LAHORE: At a time when Pakistan is moving towards a new wave of wild polio virus epidemiology, the International Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) has said that changes in government have often seriously harmed the polio programme in the country.

While releasing its April’s report in the last week of May it has linked the polio cases surge in Pakistan with the ‘unwanted’ changes made by the Pakistan government [Pakistan Tehreek-i-Insaf] in polio programme.

“The IMB is uneasy because 2023 will be an election year in Pakistan and the changes in government have often harmed the polio programme in Pakistan”, reads the board report.

It has also raised another serious issue of ‘still missed children’ surfacing in all the four provinces of the country, an unending problem that is yet to be addressed seriously.

GPEI board finds issue of ‘still missed children’ worrisome

The IMB further said the GPEI leadership is also concerned about a strong likelihood of sustaining transmission in very specific high-risk populations and districts straddling the Pakistan-Afghanistan border.

This includes Afghan returnees from south-east Afghanistan, who move internally within Afghanistan, and into North and South Waziristan and adjoining districts of Pakistan.

At that time (April), the wild polio virus epidemiology in Pakistan was looking much more favourable than it had been a year previously.

The IMB lamented that despite the unequivocal statements of cross-party support for polio eradication given to the IMB in early 2018, these promises were not honoured, continuity was seriously disrupted, changes to the programme were made that did not work and polio cases surged in Pakistan during 2019 and 2020.

“In the weeks after the IMB meeting, the national political context changed dramatically. Prime Minister Imran Khan was ousted after a parliamentary vote of no confidence in early April 2022 and much of his ruling party then resigned”, reads the report.

“While the national elections will still be in 2023, a new government is likely to be continuously in place from now until then (though there are circumstances in which this could change). The full implications of the break in continuity for the polio programme are not yet clear.”

The IMB said a number of key organisational and governance features of the Pakistan polio programme have been transformative in keeping the country safe from the effects of wild polio virus for more than a year, until the appearance of two recent cases.

It warned that if the new government does not ensure continuity of approach and puts in place measures that do not replicate the key features of the previous arrangements, polio is likely to make a return on a larger scale in Pakistan.

It said the gaps in the programme performance, particularly in southern Khyber Pakhtunkhwa are worrying.

“Most of the IMB’s discussion on Pakistan with the global and national polio teams have centred on concerns about the risks of a wild poliovirus outbreak in southern Khyber Pakhtunkhwa’, reads the report.

It further says the perception that this geographical area is pivotal to the eradication of polio in Pakistan was captured in a remark made by a member of the federal government polio team: “If we get the virus in Quetta or Karachi or Lahore or in any other city, that means we have lost the battle in south KP”.

The GPEI reported that, in Pakistan, two new cases of type 1 wild poliovirus had been detected in North Waziristan in the Khyber Pakhtunkhwa province.

“It remains to be seen whether these two cases that came a few weeks after the IMB meeting are the start of something bigger,” reads the report.

However, there were many causes for concern. The IMB said the data showing suboptimal campaign quality, the number of “still missed” children after active vaccination campaigns, the difficulties in comprehensively reaching populations flowing back and forth across the border with Afghanistan, and the ongoing pockets of insecurity in parts of the south of the province are among the reasons that southern Khyber Pakhtunkhwa is undermining the feelings of optimism about Pakistan’s progress.

The global body was much worried about the ‘still missed children”, a common issue surfacing in all the four provinces of the country.

“Each of the four provincial polio programme teams was asked by the IMB to spell out their top three worries. The response was the same across the three provinces of Sindh, Balochistan and Punjab: high numbers of “still missed” children; the risks of population movement (cross-border or high-risk mobile) and low rates of essential immunisation and high numbers of zero-dose children”, reads the report.

The KP polio team also mentioned cross-border population influx from Afghanistan, says the IMB.

It says investigating the reasons for refusals and “still missed” children is essential work that the IMB has been recommending since its early days at a time that such qualitative data were not mainstreamed into the polio programme’s work.

Published in Dawn, June 2nd, 2022