All these years Habiba Haider has been working in difficult situations. A Lady Health Supervisor in Karachi's SITE area, she has often faced security situations, where she has been forced to give up and flee. However, she has never been scared of convincing the parents of children about the safety of the polio vaccine or how getting their children vaccinated against the disease is so important. She wants a polio free Pakistan.

However, this time around, the polio campaign has a new set of challenges for Haider.

Pakistan is currently facing an alarming situation when it comes to polio eradication as the virus is being detected in sewage waters in major cities across Pakistan.

So far in the current year, a total of 59 cases of the wild polio virus have been reported in the country, including 21 from Khyber Pakhtunkhwa, 20 from Sindh, 14 from Balochistan and four from Punjab. And since March 2020, routine immunisation services have been significantly affected on account of the strict lockdowns due to Covid-19. But even after the lockdowns eased up, fears about transmission of coronavirus prevented parents from accessing immunisation services, putting millions of children at risk of a resurgence of vaccine-preventable diseases.

Pakistan, like many countries, also temporarily (and justifiably) suspended vaccination campaigns, including polio, due to risk of transmission of coronavirus and the need to maintain physical distancing during the early stages of the Covid-19 outbreak. In addition, all focus and attention was diverted towards battling the coronavirus.

This happened as the World Health Organisation and other international health authorities in an extraordinary decision announced that all global vaccination campaigns should temporarily be halted because of the pandemic. And on March 24, the Global Polio Eradication Initiative (GPEI) also announced that all vaccination programmes be paused until the second half of 2020.

As was expected, the disruption in immunisation led to widening the immunity gap against polio. The cohort of unimmunised children has increased, including close to 700,000 newborns per month, since the door-to-door campaigns were suspended.

Although routine immunisation resumed after a gap of two months, following guidelines and SOPs, the door-to-door polio campaigns could not restart at the time.

Experts have been warning of a surge in other infectious diseases as well and fear that the post-coronavirus situation in Pakistan will be quite tough due to looming threats from other diseases that have gone completely neglected. As for polio, public health consequences in halting campaigns for a long time may end up having grave implications for children's health.

The decision to halt door-to-door campaigns taken earlier was not only difficult but also unparalleled. The polio programme has already observed persistent circulation of the wild polio virus (WPV1) and the vaccine-derived poliovirus type-2 (cVDPV2) in Pakistan with the case count of the former having reached 59 in 28 infected districts and the latter surging with 47 cases. This is alarming when compared to the numbers for the two from around the same time last year — WPV cases were at 44 and cVDPV2 cases were 0.

Failure to contain the outbreaks has resulted in the expansion and introduction of WPV1 and cVDPV2 into new areas. If a population is fully immunised against polio, it will be protected against both wild and vaccine-derived strains of the virus.

This situation appears to have led to the government's decision to resume polio vaccination activities from July 20, albeit on a relatively smaller scale with door-to-door campaigns to be held in selected districts after a four-month suspension of all vaccination activities since March.

The districts included in the first round are Faisalabad, Attock, South Waziristan, and parts of Karachi and Quetta with a target to vaccinate almost 800,000 children under the age of five.

This will be followed by subsequent rounds in August and September and three nationwide campaigns during the last quarter of the year.

The vaccinators are being especially trained when it comes to preventive measures to be followed, including protocols of door-knocking and marking, keeping the required physical distance inside homes, and ensuring safe handling of a child while vaccinating.

The decision has been taken to ensure the safety for both health workers as well as the communities that they will be visiting.

The visiting team will knock at the door without using their hands. Parents will be requested to bring the child out where the health worker will first sanitise her/his hands in front of the parent. In order to ensure minimal physical interaction, parents will then be requested to open the child's mouth and the health worker will administer the polio drops and mark the finger of the child keeping the two-metre distance.

With an infectious disease like polio that invades the nervous system causing lifelong paralysis and sometimes even death, the only protective measure is vaccination.

It is indeed the need of the hour to encourage and rebuild the trust of the parents towards getting their children immunised.

In 2017, the fight against this disease was being won and Pakistan had come down to a total of eight polio cases. However, in 2019, the situation worsened and the number of polio cases rose to 147.

Repeated immunisation in the two polio-endemic countries — Pakistan and Afghanistan — is the only way to protect millions of children globally from getting afflicted by polio. And as things stand, we face an essential challenge: to make up for all the lost ground and reach every last child.