after some delay, these districts were partially covered by the June 2021 vaccination campaign,” reads the report.

Apparently, the delay was caused by a local political matter, not related to polio. Any delay or failure of quality assurance in the August 2021 round will be very bad news.

Published in Dawn, July 29th, 2021