Dr Rana Muhammad Safdar, Coordinator, National Emergency Operations Centre
As the celebrated disabled sports person, Roger Crawford said “being challenged in life is inevitable, being defeated is optional”. Polio, the second human disease after smallpox targeted for eradication, is a highly infectious viral disease which mainly affects young children. Over the millennia, the virus has paralyzed tens of millions of children across the world. Over the past century, effective and safe polio vaccines have been developed to improve immunity and prevent infection (unfortunately, once paralyzed a child may not be cured). As we approach the end of 2016, only 35 cases have been recorded this year in just 3 countries as a direct result of improved global vaccination coverage. The virus is trying to respond and break out of its encirclement but remains locked in a primitive struggle for survival and cornered in ever-shrinking safe areas.
Pakistan is one of three remaining endemic countries along with Afghanistan and Nigeria. Through a whole of Government approach and committed government leadership at national, provincial, divisional and district levels which enjoys cross-party, security agency and Global Polio Eradication Initiative (GPEI) partner support, between 20 and 37 million children under five are now being reached and vaccinated during each monthly house-to-house campaign. Inaccessibility is no longer a barrier to reach children, 96% of the children which cannot be vaccinated during campaign days because of any reason are now reached and vaccinated. The expansion of vaccination coverage has prioritized under-served communities and long-range mobile populations in particular. The annual polio prevalence rate reflects these gains in terms of expanded vaccination coverage and has reduced to 0.5 cases per million children (306 cases in 2014, 54 in 2015 and 19 in 2016).
The progress made by the national programme over a 24 month period is impressive by almost any standard but polio eradication is a zero-sum game and we are not yet at zero. How do we stay on track and finish the job?
Firstly, parents have continued to demonstrate acceptance and trust of vaccination and vaccinators as in the best interests of the health and welfare of their children. The recent survey undertaken Pakistan shows one of the highest acceptance rates of the vaccine in the world at 97%. Parents clearly recognize that accepting the polio drops each and every time they are offered not only protects their own child but helps to build the ‘herd protection’ from the virus for each and every child living in their community. This increased demand for Polio vaccination must continue and in fact expand to all routine immunization vaccines including Inactivated Polio Vaccine (IPV) which is an injectable.
Secondly, almost 250,000 local frontline workers, our Sehat Muhafez remain the real heroes and heroines of the polio vaccination programme. Well motivated, well trained and well supervised, they continue to effectively serve their own communities – in the cities, in the countryside, in the deserts, in the riverine areas, in the mountain villages through winter, spring, summer to autumn. This improved service to households and communities must continue and respectfully acknowledged by communities.
Thirdly, the polio programme continues to enjoy the broad support of the medical, religious, media and local community leadership and organizations. For example, at the most recent meeting at Head of State level of the 57-member Organization for Islamic Cooperation "The Conference reaffirmed that preserving the wellbeing and physical health of children is a duty of every parent and society as prescribed by Islam”. It, therefore, appealed to religious scholars and leaders to support the polio eradication campaign and encourage people to respond positively to it." This type of enhanced support must continue.
We may draw confidence that our national programme has the right strategy, structures, support and people in place to finish the job – we are surfacing and solving problems in a way never achieved before. It is a critical work experience that is going to benefit Pakistan in all public health initiatives beyond Polio.
As we enter the winter season where the virus is historically at the lowest transmission range of its cycle and thus at its weakest and most vulnerable, we must continue to build and sustain our performance momentum. In practical terms, this means that we must reach and vaccinate each and every child in the upcoming campaigns, the immediate national campaign starting on 16 January, and others to follow till May 2016.
We therefore begin 2017 on a positive note. With door to door campaigns as a universal norm now - to finish the job we need continuous and enormous support from all people from all walks of life. Misleading stories about unrelated incidents during the campaign unnecessarily burden our efforts. After observing more than 10 billion doses administered safely to over 2.5 billion children across the globe, the debate on vaccine safety and haram/halal should end. Parents, Sehat Muhafiz, religious, medical and community leaders, Commissioners and Deputy Commissioners; now is the time - we rely and count on your support to make these campaigns a success. We are almost there so for the sake of current and future generations of Pakistani children, let’s not allow this virus wriggle off the hook and instead work to achieve our collective goal of a polio-free Pakistan.