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In April 2019, Dawn published an article entitled "Will Pakistan be Polio-Free One Day?". I think the relevant question should be, "Why is Pakistan not free of polio?
The number of polio cases continued to increase, from 17 in April 2019 to 41 until early July and again; KP, including the newly merged tribal districts, three in Punjab and Sindh, and two in Baluchistan. These figures show a decline from the total of 12 cases and from eight in 2017 last year. Here we are after three decades of effort, generous international funding – GAVI alone paid $ 1,291,736,081 and the Pakistani government's budget for 2018 granted Rs 7.83 billion to the Expanded Immunization Program. All the governments of the past three decades have made it a priority to eradicate polio. Political will has not failed.
Policy makers and program administrators cited the failure of polio eradication, including the lack of quality vaccines and inadequate treatment of vaccines by eradication teams; parents / community, religious issues, fear of vaccines and poorly paid vaccinators. Global climate change and worsening environmental conditions resulting in severe and frequent droughts, areas of lack of basic sanitary facilities and safe drinking water are recent additions to the listing. For example, there are 564 slums in Karachi where the drains are full of untreated sewage. The poliovirus has been isolated from the wastewater of the KP cities and is also suspected in wastewater from other cities. Senior officials accuse the "culture" of Pakistan.
If India and Bangladesh can eradicate polio, why not Pakistan?
These explanations may seem true. However, they do not know what is at the heart of this persistent failure. It is the inability of program managers to undertake a serious badysis to determine the reasons for the poor performance of the eradication program, the lack of an appropriate coherent strategy based on this badysis, and an indiscriminate reliance on campaigns. obsolete vaccination. In this context, hoping to improve vaccination rates by tinkering with the vaccine distribution program will probably not work in the future.
What is likely to work?
It is instructive to look here at other countries that have managed to eradicate polio. The example of the United States was cited in a previous editorial published in this article ("Polio: No Quick Fix", Dawn, July 1). If the level of development of the United States is much higher than that of Pakistan, then this comparison can not be considered useful. Countries closer to home, such as India and Bangladesh, have also achieved polio-free status. Even small countries in Southeast Asia, such as Vietnam, are polio-free. Meanwhile, Nigeria, one of three countries – Pakistan and Afghanistan being the other two – harboring the virus, is set to become polio-free. Nigeria has had no cases for 22 months, and even Afghanistan had only 10 cases this year.
How India and Bangladesh, culturally similar to Pakistan and having more or less similar levels of development, have they done? In short, they did so because their leaders did not resort to clever gadgets, seriously invested themselves in the problems, badyzed the data to design the overall strategy of the program and a set of Activities adapted to local conditions and challenges specific to different communities.
For example, India, which still accounted for 60% of all polio cases in the world in 2009, was declared polio-free in 2014. This achievement is the result of the advisory group's recommendation. Indian experts of a strategy to ensure that no cases of polio are neglected and no children are missing from the vaccinators.
Each State has carried out a detailed risk badysis and contingency plan to deal with any new cases, in accordance with the recommendations of the independent supervisory board. These risk badyzes included a review of gaps in surveillance to allow supplementary immunization activities to focus on areas with immunity gaps. Serological surveys have been conducted in high-risk areas to provide definitive information on the immunity status of children. The badysis led to focus on Uttar Pradesh and Bihar, two of the poorest states with uninterrupted polio transmission, to target the children of migrant workers. The polio vaccine was administered to each child along the trail of workers entering and exiting the two states.
Although only 2% of Bangladeshi children under 5 were vaccinated before 1985, this number has risen to 60% in 10 years, despite the enormous challenges the country faces as a result of its independence from Pakistan. . In 2006, Bangladesh had no more polio. This result was possible because the government is committed to developing a national strategy in the context of local conditions and to implementing health reforms. The cornerstone of the national strategy was routine immunization. The strategy was based on local data and micro-planning including community mapping at the most basic level to ensure that all children could be reached by routine immunization.
Health reforms consisted of building latrines to reduce open defecation to interrupt the fecal-oral virus transmission pathway. The strategy also included regular national immunization days and the development of strong multi-sectoral collaborations, such as mobilizing 250,000 youth volunteers / students to educate communities. Bangladesh is now focusing on quality surveillance and case detection (acute flaccid paralysis) in order to maintain its polio-free status.
If India and Bangladesh can eradicate polio, why not Pakistan?
In his July 12 address, the Pakistani Prime Minister, in launching the low-income housing program in Islamabad, recognized the knowledge and meaningful consultation he had with people who had carried out similar work in the field of housing in India. Perhaps its polio eradication technical team should be inspired by the Prime Minister's book and learn from the experience of eradicating polio in the country. 39, Uttar Pradesh and Bihar.
The writer is a public health physician, researcher at Lums and author of So Much Aid; So little development: Stories of Pakistan.
Posted in Dawn, July 20, 2019
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