The two-day meeting of the Independent Monitoring Board for Polio is due to take place on September 30, 2014 in London. The last time it met it made recommendations that led to imposition of international travel restrictions for Pakistan by the World Health Organisation (WHO) on May 5, 2014.

The travel restrictions made it obligatory for every Pakistani going out of the country to produce polio vaccination certificate at all international airports across the country or get on-the-spot vaccinations at the time of travel.

However, little has been done since then and recommendations made on June 2 are yet to be implemented by Pakistan. One such recommendation was that an Emergency Operation Centre for Polio should be established before July 1, 2014 and that this unit should be overseen by both the president and the prime minister of the country.

Polio (poliomyelitis) mainly affects children under five years of age. One in 200 infections lead to irreversible paralysis and five to 10 per cent among the paralysed die due to immobilisation of breathing muscles. Of the three strains of wild poliovirus, WPV type 2 was eradicated in 1999 and the last case of WPV type 3 was reported in Nigeria in November 2012.

According to information available on the WHO website, polio cases have decreased by over 99 per cent since 1988 when the global polio eradication efforts begun from an estimated 350,000 cases to 406 reported in 2013. The number of polio-endemic countries came down from 125 in 1988 to only three in 2014 (Afghanistan, Nigeria and Pakistan).

Compared to 58 and 93 cases in 2012 and 2013, respectively, the number of confirmed polio cases in Pakistan rose to 158 by September 16, accounting for almost 84 per cent of the polio cases in the world. Eighteen of the reported cases are circulating vaccine-derived polioviruses (VDPV) while the rest are all wild poliovirus type 1 (WPV1).

Dr Imtiaz Ali Shah, technical focal person for Polio in Khyber Pakhtunkhwa, told TNS that majority of the polio cases were from areas where no vaccination campaigns were carried out for the past two to three years. These include North Waziristan, South Waziristan and Khyber Agency where security situation did not permit vaccination drives. "No vaccination means children were not protected against virus that spread freely. The virus moved from one area to another without restrictions and affected children in places adjacent to the areas of polio outbreak," he added.

Polio outbreak alarm rang in North Waziristan in June 2013 when 25 cases were reported from there. It continued into 2014 due to absence of vaccination drives and as a result it is now the most affected place with 66 new polio cases to-date this year.

Other known-high-risk areas in Fata are Khyber Agency with 31 polio cases and South Waziristan Agency with 14. Bannu and Peshawar remained at the top in Khyber Pakhtunkhwa with 11 and eight cases, respectively. The number of confirmed polio cases in Fata was 113 and Khyber Pakhtunkhwa remained second at 27 cases, Sindh 12, Balochistan two and Punjab two.

Despite being in proximity to high-risk areas, Khyber Pakhtunkhwa’s southern districts of Lakki Marwat and Tank remained relatively safe with three and two cases, respectively. Two cases were reported from Frontier Region Bannu this year. The most recently reported cases included the first ones in Buner, where two polio infected children brought the virus with them from Karachi.

The positive sign was that the displacement of people from North Waziristan due to the military operation Zarb-e-Azab enabled health workers to reach children who had never been vaccinated against polio and other diseases.

Dr Bilal Ahmad, polio team leader for Khyber Pakhtunkhwa and Fata told TNS that the immunisation activities continued with particular focus on known high-risk areas. "We have been organising immunisation drives in areas that are high-risk. In total 328,951 internally displaced children from North Waziristan Agency have been vaccinated at 182 permanent vaccination points," he said.

Dr Imtiaz Ali added that infected children who are not vaccinated carry polio virus from one place to another. "The virus spreads in drainage system. We have 27 environmental sites in Pakistan where we check for polio viruses. Unfortunately, all sites tested positive for virus circulation in the latest tests in August," he informed.

He further said that 60 per cent of the affected children had zero doses. "One or two occasional doses are also counted as zero dose. The vaccine does not guarantee 100 per cent protection. However, a child must have at least four regular doses to reach the 70 per cent mark of protection. Continued vaccination helps in building children’s immune system to fight polio virus," he explained.

Four-year old Huzaifa is the only polio case from Mardan. His father, Hazrat Ali, told TNS that Huzaifa was a healthy child who used to run and play before he was diagnosed with polio three days after vaccination earlier this year. "My son is no more the same. The health officials have promised us all they could do to treat Huzaifa. They provided him with an artificial orthotic limb at the Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS) in Hayatabad, Peshawar which supports my son to stand and walk without support," Hazrat Ali added.

PIPOS has been providing victims of bomb blasts and other injuries with artificial limbs. The International Committee of the Red Cross (ICRC)-supported PIPOS centre also helps children affected with polio and clubfoot.

Mian Yaqoob Jan, representative of the ICRC at the centre informed TNS that they provide patients free of cost services. "After registration and initial examination by our qualified staff, polio affected children are provided with artificial orthotic devices that help them in movement without external help. These devices are modified or replaced with time to accommodate for the growth of the child," he said.

Also read: Polio position

A provincial health department official said on condition of anonymity that opening up of high-risk areas that were previously inaccessible means there are good chances Pakistan would control the polio-endemic in as less as nine months.

However, he argued that the lack of commitment from the government of Pakistan in dealing with polio as an emergency is one of the major hurdles in eradicating polio from the country. "Access to children in North Waziristan, South Waziristan and Khyber Agency is there for the first time in years. If the government shows sincerity, there is no reason why we would not be able to control polio in the low transmission period. The prime minister should take polio as seriously as the floods in Punjab," he added.

Polio virus is at its weakest from November to March. Regular door-to-door vaccination drives during this period can almost guarantee eradication of polio from a country. Dr Bilal Ahmad believes Pakistan can eradicate polio if neighbouring India could do so with an efficient immunisation system. "Refusal rates are going down sharply and people now happily allow their children to be vaccinated. At least 700,000 children under the age of five in Peshawar were vaccinated multiple times during the provincial government’s Sehat-Ka-Insaf polio campaign this year," he explained.

He added that the success of the three-month campaign was judged by the results of tests of water samples collected from Peshawar. "The samples collected from Larama and Shaheen Muslim Town tested negative for polio virus after the completion of the Sehat-ka-Insaf campaign. It was an achievement and the health officials want to replicate the process in the southern districts and Bara tehsil of Khyber Agency," Dr Bilal said.

Unless the wild polio virus was completely wiped out of the country and the world, there were strong chances that children worldwide would face the fearsome disease that cripples not just one child but the whole society around him.

According to Dr Imtiaz Ali Shah, once the WPV is wiped out there would be no need for polio vaccination. "This vaccination is not just for the protection of children. It is important to eradicate WPV by vaccinating children. It is a must that every child gets polio drops every time during the vaccination campaigns," he said.

It is not hard to predict that the Independent Monitoring Board officials would be grilling Pakistani delegation at the meeting in London on September 30 if the emergency operation centre for polio is not established by then. The board would also be making sure to put enough pressure on Pakistan to make polio eradication a priority and give it due attention as it is not just a national issue, but people all over the world are at risk as Pakistan is already blamed for the spread of the virus to Afghanistan, Iraq, Israel and Syria.