By Dr. Nadeem Jan
Since its inception in 1988, the GPEI (Global Polio Eradication Initiative) has done indisputable good. There has overseen a 99·9 percent reduction in the global incidence of polio, saved more than 1·5 million lives, and spared an estimated 16 million people from paralysis. Two of the three serotypes of wild poliovirus (types 2 and 3) have been certified as eradicated.
These are huge achievements, but the programme also faces clear challenges that once again threaten its viability. The still endemic countries like Pakistan and Afghanistan have become nightmares for the programme. While only two cases were reported in Afghanistan this year, the tally in Pakistan has already reached 20.
Polio virus in Pakistan
This worry is magnified by the virus in water sewerages in KP, Sindh, and Punjab, ringing alarm bells in the program nerve canter. The devastating Floods disruption is likely to impact the vaccination drives as well.
The detection of Poliovirus in Mozambique, Malawi, and the US- affecting a young man-, Israel and sewage of the UK is enough of the warning that “A country can be Polio Free but not Polio Risk
free” as long as the virus exists in any art of the world.
Significance of Polio vaccination
The common factor responsible for allowing the virus to take root in an otherwise Polio-free or Polio Endemic country is the lower Polio vaccination coverage.
This signifies the value of sustaining consistent optimum immunity everywhere if people have to be protected against this virus. No one is safe until everyone is safe.
The key barrier at this point is more of the demand side; vaccine hesitancy, faked finger marking, and a waning front-line worker’s motivation.
Outbreak in the US
Interesting to mention that it’s not Pakistan-specific, the US Polio outbreak in New York was reported in the right-wing orthodox Jewish community of Rockland County, which had traditionally resisted vaccination.
The county has had the lowest Polio and measles vaccination coverage, and a Measles outbreak was reported a few years back for the same reasons.
The extraordinary focus on Polio eradication reinforces community skepticism as a vertical initiative while other vital needs like nutrition and mother and child diseases are ignored, in stark contravention to the community demands; this connotation further fuels the conspiracy bandwagon.
UNICEF and vaccination in Pakistan
A UNICEF-sponsored KAP (Knowledge, Attitude and Practices) survey in 2021 in Pakistan revealed trust deficit as one key reason for vaccine hesitancy.
In addition to the demand issue, sustained Political commitment, consensus building amongst partners, programmatic alignment, and top-to-bottom coordination are other vital elements for making the program successful.
Global watchdog IMB report on Pakistan
The IMB (Independent Monitoring Board) – The Global Polio watchdog body- in its 2021 report, highlights the critical need for a performance overhaul. It reminds the program leadership that for the Pakistan program to succeed, it has to build on five factors: one, technical excellence in programmatic planning, organization, and delivery; two, supportive communities; three, good levels of essential immunization coverage; fourth, capability to get to hard-to-reach populations and fifth, an improved sanitary environment.
Polio programme in Pakistan
The report warns that the “Polio Programme in Pakistan is struggling to score highly in all of these five areas.”
In addition, the other essential ingredients for a successful program of this scale are across-the-board accountability and value for money.
While the new program strategy 2022-26 has put theoretical emphasis on accountability, making this walk would be a treat to the eyes, discounting the universal rule of “punishing the weaker”
In addition, the funding scenario on the global stage poses a serious challenge to the program. The program needs 4.8 B to sustain it through 2026 – the target for a Polio Free world.
There are no fewer than eight fundraising efforts in 2022 for global health, of which GPEI is just one, and the estimated cost of all these fundraisers and replenishments is between $130 billion and $140 billion.
In the backdrop of the global recession and a plethora of high-priority diseases/ pandemics, Positioning Polio as a solo priority seems a formidable challenge to address.
Polio-virus and World Health Summit
The last week Berlin World Health Summit, where the program made a plea for 4.8 billion, only 2.3 B USD pledges came forth- translating pledges into action is another debate, though-, even taking it at face value, the program is still at a critical shortage of funding to achieve its mandate.
In the wake of all these interrelated challenges, the key lies in building synergies and integration.
Polio programme significance
The polio program has the most sophisticated surveillance, operations, and communication systems that can work wonders in other pandemics/emergencies.
It has established high-level policy and advocacy fora – from the PM to the UC level -, merely adding another health initiative would deliver better.
Unfortunately, the potential in the Polio program for an integrated approach was little explored. Thanks to the Covid pandemic, this realization was made.
It’s pertinent to highlight that this scribe 2016 had advocated for an” integrated approach,” published in “The News International” on 25th October 2016, but was then ridiculed and vilified.
Polio programme model
It’s spiritually gratifying that the new program model is being shaped on that strategy, and the naysayers are now its greatest advocate.
The theme for this year’s WPD, “World Polio Day 2022 and Beyond: A healthier future for mothers and children.” is emblematic of a looming paradigm shift in the bigger scheme of things.
This, in a way, speaks of the program’s conscious decision to move from a vertical approach to an integrated one.
Polio programme a health security
This Polio and broader health security symbiosis is technically feasible, prompt, cost-efficient, and acceptable. The underlying threat is the missing strategic depth and a passionate Will.
The formula for a win-win is simple, let Polio vaccinations be holistically packaged with other health interventions, a more efficient, cost-effective, and palatable mode of delivery.
Save that, the viral spills in different shapes and locations might keep us haunted; the writing on the wall is clear: The world can’t afford to miss another eradication deadline.
Let that count not daunt the program from what could be another miracle in human history.
About the author
The author is a multi-Awards-winning Global Health Security and Public Policy expert who has had an illustrious career with UNICEF, WHO, USAID, The World Bank, and various governments. His analysis has been featured in BBC, Aljazeera, VOA, Geo, Hum news, BMJ, Arab news, Tribune, News International, Daily Times Pakistan, and Pakistan Observer.
He tweets at @DrNadeemjan
