Three anti-polio workers were killed in Mohammad Ghat in Mohmand Agency when an improvised explosive device planted outside the house of one of them detonated on October 8.

Prior to the attack in the Mohmand tribal region bordering Afghanistan, 15 workers busy in anti-polio campaign had been killed in recent years in the Federally Administered Tribal Areas (Fata) while another eight were assassinated in Khyber Pakhtunkhwa (KP).

The number of security personnel killed while providing security to polio workers during the vaccination drives stood at six in KP. To-date, 13 security men were killed in Fata and another 16 were injured in the attacks on the polio teams during vaccination campaigns.

The sacrifices of the brave polio volunteers and security personnel were more than enough to prove the dedication of those committed to eradicate polio from Pakistan, the issue at hand continued to pose a serious challenge as the number of polio-affected children in the country kept rising.

Pakistan remained one of the three polio-endemic countries. Most cases recorded in the country in the recent past were 199 in 2001 and 198 in 2011. A sharp decline was witnessed in 2012 and 2013 when only 58 and 93 cases, respectively, were reported.

However, the number of children affected this year has already reached 202, the highest till date. Most of the polio victims are from Fata where 135 cases were reported.

Sixty-nine children identified with polio virus are the internally displaced persons (IDPs) from North Wazirisitan while 43 children belonged to Khyber Agency. Both the tribal agencies are high-risk in terms of the spread of polio virus and were inaccessible to vaccinators due to the ban imposed by Taliban militants until the military operations against the militants there.

Other high-risk areas in Fata are South Waziristan and the semi-tribal Frontier Region (FR) Bannu that recorded 16 and seven cases, respectively.

Peshawar and Bannu remained jointly on top in Khyber Pakhtunkhwa with 12 cases each. Tank recorded five polio cases while four cases were reported from Mardan, three from Buner, two from Lakki Marwat and one from the Torghar district in Hazara division.

Ninteen cases were reported from Sindh while six children were affected by the crippling virus in Balochistan and two in Punjab.

According to Dr Bilal Ahmad, polio team leader for Khyber Pakhtunkhwa and Fata, the 82 per cent of the children reported with polio virus were under the age of two years and the main reason for it was the lack of access to vaccinators inside houses. "Male vaccinators often miss children as they are not brought outside the houses. At least 80 per cent of vaccinators should be female who could go inside the houses and vaccinate toddlers and suckling babies," he says.

The emergence of the record number of polio cases is alarming as the disease threatened the goal of polio-free Pakistan. The country also faces other serious implications, including travel restriction on its citizens. There can be possibly further implications in the near future as conclusions from a recently held meeting of the international monitoring board for polio were awaited.

Of all the unwanted news about polio, one positive point was that unlike the previous years, most of the fresh cases emerged in the high transmission period of summers when the virus is at its strongest. "The polio virus strikes most during summer times. It is worrying if more cases are reported in the winter period," says Dr Bilal.

Dr Bilal argued that some of the reasons for the rise in polio cases included the movement of IDPs as it allowed polio teams to vaccinate children previously inaccessible. "The inability of teams to vaccinate all the children doing door-to-door campaigns,  insufficient number of local polio teams, constant rotation of teams and below standard quality of the campaigns were also affecting the efficiency of these drives," he adds.

He also pointed to the effectiveness of anti-polio teams at the permanent transit points. These teams are supposed to vaccinate all children exiting or entering major cities on national highways and motorways. "The three cases in Tank, one in Torghar and two in Buner are all related to Karachi while the cases in Bannu are related to North Waziristan Agency. These children missed vaccinations in their original cities and also on their way to the current areas of residence," he says.

On the positive note, special vaccination camps in Bara sub-division of Khyber Agency in June and August resulted in high percentage of vaccination. The vaccination teams were able to reach 96 per cent of the target mark in the last drive in August.

In 11 KP districts bordering Fata, 92 per cent of the target quantity or 1943838 children were vaccinated in the campaign in August.

The vaccination campaigns in Balochistan were successful most of the time and less than one per cent of the target 2.3 million children were missed during the drives. Jawahir Habib, communication specialist at the UNICEF Quetta, tells TNS that extensive cross-border movement was one of the reasons for the spread of virus. "From 18,000 to 20,000 children crossing borders between Pakistan and Afghanistan are vaccinated by polio teams on the border each month," she says.

Three cases each were reported in Quetta and Killa Abdullah this year. "Quetta, Pishin and Killa Abdullah are high-risk areas in Balochistan. The percentage of children missing vaccination is high there mainly due to non-availability of children and on account of weak monitoring and supervision," she adds.

The vaccination campaigns under the United Arab Emirates (UAE)-funded Pakistan Assistance Programme (UPAP) in Bajaur, Mohmand, Khyber, South Waziristan, Orakzai and Kurram tribal agencies and six FRs were made possible with the support and facilitation of the Pakistan Army.

Up to 97 per cent of the target figure was achieved in the vaccination campaigns in June this year when 679237 children under five years were vaccinated in the aforementioned 12 areas.

The percentage went a digit higher in similar campaigns in August when 659596 children were vaccinated. However, no vaccinations were done in the FR Bannu this time.

The winter season is near and the low temperatures result in the weakening of the polio virus. It is time to work with a new zeal to knock polio out of Pakistan.