ISLAMABAD: The high-level National Strategic Advisory Group formed by the government as part of a transformation agenda for polio and essential immunisation in the country has never met since its establishment in 2019 and now it appears that the idea of having such a group has been dropped entirely.

“The thinking apparently is that because of the coming together of political groups in response to the threat posed by Covid-19, positive political unanimity will be the new attitude to polio also,” according to the latest report of the Independent Monitoring Board (IMB) for global polio eradication initiative.

The IMB was very impressed by the new special health adviser to the prime minister, Dr Faisal Sultan, but remains concerned that the new adviser and the head of the National Emergency Operations Centre have very heavy workload.

Since its formation in 2019, National Strategic Advisory Group has not held a single meeting

“It is important that special health adviser has the space to fully understand the complex context of polio in Pakistan; if he is to succeed, it is vital for him to be clear why the country has repeatedly failed to eradicate the disease, and why it is not enough to see it through an infectious disease technical lens,” the report notes.

Crucially, coming new to the polio field, exploring and fully understanding the political and social dynamics of the programme at the provincial level is an essential first step.

The rationale for developing this national all-party group was to help achieve political consensus for polio eradication, and to make the process and solidarity visible to the Pakistani people. It would also provide a visible means of accountability, if political promises were broken.

Looked at through a polio lens, the IMB report says, it is vital that the National Emergency Operations Centre leader has close and day-to-day contact with his counterparts at the provincial level. This is not just a matter of quick progress checking. The provincial Emergency Operations Centre teams will need regular guidance, encouragement and sometimes troubleshooting support.

Without strong national-provincial teamwork, barriers to eradication will endure. This effective leadership role can only work if there are actual visits to the provinces as well as regular discussions through video-conferencing.

It is striking that in a global effort costing more than $1 billion a year and involving work of health workers in very many countries, there is any delay or hesitancy in providing a robust team and full support for the leadership of the programme. This means that the new special health adviser to the prime minister and the head of the National Emergency Operations Centre must create the time, space and staffing structure to maintain an unrelenting focus on polio.

The report noted that the resurgence of wild poliovirus cases in Pakistan began in the second half of 2018 and peaked in late 2019. It started declining in early 2020 and then plateaued.

The increases in the proportion of wild poliovirus positive environmental samples in 2020 compared with 2019 have been much greater in Punjab and Baluchistan than in other provinces. The outbreak of wild poliovirus cases began in southern Khyber Pakhtunkhwa in April 2019 and continued unabated until early 2020.

The IMB assessment says the number of cases was similar to the same time of year in 2019, but the detection of wild poliovirus in environmental sample was higher in 2020 (60 per cent) than in 2019 (47pc). Environmental surveillance is an indicator of widespread infection with wild poliovirus.

If the IMB is to be convinced of the Sindh programme’s capability to eradicate polio, it must demonstrate improvement quickly, with visible and incontrovertible evidence, the report says.

In Punjab, the polio programme needs to give particular attention to sustaining quality in districts with weaker health systems.

The Quetta block is a high-risk contributor to the southern cross-border poliovirus corridor to the southern region of Afghanistan. With reinfection of districts in northern Sindh, the adjoining districts of Balochistan are also affected by contiguous spread. The only reason why there is no continuous poliovirus transmission in interior Balochistan is due to its sparse population. The provincial government has found no comprehensive solution to longstanding problems associated with persistent or repeated poliovirus infection.

The government of Khyber Pakhtunkhwa must take concerted political, administrative and community-oriented actions to address long-standing programmatic weaknesses and vulnerabilities in the south of the province. This means providing essential public services and putting a stop to the activities of factions looking to use population access to polio vaccine as a bargaining tool.

The social engagement of communities is vital. It is essential to involve locally respected community members, influencers, and tribal leaders, as well as political and government administrative leaders; they too must be mobilised. The programme will need to tailor the “Pashtun strategy” to the local context.

Following a pause of four months due to the coronavirus pandemic, large-scale vaccination campaigns have been conducted across the country during August and October 2020. Overall, the trend indicates that in districts where two or more rounds were delivered either with monovalent type 2 or trivalent oral polio vaccine, there has been no sustained breakthrough transmission.

Published in Dawn, January 9th, 2021