Even after vaccination campaigns over the years, polio remains endemic in Pakistan. To understand why Pakistan remains one of the only two countries struggling to rid itself of polio in 2023, The News on Sunday spoke with Khizar Afzaal Chaudhary, in charge of the Punab Polio Eradication Programme. Excerpts follow:

he News on Sunday: The Punjab has been declared polio-free. However, positive environmental samples continue to be reported across the province. What is being done to rid the province of these?

Khizar Afzaal Chaudhary: The Punjab has been polio free since October 2020. However, we still have positive polio cases in 2023; four were reported in Khyber Pakhtunkhwa and two in Karachi. Although the Punjab has not had a polio case recently, we keep getting positive environmental samples.

There is a difference between a positive environmental sample and a positive polio case. A positive polio case means that some children have been affected by the virus, leading to paralysis. As far as positive environmental samples are concerned, we keep collecting samples from the drains in the Punjab. We currently collect samples from 31 drains. A bucket of water is taken from drains in 19 cities at 31 spots. The samples are then sent to our laboratory in Islamabad. There, these samples are tested for the presence of poliovirus.

TNS: How does the virus reach these drain sites?

KAC: The virus lives in the human intestines. It is a special kind of virus that is, in many cases, asymptomatic. Anytime there is a positive environmental sample with no reported positive cases, it means that there are asymptomatic cases in the area.

Nine environmental samples collected from Lahore (6) and Rawalpindi (3) have tested positive in 2023. The number was 12 in 2022. Every time we receive a positive sample, we thoroughly analyse the area. After successful vaccination campaigns, samples from all environmental sites have turned negative.

TNS: What type of campaigns were conducted in the Punjab?

KAC: We have two types of campaigns. One is the National Immunisation Days when a country-wide campaign is conducted, and children under five are given polio drops. Then, we have Special Immunisation Days, during which specific areas are targeted. Of the nine campaigns, two were NIDs, and seven were SIDs. These campaigns have put a stop to the circulation of poliovirus in the Punjab.

TNS: There may be no more positive cases or environmental samples in the Punjab, but what are we doing to ensure that this remains the case in future?

KAC: Every time we have a positive sample, we go for genomic sequencing. It is similar to DNA sequencing for humans. The genome testing allows us to understand the geographic origins of the virus.

A majority of the environmental samples found in the Punjab, the KP and Karachi originated from Afghanistan. We hypothesise that the virus is travelling into Pakistan from Afghanistan. We are not the exporters of poliovirus; it is an import to the country. The reason for this is the high-risk population movement from Afghanistan into Pakistan.

Certain areas in the KP are security-sensitive, so the quality of campaigns is compromised because of security concerns. We are unable to hold effective campaigns in some of these virus-carrying areas.

Security forces assist Pakistan’s Polio Eradication Programme in carrying out campaigns in these areas. However, their quality is sometimes inferior to that in the Punjab. The virus then travels into the Punjab due to high-risk population movement between the provinces.

TNS: Since curtailing population movement between the provinces is not possible, what are we doing to ensure that this does not affect the polio-free status of the Punjab?

KAC: We have established 23 permanent transit points. These are located at entry and exit points into and from the Punjab. Our polio teams are present at these points 24/7 throughout the year. All children coming into the Punjab, five years old or younger, are given polio drops.

Also, we carry out immunisation drives in the form of health camps in areas with vulnerable populations. The high-risk districts are Lahore, Rawalpindi and Faisalabad. They have been categorised as such because of the greater population density and movement from the KP and Afghan settlements.

An important aspect of the Punjab’s polio eradication programme is that we have linked it with our routine immunisation drive. We believe that polio eradication will only be possible in Pakistan if we link it with our regular immunisation campaigns. If the percentage of our fully immunised children is high, we can completely rid ourselves of polio.

Not only have we improved our campaign quality through surveillance and community mobilisation, but according to a third-party study conducted by Agha Khan University, the routine immunisation rates have also increased to 85 per cent in Lahore (in 2023).

Acceptance of vaccination has increased manifold in the country, but we do face some resistance in some regions. In the Punjab, we have encountered no vaccine reluctance.

TNS: Polio workers’ safety remains a concern. What steps are being taken to ensure that teams visiting security-sensitive areas can perform their duties without a threat?

KAC: Frontline polio workers are the real heroes. Punjab Polio Eradication Programme, the federal government and the provincial governments have a zero-tolerance policy when it comes to harassment of our teams.

In the Punjab, we have more than 200,000 polio workers. Each team consists of two members.

More than 80 percent of our teams have at least one female worker. In case of an untoward incident, strict action is taken. Before the start of each campaign, we ask district authorities and security and law enforcement agencies to ensure that our workers can carry out these campaigns safely.

As far as our teams’ welfare is concerned, we have an insurance programme in place.

The interviewer is a staff member