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Despite multiple challenges, Pakistan has made notable progress on its journey

toward stopping polio virus transmission and eradication over the past years. No

isolation of Wild Polio Virus type 3 (WPV3) has been reported since April 2012.

This progress is the result of concerted effort of the government at all levels, civil

society and all national and international partners to implement a national polio

emergency action plan aimed at overcoming long-standing challenges during

polio activities. More children are being reached than ever before, in particular in

the traditional reservoir areas of Peshawar, Karachi and Quetta Block.

Pakistan presents one of the most complex polio eradication environments in the

world. The total number of confirmed polio cases in 2014 came to 297 (compared

to 93 in 2013 till this time) from 41 districts/towns/tribal agencies/FR areas

(compared to 23 in 2013 till this time). 85 per cent of the polio cases have been

reported from security compromised areas, as many as 81.7 percent (241/295)

cases from Khyber Pakhtunkhwa and FATA together, of which 31.5 percent

(93/295) are from North and South Waziristan agencies and 24.7 percent

(73/295) are from Khyber agency alone. Environmental sampling results further

confirm that since January 2014, the virus is circulating across the country.

Persistent wild poliovirus transmission in Pakistan is restricted to three polio res-

ervoir areas including, Karachi (specifically UC-4 Gadap), the Quetta Block

(Quetta, Pishin and Killa Abdullah), Khyber Pakhtunkhwa and FATA. These res-

ervoirs for polio virus are considered high priority if Pakistan is to eradicate polio.

While 90% of Pakistani people live in communities that are polio-free, the remain-

ing 10% live in polio reservoirs and disproportionately contribute to the country’s

rates of infection. Absolute ban ion polio vaccination in North and South Waziri-

stan since 2012, ongoing insurgence and military operations in Khyber Agency/

Bara and FR areas and parts of southern Khyber Pakhtunkhwa adjoining the

North and South Waziristan, internally displaced and temporary dislocated popu-

lations and migrants throughout all of the highest priority areas have posed barri-

ers to immunization.

In Pakistan, other major and longstanding factors are also influencing the eradica-

tion programme performance. Acute Flaccid Paralysis (AFP) and environmental

surveillance in Pakistan reveal polio in areas where poor campaign management

is at the heart of substandard performance. Enduring weaknesses in routine im-

munization systems compound the challenge of adequately protecting children

against polio.

On 5 May 2014, the World Health Organization declared polio an international

emergency of international concern and issued temporary travel recommenda-

tions for countries that are currently exporting polio, which includes Pakistan. To-

date, the government of Pakistan established 15 vaccination points and vaccinat-

ed more than two million travelers.

An extensive consultation was convened on 18-20 Nov to finalize the provincial

and polio reservoirs specific plans for the upcoming low transmission season. The

PAKISTAN Polio Update

Updated: 03 Jan 2015

For further information visit www.endpolio.com.pk

Pakistan is at a pping point on

polio – the number of children para-

lyzed by the disease is the highest

in a decade, yet the country sll has

an opportunity to reverse the trend

and take the world over the finish

line on eradicaon

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planning process was facilitated by the international experts on polio operations

and communications. The follow up on finalizing the low transmission season

plans is in process and the implementation will kick off in December National

Immunization Days.

Pakistan recently introduced the inactivated polio vaccine into routine immuniza-

tion systems. One dose of the injectable vaccine will be given out alongside the

oral polio vaccine in key polio reservoirs through the end of the year.

The attacks on Polio workers since 2012 highlighted the critical need for adaptive

methods to increase access to children for vaccinations in areas of high threat,

and closer monitoring of the risks that could severely impact the success of the

global initiative.

Currently reporting 90% of polio cases worldwide, Pakistan presents the greatest

obstacle to Global Polio Eradication. Polio has been all but restricted to just two

areas: a region along the Pakistan-Afghanistan border and several states in

northern Nigeria. Pakistan is the only polio-endemic country to see a year-on-

year increase in cases.

The genomic sequencing of the recent polio outbreak in Syria indicates that the

virus isolated there is closely linked to a virus detected in environmental samples

in Egypt in December 2012 – which again was linked to Wild poliovirus circulat-

ing in Pakistan. Wild poliovirus strain closely related to a strain from Pakistan has

also been detected in environmental samples in Israel, West Bank and Gaza

Strip since February 2013.

Pakistan is crucial to eradicating polio from the globe, it has also become the

focus of local, national, and international partners coming together with a singular

purpose: to interrupt the transmission of poliovirus in Pakistan by the end of

2015.

The security situation has resulted in the establishment of provincial and district

security coordination committees to engage law enforcement agencies and po-

lice forces in campaign planning and implementation. There has also been a shift

from a highly-publicized National Immunization Days approach across the coun-

try on specific dates, to staggered, localized campaigns in selected areas.

VACCINATION CAMPAIGNS TO STAMP OUT THE VIRUS Pakistan held intense immunization activities this year with at least 4 NIDs, 4

SNIDs (sub national campaign covering 60% of the below five child population) as well as localized supplementary immunization activities, case response and mop up campaigns. There has been a substantial focus on vaccination at transit posts and populations coming out of North Waziristan. In early 2014, a plan of

action with intensive vaccination rounds was undertaken in Peshawar, a hotspot for the disease, which led to water samples from the city being declared polio free in May for the first time in history.

More than 180,000 vaccinators across the country reach out to some 34.6 million children below five years during each nationwide campaign. The oral polio vac-cine is being delivered to children through mobile, fixed and transit teams.

PAKISTAN Polio Update

Updated: 03 Jan 2015

For further information visit www.endpolio.com.pk

3

The last round of Sub National Immunization Days (SNIDs) for 2014 completed in 60 out of the total 77 planned districts / towns/ agencies. Quetta from Balochi-stan and Swabi from KP started their SNIDs on 3 Jan whereas Islamabad com-pleted its vaccination activities which were postponed due to security reasons.

The campaign is still in progress in Punjab in staggering mode. In FATA, plan for Bara Tehsil of Khyber agency is still awaited.

COMMUNICATION STRATEGIES Advocacy efforts are primarily focused on gaining the support of political leaders, parliamentarians, religious scholars and leaders as well as the Government at federal and provincial level to create conducive environment for the achievement of polio eradication in Pakistan. Efforts are currently being sought from the Gov-ernment and political leadership at all levels to track and reach missed children (refusals and not available) with a special emphasis on clusters out to inaccessi-ble children of FATA.

Increased ownership of the Government is pursued through greater involvement of the parliamentary standing committees on health in the oversight of the polio eradication programme implementation. Current communication strategy builds upon rigorous evidence obtained from various researches and is tailored to the needs of particular groups, identified as high risk or living in high risk districts.

The strategy’s main objective is to build community ownership of the polio pro-gramme. A Civil Society Initiative has been conceptualized to create public movement for polio eradication in Pakistan. Particular emphasis is made on strengthening of social mobilization activities at transit points to ensure that all children on the move are reached. In areas with high levels of insecurity integrat-ed messaging strategy is implemented to present polio as part of a larger health package and an important component in the overall routine immunization.

More than 1,800 social mobilizers of the Communication Network (COMNet) have been trained in interactive communication and deployed at community lev-el. COMNet provides social mobilization and awareness support to the pro-gramme in 47 polio high risk districts. They go house to house to mobilize com-munities and listen to parental concerns. COMNet engage with influencers and leaders and establish trust, community support and establish an enabling envi-ronment for vaccination teams to operate in. COMNet staff embed themselves with polio teams vaccinating children to help improve knowledge about the area and about polio.

WORKING WITH RELIGIOUS LEADERS Well-respected religious leaders often prompt changes in the education and health-seeking behaviours of their followers. They also operate in security-

compromised parts of the country and can access the hardest to reach children. In collaboration with the Ministry of Religious Affairs and International Islamic University Islamabad (IIUI) polio eradication partners continue to engage reli-gious leaders and harnessing their influence to educate the public about polio and influence acceptance of the vaccine.

The International Advisory Group (IAG) of the Global Polio Eradication Initiative was unequivocal about its support for polio vaccination based on Islamic rulings

PAKISTAN Polio Update

Updated: 03 Jan 2015

For further information visit www.endpolio.com.pk

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and condemning the unjustified pronouncements against polio vaccination and attacks on polio health workers misusing the name of religion. A National Islamic Advisory Group (NIAG) comprising religious scholars and technical experts has been established to address misconceptions around OPV and all other antigens. Prominent scholars from Pakistan, Saudi Arabia, Egypt and other Muslim coun-tries met in Islamabad recently and issued a fatwa in support for polio eradication in Pakistan.

DATA COLLECTION, MONITORING AND EVALUATION

To achieve the Polio Eradication Goal, the programme has taken a strategic shift from refusal coverage to missed children (Refusal and Not Available). An online real time database system called “Polio Info Pakistan” has been launched in 2014. This is one stop database system compatible to synchronize with other government owned systems. The new system gives basis and comprehensive analysis of missed children for evidence based planning.

A Knowledge, Attitudes and Practices (KAP) study was conducted in 16 Polio reservoir districts that contributing to reshape communication strategies for polio and routine immunization. Subsequent poll sequences will continue to provide data for timely guidance for strategic direction of the programme, particularly at the district level.

To further improve field monitoring especially in remote and hard to reach areas, the programme is piloting an Android and a GIS monitoring system to monitor and enhance the performance in the field.

VACCINE MANAGEMENT

In order to improve vaccine management and generate a multiyear forecast of equipment needs to meet future requirements, the first electronic national data-base utilizing Cold Chain Equipment Manager has been initiated across the country. The database is fed information from 63 districts/towns/agencies having details of cold chain equipment form more than 2,800 EPI centers and stores. The dataset will be available online with the help of Vaccine Logistic Information System (vLMIS).

PARTNERSHIP FOR POLIO ERADICATION IN PAKISTAN The Pakistan Polio Eradication Initiative is a public-private partnership led by The Government and supported by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) as implementing partners. Rotary Internation-al, the US Centers for Disease Control and Prevention (CDC), Bill and Melinda Gates Foundation, are also important members of the partnership. Japan Inter-national Cooperation Agency (JICA), the World Bank, USAID, DFID and the Is-lamic Development Bank IDB are major donors to the initiative.

Public private partnerships have been forged and resulted in reaching 40,000 households with story teller initiative of SPEAKING BOOKS with Rotary, 2.3 mil-lion households utility bills with behavior change messaging every month through Karachi Electric and 185.3 million household through SMS, voice mes-sages and polio helpline through mobile phone operators Mobilink, Warid, Zong, Ufone and PTCL.

PAKISTAN Polio Update

Updated: 03 Jan 2015

For further information visit www.endpolio.com.pk