ISLAMABAD: Pakistan’s Polio Programme is facing significant challenges, with over 4 million planned vaccinations missed during immunisation campaigns across the country in 2024.
This was revealed in a report by Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) released this month.
These gaps in coverage, rather than individual children being missed, reflect the scope of challenges facing the programme.
This year, Pakistan has reported 24 new polio cases, with infections emerging from all four provinces and Islamabad. Missed children in Khyber Pakhtunkhwa, Sindh and Balochistan are contributing to the continued circulation of poliovirus in the country, the report disclosed.
In Khyber Pakhtunkhwa, 423,000 children were missed during each full campaign. In Karachi East, number of zero-dose or unvaccinated children remains alarmingly high.
The report said situation in Balochistan’s Quetta Block, particularly in districts like Killa Abdullah and Chaman, remains dire, with persistent insecurity and poor healthcare access contributing to large number of unvaccinated children. 19 new polio cases in Afghanistan are further complicating regional eradication efforts.
The IMB, an independent body tasked with assessing global polio eradication progress, plays a crucial role in identifying strengths and weaknesses in country-level programmes. Its reports provide an unbiased evaluation of national efforts and offer recommendations for improvement.
The Board consists of leading global health figures, including Sir Liam Donaldson, former Chief Medical Officer of England, Dr Ala Alwan, Regional Director Emeritus of WHO and Dr Tom Frieden, former Director of US Centers for Disease Control and Prevention. The IMB’s evaluations carry significant weight, influencing high-level decisions at both GPEI and national government levels.
The report said situation in Afghanistan continues to pose a major risk to Pakistan’s polio eradication efforts. The report highlights ongoing polio transmission in Afghanistan, particularly in Kandahar, which serves as a significant reservoir for the virus.Cross-border movements between the two countries, including return of refugees and frequent migration, have made it difficult for Pakistan to maintain control over the virus, it said.
Despite Afghanistan expanding house-to-house vaccination coverage to 94pc, access to Kandahar City remains restricted due to security concerns. If poliovirus transmission in Afghanistan is not interrupted, it could spill back into Pakistan, further complicating the efforts.
Khyber Pakhtunkhwa remains one of the most challenging areas for Pakistan’s Polio Programme. The security situation in the province has forced health teams to carry out fragmented vaccination rounds, allowing the virus to continue circulating, the report said.
In Peshawar, the virus has been circulating for over 16 months, with many missed children unaccounted for despite efforts to improve campaign quality.
Karachi faces a similar challenge, with high numbers of unvaccinated children in key districts. In Balochistan, particularly in Quetta Block, insecurity and weak healthcare infrastructure have contributed to high number of missed children.
The IMB report also pointed to systemic weaknesses in Pakistan’s Polio Programme. Pressure on health teams to meet vaccination targets has led to unethical practices, such as fake finger marking and concealing unvaccinated children, it said.
These practices, the report said have compromised accuracy of data and effectiveness of immunisation efforts, particularly in areas like Khyber Pakhtunkhwa and Balochistan. The report emphasises need for stronger supportive supervision and more preventive vaccination campaigns to address high rates of missed children and prevent further spread of the virus.
The IMB acknowledged clarity of understanding and structured “2-4-6 roadmap” presented by Pakistan’s new leadership during its July 2024 meeting.
The IMB commended new leadership for their comprehensive approach to revitalising Polio Programme, recognising their efforts to improve oversight, vaccination quality and community engagement. This new strategy offers hope the country can reverse current trend and edge closer to its polio eradication goals, it said.
Anwar-ul-Haq, National Coordinator for Emergency Operation Centre (EOC) in Islamabad, noted two core reservoirs of transmission—Karachi and Quetta Block—are maintaining intense circulation, alongside Kandahar and Helmand in Afghanistan. “Most detections elsewhere are genetically linked to these engines of transmission”, he said.
A targeted fIPV campaign last month, Sub-National Immunisation Days (SNIDs) in September and National Immunisation Day (NID) in October, aim to administer at least three doses of vaccine to vulnerable children, reducing intensity of circulation in Karachi and benefiting rest of Sindh and other provinces, Anwar maintained.