Sustaining the polio gains and beyond

The “carpe diem” for Pakistan in its long battle of polio eradication is very much insight, coming from a heavy toll of 147 wild polio cases in 2019 and 84 the previous year to only one thus far is a mega success. Similarly, the number of vaccine-derived polio 2 cases have come down from 135 the previous year to eight cases so far this year, this is a hallmark progress.

All this speaks, we are there, save force majeure.

Polio has had a colossal toll on children health, crippling 350,000 children each year before 1988 – the year polio eradication resolution was passed by WHO -. Since then 18 million children who would have otherwise been crippled due to polio are now able to walk, thanks to the polio vaccine.

24th of October is celebrated each year as the “World Polio Day”, to commemorate the birth of Jonas Salk, who led the development of the polio vaccine. The use of this inactivated poliovirus vaccine and subsequent widespread use of the oral polio vaccine, developed by Albert Sabin, provided reasons for the world to make history yet another time by resolving to eradicate polio once and for all; making it the only second disease after smallpox to have been eradicated.

Read more: Polio drive extended as parents refuse to vaccinate children

If Pakistan could make it to zero the next year and sustain it for another three years, we would be certified polio-free, a dream that has cost us so much.

The incredible performance over three decades speaks of the enormous efforts undertaken by the field workforce who braved all hardships to vaccinate children in every nook and corner of Pakistan and that too at pretty meagre wages.

This bumpy journey is written with sweat, blood and tears, scores of polio workers and security personnel have embraced martyrdom, billions of dollars spent and enormous amount of time dedicated to accomplish the task.

Pakistan's story is an unprecedented commitment of civil and military leadership. Despite thundering bullets, the vaccination team were provided foolproof security to carry of vaccination. I am an eye witness to this zeal and enthusiasm from top army leadership to the field formations in the ex-FATA areas.

Given that a polio-free Pakistan is very much in sight now, there is ample logic to think of transitioning the rich polio resources to the health system for effective sustainability of the investment. The programme technical, logistical and coordination assets have every capacity to be utilised for interventions beyond polio. The coordination platforms, surveillance system, trained HR, a robust communication system and emergency operation centres (EOCs) are assets that offer opportunities for more holistic utilisation.

1. The programme have had developed high-level fora for creating multi-sectoral coordination avenues that provided a big boost to programme planning, troubleshooting and advocacy.

Also read: Polio progress

The highest forum led by the prime minister is the “National Task Force” and participated by all ministerial heads, administrative secretaries, CMs and technical leads.

Similarly, at provincial and district levels the fora bring together all administrative machinery under chief secretaries and DC leadership respectively. These existing entities have revolutionised public health approach and brought in the essential “out of the box” thinking by bringing in outside the health leadership to this platform. Continuation of these platforms for utilisation in nutrition, EPI, dengue and other health emergencies would be the best succession planning.

2. Polio programme has a resource-intensive and functional surveillance system, not only limited to human surveillance but environmental surveillance as well. In the interim, this system should incrementally include other public health threats like dengue, measles, meningitis, diphtheria and tetanus. In the next phase, this can be extended and augmented to include all infectious diseases under one national surveillance system.

3. Embedded in polio programme is a technical hub at national, provincial and district levels in the form of EOCs. These hubs bring in all partners and government under one roof, thereby, ensuring ease of doing business, furthering coordination and saving time and money.

Gradual incorporation of other infectious diseases and national priorities like Covid-19 nutrition, water & sanitation, malaria/dengue in this network would ensure effective sustainability of the huge investment.

4. Community’s resistance and hesitation to polio vaccination for various reasons have affected the pace and success of the programme. The programme then recreated itself- a bit late though- to invest more in addressing the community apprehensions and focused on buying hearts and minds of the people through a well-resourced “communication and perception management strategy”. Making meaningful interactions with the communities, the issue has been greatly managed. These health volunteers- community interactions could be the bedrock for other health emergencies and national priorities.

5. Over the last three decades the programme has created huge work forces in various domains. Of which a“community-based vaccinators” cadre has proved a game-changer. This cadre with the expertise and acceptability at the grass-root level has the potential to support other health interventions.

Gradual but strategic integration of nutrition, WASH and other infectious diseases at scale in polio programme can prove a mutual win-win.

At the heart of the problem lies the core determinants of human sufferings i.e. poverty, gender imbalance, inequity and poor access to basic services.

Polio, like other diseases, is predominantly a disease of the poor, for poor access to services and low literacy rate.

A pragmatic collaboration with the EHSAS programme would not only help polio but transform people’s perception, improving health and enhancing govt credibility.

It would be prudent that the programme develops a “transition framework” for the gradual transformation of polio programme assets.

A revised programmatic strategy and direction would best address the “universal health coverage" and wider health and development gaps through a more holistic approach. This would also relive, somehow, the strangulated economy.

Dr Nadeem Jan (Tamgha-e-Imtiaz) is an internationally recognised health & public policy expert, who has had an illustrious career with UN, USAID, World Bank, Gates Foundation and various countries. His e-mail: Nadeemjan77@hotmail.com.

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