The Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) acknowledged the strong visible national and provincial leadership of the polio eradication programme in Pakistan.
Commending the dedication and hard work of leaders and staff of the polio programme, the 15th IMB report titled “Every Hiding Place” noted that Pakistan’s Prime Minister is taking an encouragingly hands-on approach as he chairs regular National Task Force meetings, as well as conducting fortnightly meetings with leaders at the provincial level.
Strong political support has been necessary to urgently strengthen workforce capacity; for example, limited effectiveness of health workers in Islamabad was identified as a problem and a decision to appoint more effective staff has been taken. It is an example where identifying a root cause of weak performance and taking decisive action to address it can be pivotal in achieving a breakthrough, the report mentioned.
The report follows a meeting in late October and early November 2017 in London with GPEI staff, donors, extended partners, together with health ministers and officials from Pakistan, Afghanistan and Nigeria. The IMB provides an independent assessment of the progress being made by the GPEI in the detection and interruption of polio transmission globally.
Taking an overview of the epidemiological situation in Pakistan, transmission of poliovirus has been interrupted at every site but never at the same time. In spite of a very low number of paralytic cases, the poliovirus is still being found in many parts of the country in the environment, the report noted. The main concern lies at the ongoing circulations of poliovirus in Quetta Block, Karachi and wider Sindh as well as the twin cities of Islamabad and Rawalpindi where the virus has found a new home outside the core polio reservoirs.
Continuing to endorse the approach of the GPEI to regard Pakistan and Afghanistan as one epidemiological block with poliovirus corridors that span the two countries, the IMB emphasized on continuing action by the governments of the two countries to work cooperatively to secure strong cross-border arrangements for polio vaccination.
The report noted that the current programme performance is yet to reach the level necessary to clear wild poliovirus out of either of these two endemic countries, calling for a transformative solution for an inaccessible large, high-risk mobile population, potentially moving poliovirus across and between the two countries.
The quality of micro planning and micro censuses is vital when there is such large-scale population movement, the IMB underlined. While the polio programme in both Pakistan and Afghanistan is focusing on the very high-risk districts within their countries, the high-risk mobile populations that enter and leave key reservoir areas and the major population flows across the borders, and a great deal of work has been undertaken to describe the composition of the high-risk populations and in mapping their movements, detailed assessment, profiling and small area analysis is allowing segmentation of districts is recommended so that intensive effort can be directed towards the most polio-vulnerable geographies.
The IMB was convened in November 2010 at the request of the World Health Assembly to monitor and guide the progress of the Global Polio Eradication Initiative’s 2010-2012 Strategic Plan. The IMB releases quarterly reports to provide an honest and transparent external assessment of the progress being made toward polio eradication.