Towards a polio-free Pakistan in 2021

Year 2020 will be remembered for the challenges it brought to global public health. Like others, Pakistan had to focus on mounting best possible response to control Covid-19. But perhaps the most critical contribution came from the national polio eradication programme. By using all available resources, its team helped build Covid surveillance and data management systems and raised awareness among people.

While Pakistan was applauded for successfully tackling the pandemic, questions were raised as to why we couldn’t eradicate polio so far. Pakistan and Afghanistan are the only ones left where wild polio virus continues to threaten children’s health — underlying the urgency we must work with in order to deliver a polio-free world.

Our surveillance system stays highly sensitive as 84 wild polio cases were detected from Pakistan’s 38 districts in 2020. Amidst Covid, it represents 43% decline, over the 147 cases reported in 2019. Nevertheless, environmental surveillance indicates presence in Pakistan’s different geographical zones. As part of the epidemiological bloc, Afghanistan recorded 56 polio cases in 2020.

Efforts to eradicate polio suffered immensely in 2019. With persistent challenges in ensuring optimal essential immunisation coverage, the slip in programme oversight in 2019 was enough to impact vaccination campaign performance to generate marked immunity gap. Meanwhile, vaccine hesitancy soared due to false propaganda. High rates of malnutrition, poor basic healthcare and poor water, sanitation and hygiene services further provided environment rife for increased polio transmission.

Learning from these, in 2020, the programme identified ways to bring communities along, improve operational performance, and contain polio spread. A comprehensive structural transformation was initiated and implemented to retain the best performing staff, improve management structures and enhance utility of data collected for decision-making. 

The reinvigorated programme promoted polio eradication as a shared priority across political divide and society. ‘One Team’ approach was revived, and a battle initiated from Dec 2019 conducting two nationwide and subnational door-to-door campaigns before Covid. Later, the programme’s strengths were successfully diverted towards Covid surveillance and response.

Sensing risks associated with disruption of essential and supplementary immunisation, the programme resumed campaigns in July using revised modalities. Since then, six campaigns have been conducted, with national engagement of leaders ensuring successful implementation of door-to-door campaigns. The security and armed forces continue their support, including security to frontline workers vaccinating children. Vaccinators were trained on Covid-19 preventative measures, while strict rules were enforced to prevent Covid spread amongst vaccinators and citizens.

Essential immunisation was also heavily affected due to lockdown. With strong support, services were resumed and enhanced outreach activities increased coverage above pre-Covid times with focus on populations living away from health facilities.

We are confident in steps Pakistan Polio Programme took in 2020 to re-think, re-strategise and innovate. Comprehensive reviews of operations and data analysis helped the programme battle polio with renewed energy. We’re implementing a new communication strategy to support high vaccine acceptance. Further investments through community engagement are underway.

We look forward to sustaining high leadership and support levels in 2021, consolidating programme structure change, better engagement, reinforcing essential immunisation, delivery services to underserved communities, and coordinating with our Afghan colleagues to manage polio spread. Through committed frontline workers, the programme aims to restrict the geographic scope of polio and eradicate it in 2021!

We thank all polio frontline workers, our heroes, who contributed to the progress in 2020, and our partners who supported the polio eradication efforts. Above all, we thank parents and caregivers, and urge their support in vaccinating all children in 2021 for a polio-free Pakistan!