he sit-in against the One-Document border crossing regime at the Chaman border and greater use of undocumented routes taken by Afghan nationals to enter Pakistan have seen a concurrent increase in poliovirus transmission. 15 instances of the life-threatening illness have been confirmed so far in 2024.

The campaign quality on the Afghanistan side is compromised due to a ban on house-to-house vaccination in southern Afghanistan since 2018. Although the border is closed people continue to use informal routes to cross over. This is leading to considerable virus transmission across the border.

After a gap of 28 months, a YB3A cluster wild poliovirus Type 1 (WPV1) came from Qandahar city of Afghanistan to Chaman district of Pakistan due to cross border movement.

With the on-going sit-in (parlat) against the One Document regime which is already 10 months old, vaccine refusal in border districts of Chaman and Kila Abdullah has increased. Some of the tribes in this region have tried to use polio vaccination as a bargaining chip to pressure government to meet their demands.

“We have started mapping all migrant populations in all districts of Balochistan,” Emergency Operation Centre coordinator for Balochistan Inam-ul Haq says. He says a biker strategy has been introduced to reach migrant population to vaccinate them for routine immunisation and oral polio vaccine.

He says people of all ages are being vaccinated at Friendship Gate at Chaman.

With deaths of three children, the increasing trend of environmental positivity of the crippling wild poliovirus samples and the high number of reported cases during the eight months of year 2024 pose a serious threat to the strenuous efforts of the government and UN agencies.

As many as 271 samples collected from the environment sewage have been found positive since January 2024. The number had been 126 last year.

The polio epidemiology 2023-2024 prepared by the polio wing of the National Health Service shows that the environmental positivity of the polio cases from January to August 2023 was 1 percent with 2 WPV1 cases. It has surged to 22 percent with 15 cases since January this year.

Over the same span of time, the number of districts with reported infections was eight last year. This year, it is 58.

“Point of time comparison 2023 and 2024 suggests that cases of the deadly virus are up six times, infected districts seven times, environment samples isolations 19 times and environment positivity 22 times.”

As many as 15 cases have been reported from Balochistan, Sindh and the Punab provinces.

Balochistan, currently the epicentre of the disease, has reported 12 cases from seven districts Dera Bugti, Chaman, Qila Abdullah, Quetta, Jhal Magsi, Zhob, Qila Saifullah and Mekran.

Health officials say all the infections have been by the YB3A cluster originating in Afghanistan.

The surge in polio cases has rung alarming bells, compelling the government and UN agencies to reinvigorate the drive with a more concerted plan.

In this connection, a meeting chaired by the chief secretary and attended by deputy commissioners of all 36 districts of Balochistan and UN agencies in Quetta was convened in order to devise a concerted strategy for controlling the deadly virus.

Many issues including quality of immunisation drive, obstacles in successful rounds of anti-polio campaign, refusal and access to children and checks on the land and air routes were discussed.

Talking about the reasons for poliovirus transmission, the EOC coordinator said, “Unchecked cross border movement and poor security lead to compromised campaign quality.”

He said the polio eradication policy required that all children below the age of 5 be vaccinated during all campaigns. However, a significant fraction was missed for various reasons (operational gaps, children not home, refusals). These unvaccinated children maintain the chain of virus transmission.

Eradication of poliovirus is a top priority of the government. Prime Minister Shahbaz Sharif has vowed that all available resources will be used to eliminate polio from the country.

He has directed the anti-polio national team to ensure the availability of polio vaccines in security risk areas.

“The government is fully committed; DCs and DHOs are leading the programme,” Shahid Rind, a Balochistan government spokesman, says.

He says the chief secretary regularly holds campaign readiness meetings. He mentions that a two-day workshop was recently convened at Quetta.

In view of the recent surge in the number of polio cases, Prime Minister’s Focal Person on Polio Eradication Ayesha Raza Farooq, held a special meeting with Chief Minister Sarfraz Bugti. The meeting decided to launch a special anti-polio campaign during September, October and November.

Dr Hadi, the Qila Abdullah DHO, blamed accessibility issues and absence of community based vaccination (CBV) as one of the reasons for the spread of polio. CBV is being practiced in the Quetta-block but not in Qila Abdullah.

UNICEF officials have expressed concern over frequent changes of deputy commissioners and DHOs, vaccine refusal and poor quality of the routine immunisation drive.

Keeping a vigilant eye on cross-border movement, a focused and robust communication plan for refusal communities, accountability of poor performers, strengthening routine immunisation, avoiding DCs and DHOs transfers and improving campaign quality at all levels can help achieve the goal of polio-free Pakistan.

The writer is a journalist based in Quetta