Polio’s Last Stand !

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Senator Ayesha Raza Farooq

Each time a drop of Polio vaccine finds its way to the gut of a child, we have taken one more step away from a world where young innocent lives are imperilled by a disease that has no cure. To most of us it may look like governments and health departments are undertaking this initiative by running vaccination drives. That may only be partly true. Each and everyone who has children and gets them vaccinated is a Polio Activist implementing this campaign. My message to parents is that you are protecting both your child and the future of the world from disability. You are part of one of the greatest public health movements in the history of human kind. It is the Power of One, that one step, that one decision that you as a parent take in seeking awareness of the vaccination drives and ensuring that your child receives the vaccination that drives this campaign. That is precisely why this campaign is about you and the decisions you take to give your families a healthful life. Therefore, if there has been progress in defeating polio or other diseases through vaccination the victory belongs to you the parent.
Vaccination is the single most cost effective means of prevention from disease, saving our children from enduring a life of suffering and the catastrophic expenses incurred on treatment and rehabilitation. So clearly there is both a science and maths to it.
Pakistan is the world’s sixth most populous country. We are one of the world’s seven nuclear powers. We have the courage and resilience to bounce back from adversity and convert challenges in to opportunities. The country once infested with the malaise of terrorism is fast becoming a peaceful abode for its people who have stood by this Government in fighting the scourge. The democratically elected government with the support of the people has worked with fullest of commitment to address the energy crisis. The results today speak for themselves. There is no industrial load-shedding ensuring that the engine of growth runs on full throttle. Load-shedding for domestic consumers is on its way out. Sweeping reforms, good governance and fiscal discipline have pushed the economic trajectory upwards as acknowledged by major rating organisations. When the reins were given to this government by the people, the country was facing a major challenge with regard to the raging polio epidemic. To arrest the epidemic and stop the transmission of the crippling virus was a challenge this Government under the leadership of Prime Minister Nawaz Sharif accepted. With the right strategies, commitment and determination, we were able to achieve a turnaround in the situation with critics turning in to supporters and concern by the international community replaced by applause.
As we step in to the year 2017 with the awareness that our struggle to squeeze out the virus from Pakistan has resulted in the least cases we have had since 2005, we are confident that we will soon be triumphant in our efforts to completely stop virus transmission. We closed 2016 with 19 cases as compared to 2015 with 54 cases and in stark contrast to 306 cases in an explosive outbreak in 2014 — a decrease of 94% since 2014 and 65 % since 2015.
The current polio epidemiology remains the best we have ever seen but we need to continue with the same momentum to interrupt virus circulation. As in all eradication initiatives the virus becomes resilient before finally giving in. We must therefore not relent in our efforts and mobilise all resources- the Sehat Muhafiz, the community, opinion leaders and administrative leaders to safeguard the health of our children and the future of Pakistan.
During these past 12 months, we have seen many ups and downs. Key challenges have been in reaching all the highly mobile population in Pakistan that moves across provinces but also across borders. The challenge in sustaining immunity of children is also hampered by the limited access to adequate health care infrastructure leading to low coverage of routine immunization, in underserved areas. However, thanks to our dedicated work force of over 250,000 front line health workers, our global and local partners and more importantly our informed and motivated communities and parents, we have achieved over 99 per cent of our vaccination targets during 2016. By any national and international standards this is something to be proud of. The credit for reaching this stage goes to all our front line health workers who have braved all odds to ensure that no child is missed. These frontline polio eradicators are not only protecting children from this entirely preventable disease but also providing tactics for other health programmes to reach Pakistan’s children.
The question remains – how we are going to fare in the last stretch to eradication and will we be able to sustain the gains made so far? The answer is yes we can and yes we will, Inshallah.
In 2017, I am confident that together, we can sustain the high quality of work we are doing and defeat this deadly virus. We will continue to move at scale – and to do this we will require the support of every parent in Pakistan to vaccinate their child during every round. By doing this you will not only protect your own children from paralysis, but also the children in your community, your town, your province, your nation and thus the world.
In support, the Government of Pakistan remains committed to reaching zero polio and to deliver on the national and international commitments it has made. The core strategy elaborated in the National Emergency Action Plan remains on course – designed to root out the virus in the reservoirs, detect and react aggressively to any outbreaks and to maintain population immunity levels elsewhere in the country.
Comprehensive plans for high quality campaigns to reach every child in Pakistan, every time the vaccine is offered, have been made and put into action. The programme is being implemented at scale – every month – targeting 37 million under 5 children during every national campaign, and 20 million children during targeted campaigns. During the campaigns a key focus will be reaching children from mobile families. Another key strategy will be the implementation of combined Oral Polio Vaccine and Injectable Polio Vaccine in campaigns in core reservoir districts and other high risk districts to boost individual immunity of children. The Expanded Programme of Immunization will also enhance routine immunizations service delivery in the reservoir areas. These initiatives will provide the most vulnerable children with the best protection against polio and will be a significant blow to the virus.
Polio Eradication continues to enjoy broad political and popular support in Pakistan and we can see how this commitment has made a difference when people come together to work above political lines towards a national cause. Underpinning all of our programmatic activity has been sustained Government management and oversight at every level. Particular appreciation goes to Provincial leadership who have driven these changes. Our Chief Secretaries, Commissioners, Deputy Commissions and Emergency operations Coordinators set the appropriate tone for programme performance management and accountability and are personally demonstrating in word and deed, the highest professional standards to achieve our targets. Whilst there are only 11 tier-1 or highest risk districts on the national risk register, all of our 164 Deputy Commissioners must act as if his or her district is a tier-1 district. This is not easy work, the pressure is on to address the remaining challenges against demanding timelines but we should draw confidence and reassurance from the significant gains already made. This virus is under enormous pressure heading into the low season, and the same level of commitment to simultaneously strengthen routine immunization, health infrastructure development, clean drinking water, sanitation and nutrition will help us come closer to achieving our common goal of polio eradication.
We are also actively searching for pockets where the virus is hiding. In order to root out the virus, heightened community search is taking place to look for paralysis cases, in addition more samples are being taken from the environment to find where the virus is. As we continue to enhance the sensitivity of our surveillance system, we expect more of the virus to be revealed. This is a critical step as we edge closer to stopping transmission – we must remember that bad news now is ultimately good news for us and enables us to respond quickly.
We have entered 2017 with the awareness that we are very close but the job is not done yet. Bermal in neighbouring Afghanistan, South Waziristan, Quetta, Pishin, Peshawar, Kohistan, Lahore, Sujjawal and Karachi all point to virus transmission that has not yet been stopped. Critical lesson learnt from 2016 is that we didn’t have – across the districts – the same focus on selection and deployment of well-trained and supervised female vaccinators with realistic work burdens. The vaccinator at the doorstep is our most critical asset in the programme and having the right supported workforce remains an essential key to success. Another gap which has been identified is the need to have quality micro-plans to track and vaccinate new born, guest and transit children in a timely manner across the board. With a highly mobile population in Pakistan unless every child is tracked and vaccinated there is a high risk that virus transmission will continue. Lastly, children who do not receive polio vaccination during their routine immunization do remain vulnerable to viral infections particularly in areas covered in National Immunization Days only; this is compounded by low levels of malnutrition which challenges us to reach desired immunity levels which is why we urge parents to vaccinate their children each time.Closing the immunity gap of new born children before these infants begin to fully participate in transmission is a race against time. To achieve our goal of stopping transmission and sustaining it until certification of Polio Eradication, we must work to make significant and more urgent progress in routine immunization service delivery, which is a regular ongoing vaccination program targeting every newborn child in the country, across the board but especially in the core reservoirs.
The Pakistan Polio Eradication initiative has a strong foundation and structure to adapt to operational realities on the ground. We have developed national expertise, knowledge and systems to find the virus, to prepare communities and parents to help safeguard their children and to ensure that every human or financial resource engaged is put to the best use. This is invaluable experience. Experience has also taught us to remain focused and to continue to adjust and refine tactics to stay the course to reach what would be a significant public health landmark.
We are now entering the low transmission season where the virus is most vulnerable. We must use the upcoming campaigns to reach and vaccinate every child and give the virus no place to hide. When we succeed, no child will ever be needlessly paralysed by polio ever again, making it only the second human disease after smallpox to be eradicated in history. Every parent and every citizen is our soldier in taking the fight to the virus.
The author is member of the Upper House of Parliament of Pakistan and Prime Minister’s Focal Person for Polio Eradication