Country: Pakistan

Over the course of 2015, Pakistan has seen encouraging signs of progress against polio, with the programme tightening its grip on the last strongholds of the virus. The number of cases has declined sharply, with 39 reported to date in 2015, compared with 235 cases by the same point in 2014.

Not children reached, but children missed

One of the most important changes of the last year was a shift in focus from the number of children reached to the number missed during immunization campaigns. “How many missed, where and why?” became the determining question. The results of this shift are clear, with almost half a million children who were previously missed by vaccinators now being reached, due to gradual improvements in programme quality and access to previously unreachable areas since late 2014.

This week’s Morbidity and Mortality Weekly Report from the US Centers for Disease Control and Prevention attributes recent improvements to the establishment of a functioning Emergency Operations Centre (EOC), based on the model that contributed to success in Nigeria. A sign of the successful increase in political engagement at both regional and national levels, the EOC serves as a platform for increased government ownership of the polio programme, close collaboration among the partners of the Global Polio Eradication Initiative, and the implementation of new strategies outlined in the National Emergency Action Plan such as health camps, which have reached almost 350,000 people in high-risk areas with additional health services alongside polio vaccines this year.
As Pakistan zeroes in on continuously missed children, misconceptions about the polio vaccines and issues of inaccessibility in certain security challenged areas continue to pose challenges. An innovative approach to addressing these issues has been introduced through Continuous Community Protected Vaccination (CCPV), in which local, predominantly female community health workers are engaged to vaccinate the children of their own communities on a regular basis. With over 80% of polio cases occurring to children under two years old, there was a need to deploy vaccination teams who are in constant contact with children in the communities. CCPV was introduced in selected high-risk reservoir districts of Khyber Pakhtunkhwa and the Federally Administered Tribal Areas, using primarily female vaccinators who are more likely to gain access to households.

While cases have fallen, the virus is geographically widespread. Punjab, with no cases during 2014, has reported a case in 2015 and continues to show evidence of virus presence through environmental surveillance. Peshawar and its surrounding regions remain the heart of this reservoir of the virus, acting as a source of transmission to other parts of the country and into Afghanistan.

In order to stop the transmission of polio in Pakistan in 2016, a lot of work remains to be done. We must close immunity gaps by locating and vaccinating every last child and improving routine immunization coverage in high-risk areas. The Government of Pakistan must continue to demonstrate its leadership and to provide oversight and accountability through provincial and national EOCs. It will also be necessary to improve oversight and accountability for vaccinations delivered at transit points both inside Pakistan and at the borders with Afghanistan.

Read more about progress and challenges in Pakistan through the Morbidity and Mortality Weekly Report.

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In the shade of a tree in the remote village of Chandiya in Dera Ghazi Khan district of Punjab, a crowd of people wait their turn to receive medical treatment. Reaching children and their parents who all too often do not receive basic health care and water and sanitation services, these camps deliver polio vaccines to the children who most need them, alongside other important health services.

“This is a rare chance that a doctor is visiting our village to give us free check-up and medicines. It’s a blessing for us to services right at our neighbourhood,” said Sher Ali, a local standing in the crowd who had brought his child for vaccination.

This scene is not unique; across Pakistan, 1857 health camps have been set up by the Government of Pakistan with support from technical partners and donors. So far this year, 480 538 people have benefitted from the health services delivered at these camps, including 10 000 children under the age of five who have never previously received the oral polio vaccine. This has made health camps a vital tool in Pakistan’s push to identify and protect the children who have been missed by polio campaigns in recent years.

Dera Ghazi Khan borders several high risk areas for polio, including Balochistan, Sindh and Khyber Pakhtunkhwa. Therefore health camps like this one are essential for combatting the low immunization coverage, poor health services and misconceptions circulating among parents about oral polio vaccine, all of which leave many of the children of the district vulnerable to the virus.

Read the full story.

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Pakistan Polio Eradication Initiative

Pakistan launched a nationwide polio campaign yesterday to vaccinate more than 35 million children in 163 districts of the country. Approximately 200,000 polio workers are participating in the polio campaign, during which Vitamin A will also be distributed.

The Prime Minister’s Focal Person on Polio Eradication, Senator Ayesha Raza Farooq, monitored the campaign in various areas of Islamabad including urban and rural slums, reminding administrators that there would be zero tolerance for negligence. “Our priority is to reach out each and every child so that no child remains unvaccinated during this nationwide polio drive”, said Senator Farooq during her visit. “Nine campaigns are planned during September 2015 to May 2016 and every campaign is critically important to stop polio virus transmission.”

Pakistan currently accounts for most of the children paralyzed by wild poliovirus this year (30), followed by Afghanistan (9). These are the only two countries in the world with wild poliovirus cases in 2015: the lowest number of countries in history. Pakistan country is well-positioned to take advantage of the the current ‘low season’ for poliovirus transmission; it has prepared emergency operations centres at federal and provincial level and is improving its ability to hold every level of the administration accountable for delivering vaccine to children. The quality of these campaigns – whether missed children are given the opportunity to be vaccinated – will determine how swiftly Pakistan can eradicate polio.

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Pakistan has become the second polio-endemic country to introduce the inactivated polio vaccine into the country’s routine immunization schedule, a move which will benefit more than four million children per year across the country. With more than half of the global birth cohort now receiving IPV due to the largest globally synchronised vaccine introduction in history, the addition of Pakistan’s children to this number will help to speed Pakistan towards stopping the virus for good.

Pakistan is one of only three countries in the world where polio remains endemic. Nigeria, which recently marked one year without a case of wild polio, introduced the vaccine in February of this year, and Afghanistan is due to begin using IPV in the coming weeks. While every country in the world is set to introduce IPV, endemic countries will greatly benefit from the boost in immunity that new evidence has clearly demonstrated that adding one dose of IPV to OPV offers to children as they fight to end transmission of the virus. Aziz Memon from Rotary International emphasized that “… adding at least one dose of IPV to the routine immunisation schedule is the best possible way to protect your children from life-long polio paralysis, while the disease is being eradicated from the remaining endemic hotspots.”

The universal introduction of IPV is part of the Polio Eradication and Endgame Strategic Plan 2013-2018. It helps to build a solid base-layer of immunity against polio, and will help to secure the gains made against the disease by contributing to stronger immunisation systems, so that every child in every country has access to vaccines. “The introduction of IPV is a major landmark as it would strengthen our efforts to fight polio and eventually eradicate it from our country and the world. We are confident that this introduction will give a boost to routine immunization in the country,” said Mrs Saira Afzal Tarar, Minister of State, Ministry of National Health Services Regulation and Coordination.

Pakistan has made significant progress in the fight against polio with a 75% reduction in the number of cases of wild poliovirus compared to the same period last year (from 115 cases to 29 cases). This decline shows that, despite major challenges and remaining hurdles in some provinces, Pakistan is getting closer to polio eradication. However, the country still accounts for more than 80% of cases worldwide so far this year, and many children in high-risk areas of the country remain un- or under-immunised.

As well as its use in routine immunization, the ability of IPV to boost immunity when used alongside OPV is being utilized in polio campaigns. In critical areas of the Federally Administered Tribal Areas such as South Waziristan and Khyber Agency, which were which were not consistently reached due to insecurity over the last few years, IPV campaigns are ongoing targeting children between 4 and 24 months. The children of families returning to North Waziristan, South Waziristan and Khyber Agency following displacement are also given IPV to increase their immunity as they are a particularly vulnerable group. While OPV is still the only vaccine that can end transmission of the virus, IPV can provide a boost to speed up the development of immunity to all types of poliovirus.

“The introduction of IPV is a result of significant progress for our country in term of strengthening routine immunization,” said Dr. Syed Saqlain Ahmad Gilani, National Program Manager, EPI. “We are another step closer to ridding the world of the terrible disease of polio, and it is a result of our efforts to improve the current state of routine immunization in the country.”

Read more about the global status of IPV introductions here.

The Bill & Melinda Gates Foundation, Norway, and the United Kingdom are generously supporting the introduction of IPV in routine immunisation schedules in 72 Gavi-supported countries, while Canada is supporting its introduction in other lower-middle income countries. The top ten government donors to GPEI include the USA, the UK, Japan, Germany, Canada, the Netherlands, Norway and Australia.

The Global Polio Eradication Initiative (GPEI) is led by national governments and spearheaded by the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC), and the United Nations Children’s Fund (UNICEF), with the support of the Bill & Melinda Gates Foundation.

Since its launch at the World Health Assembly in 1988, the GPEI has reduced the global incidence of polio by more than 99%. The GPEI receives financial support from governments of countries affected by polio; private sector foundations, donor governments, multilateral organizations, private individuals, humanitarian and nongovernmental organizations and corporate partners.

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The Global Polio Eradication Initiative (GPEI) is midway through the most ambitious, largest and fastest globally synchronised vaccine introduction in history as part of its drive towards a polio-free world.

How far have we come?

As part of the Endgame strategy for polio eradication, the inactivated polio vaccine (IPV) is being introduced into the routine immunization systems of every country that currently uses the oral polio vaccine (OPV). Half way into 2015, exciting progress is being made towards this goal, which will help to boost immunity against all types of poliovirus, giving children higher protection against paralytic polio.

51% of the global birth cohort is now receiving at least one-dose of IPV

The introduction of IPV has already made great strides, with 20 countries adding the vaccine to their immunization schedules between January and July this year alone, bringing the number of countries using the vaccine to 97. This means that 51% of the global birth cohort is now receiving at least one-dose of IPV. A surge of introductions in the coming months will lead to over 75% of countries having at least one dose of IPV in their routine immunization systems by the end of October. By the end of the year, all countries with the highest risk of wild poliovirus or the emergence of vaccine-derived polioviruses- the highest priority categories for IPV introduction- will have completed the introduction. This will ensure that the most vulnerable children are given the best possible protection against polio.

Two vaccines for polio

The polio eradication programme has two vaccines with which it protects children against the virus: IPV and the OPV. The use of the oral polio vaccine (OPV) has led to wild poliovirus being stopped in nearly every country in the world, and to no cases of wild poliovirus type 2 (WPV2) since 1999. Currently, 156 countries and territories use trivalent OPV (tOPV), which protects children against all three types of wild poliovirus, to vaccinate children against polio in their routine immunization programmes. While OPV is the only vaccine that is effective in stopping the transmission of poliovirus during outbreaks, the introduction of IPV in these countries will increasingly play an important role in keeping those countries polio-free in the long term.

The weakened type 2 strain of attenuated poliovirus in tOPV is no longer needed to protect children from wild polio, as no case of type 2 has been seen since 1999. In addition, the type 2 component of OPV causes more than 90% of all vaccine derived polioviruses (VDPVs), which occur when a very rare change in the attenuated virus in the vaccine mutates into a form that may cause paralysis. This can only occur where vaccination coverage is very low. To protect children from this very rare risk, OPV will be removed in a phased manner over the next few years. The first step is to replace tOPV with bivalent OPV (bOPV), which doesn’t contain the type 2 component, thereby removing the risk of type 2 VDPVs.

Why introduce IPV?

1. Giving IPV alongside OPV has been shown to be the most effective way of rapidly building immunity against all types of poliovirus. The introduction of IPV prepares children’s bodies for a rapid build-up of immunity in case an outbreak after the switch would need fast campaigns to protect children against the virus.

2. IPV will build up some level of population immunity against the type 2 polioviruses. When the type 2 component of OPV is withdrawn, children will no longer be protected against wild poliovirus type 2. While no wild poliovirus type 2 has been seen since 1999, maintaining some immunity through IPV will be important to mitigate the risks.

3. IPV will boost immunity against poliovirus types 1 and 3 in children who had previously received OPV, bringing us closer to a world in which every child is fully protected and stopping the virus for good.

The wider impact

Strengthening routine immunization systems is a core pillar of the strategy of the Global Polio Eradication Initiative. As IPV is an injectable vaccine it needs to be delivered by a trained health worker, unlike OPV, making the urgency of strengthening routine immunization has become even more apparent. In many countries, such as Bangladesh, the introduction of a new vaccine such as IPV provides an opportunity to strengthen the entire system through the expansion of cold chains, training health workers, and renewed community outreach. By using the lessons learned through the eradication of polio to strengthen routine immunization, the GPEI is ensuring that the legacy of polio eradication stretches into the future in more ways than providing a polio-free world.

The Bill & Melinda Gates Foundation, Norway, and the United Kingdom are generously supporting the introduction of IPV in routine immunisation schedules in 72 Gavi-supported countries. In addition, Canada is providing critical catalytic one-year support to help 19 lower middle income countries, enabling them to introduce IPV.
By increasing immunity against all strains of poliovirus, filling the immunity gap against type 2 and helping to enable the removal of type 2 OPV, this global vaccine introduction is helping to secure a lasting, polio-free world for everyone.

Read more about the global introduction of inactivated polio vaccine and the switch here or see find more information on the WHO website.

The Global Polio Eradication Initiative (GPEI) receives financial support from governments of countries affected by polio; private sector foundations, donor governments, multilateral organizations, private individuals, humanitarian and nongovernmental organizations and corporate partners-. A full list of all contributors is available here.

Status of IPV use in routine immunization systems in January 2013:

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The world has never been in a better position to eradicate polio, yet Pakistan and Afghanistan face a daily battle to protect children against the virus. Pakistan, the single greatest challenge to global eradication, is getting back on track to stop transmission of polio in 2015, concluded the Technical Advisory Group (TAG) at their meeting in Islamabad on 4 and 5 June.

In 2014, Pakistan reported 85 % of the world’s polio cases. This year has seen 26 children paralysed by polio, 72% less than we had seen by this time in 2014. This drop in cases is evidence that, despite major challenges and remaining hurdles in greater Peshawar, Khyber Agency, the Federally Administered Tribal Areas (FATA), and the central Pakistan block, Pakistan is taking steps forward towards a polio-free future.

Every missed child

Key to improvements over the last few months has been the shift in focus to finding and vaccinating every missed child – rather than focusing on the numbers of children reached and vaccinated. The TAG was encouraged by the fact that the number of persistently missed children had significantly declined in all major areas including South Waziristan, parts of Peshawar and Karachi. Similarly, the exodus from North Waziristan due to military campaigns in 2014 was grabbed as an opportunity to vaccinate longstanding un-reached and unvaccinated populations. Ongoing innovations specific to each area and enhanced community engagement are the key tools being used to bring those numbers of missed children down to zero.

Pieces of the puzzle

Since the most recent consultation in February, the TAG recognised that significant progress has been made, especially through the adoption of innovations such as the use of the inactivated polio vaccine (IPV) in supplementary immunization activities, measures to protect the safety of health workers, and the health camps to reach children with vaccines alongside other health measures.

Pakistan has all the tools it requires to stop transmission of polio. It remains crucial that these tools are utilised to ensure that the final pieces of the puzzle come together in practice to see concrete change over the current high season for transmission. These essential aspects are an accountable government at all levels, community trust and health worker safety, engaged community leaders, the continued use of innovative solutions and ensuring that the programme are using the right vaccines in the right places, such as the inactivated polio vaccine (IPV) in campaigns in hard to reach areas to build immunity more rapidly.

Insecurity in certain areas remains the biggest obstacle to polio eradication in Pakistan, resulting in delayed or missed campaigns. Combatting this is where non-traditional tools, such as female community volunteers and health camps, have proved most valuable. “We cannot allow conflict and politics to get in our way because at the end of the chain, behind that door, stands a mother or a father who wants to protect their child,” argued Dr Hamid Jafari, Director of Polio Operations and Research at WHO.

The National Emergency Action Plan for Pakistan has outlined an action plan to stop transmission as soon as possible by detecting, containing and eliminating the virus, maintaining and increasing immunity, and strengthening routine immunization to help sustain protection once transmission is stopped. The plan aims at reaching every child with multiple doses of the vaccine between September 2015 and May 2016. The programme is strengthening and preparing to stand absolutely ready for high quality implementation by mid-August. The programme will also have to ensure it continues to coordinate with Afghanistan, following spread of viruses across the border in both directions. Along the 2450 km border, temporary vaccination points are in place to coincide with movement of seasonal workers, pilgrims and those forced to leave their homes due to extreme weather conditions.

“The recent progress in Pakistan is very promising. We may be looking at months- months, not years- before we eradicate polio in this country,” stated Dr Jafari. If all elements of the polio programme are accountable for reaching and immunizing every child in polio vaccination campaigns, Pakistan can take the world over the finishing line for polio eradication.

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The Convention of the Rights of the Child, which marks its 25th anniversary on the 20th November, defines the right of each child to survive and develop to their full potential.

Polio is a virus that causes irreversible paralysis, mostly to children. Before the first vaccine was developed in the 1950s, hundreds of thousands of children around the world were left unable to walk every year. With no cure, the threat of polio was a well-known source of fear for parents everywhere.

In 2014, polio has been dramatically reduced, but still circulates in geographically restricted areas of the world where insecurity prevents health workers to reach children with the vaccine. It has become an indicator of poverty, circulating where health systems are weak and where insecurity leaves children vulnerable, unprotected by the services they have the right to be provided with. That children anywhere in the world continue to be paralysed by this easily preventable virus is an inexcusable violation of the right of children to survive and develop to their full potential.

In North Waziristan, Pakistan, bans on immunization have meant that children have gone without access to polio vaccines since July 2012. North Waziristan is one of the final reservoirs of the virus. “The militants banned vaccination in their strongholds and would punish anyone in public if they were found vaccinating children,” said Salman Shah, a boy in his teens, whose studies in Political Science were interrupted by the unrest.

This summer, military campaigns in North Waziristan caused over a million people from North Waziristan to leave the area to protect their families. As unvaccinated people moved out of the area, the fear grew that this would offer the virus a chance to regain hold in other areas of the country. However, the government of Pakistan and the partners of the Global Polio Eradication Initiative, including WHO, have taken steps to seize the opportunity to reach displaced families at permanent vaccination points as they leave North Waziristan, and in the host communities in which they settle.

In Karak district, where many displaced families are settling, the provincial government is seizing the opportunity to protect every child with the crucial drops of oral polio vaccine. Doctors are going from door to door as part of health teams to vaccinate children free of cost. Noor Wali, a father who was displaced with his 7 children, expressed his gratitude that the government was finally able to reach his family with essential services. He said, “It is so important for us to shield our children from polio and other diseases.” His two youngest children, Noorul Amin and Robina, are finally protected against a disease that has been a severe threat to them since health workers stopped being able to reach their village 4 years ago.

The World Health Organisation has been crucial in ensuring that the displacement of families from North Waziristan was seized as an opportunity. Dr Margaret Chan, the Director-General of WHO, championed the importance of WHO’s role in the field of human rights: “The world needs a global health guardian, a custodian of values, a protector and defender of health, including the right to health.” By working for the past months to reach every family leaving North Waziristan, WHO has helped to ensure that over half a million children have been vaccinated against polio. In supporting governments to do everything they can to prevent life threatening diseases such as polio, WHO plays a crucial role in enabling children to survive and develop to their full potential.

Habib Ur Rehman, the father of 5 children who have now been protected with the vaccine, said: “In Darpakhel, vaccination activities took place under a cloud of fear. But the situation was worse in adjoining areas where vaccination activities were suspended. People have had to suffer a lot. I believe vaccination is the only way to prevent these life threatening diseases.”

Read more about WHO’s work on Child Rights.

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More than 42,000 children were vaccinated by the FATA Administration during a two-day campaign with the financial support of the United Arab Emirates and the protection of security forces. It was for the first time since 2009 that a comprehensive campaign could be conducted here, due to military operations and insecurity.

There were no security incidents during the campaign and according to preliminary reports, the demand from the community and the acceptance of vaccine was very high with excellent overall coverage. This opportunity allowed health officials to assess other critical health needs of the population, and to respond to the Leishmaniasis outbreak.

During the next three weeks, three more similar campaigns will be conducted on a weekly basis.

The World Health Organization (WHO) is taking immediate steps to assess the public health benefits of tightening the application of polio vaccination recommendations for travellers from polio-infected areas. These steps are being taken in response to a request by WHO Member States convening at the organization’s Executive Board (EB) in January 2014.

This request of Member States reflects growing concern about the substantial international spread of polio from key infected areas in 2013. Last year, poliovirus originating from polio-endemic countries resulted in major outbreaks in the Horn of Africa and the Middle East. Some WHO Member States, including the Kingdom of Saudi Arabia, already require that travellers from polio-affected areas show proof of vaccination before they are issued entry visas.

As an immediate first step, WHO convened the independent Polio Working Group of the Strategic Advisory Group of Experts on immunization (SAGE) on 5-6 February 2014 to review existing definitions for polio-infected areas, update WHO’s polio vaccination recommendations for travellers from infected areas based on new information and evidence, and identify potential operational and other considerations that would need to be evaluated in tightening the international application of such recommendations. These updated policy recommendations are summarized in the new ‘Polio vaccines: WHO position paper, January 2014’, published in the WHO Weekly Epidemiologic Record on 28 February 2014 and will be published in full in the 2014 edition of WHO’s International Travel and Health in April 2014.
The deliberations and recommendations of the SAGE Polio Working Group will be discussed by SAGE in April 2014 and inform deliberations under the International Health Regulations concerning potential measures for reducing the international spread of polioviruses.

Related

Polio vaccines: WHO position paper, January 2014
WHO International Travel and Health
GPEI report on polio eradication to the 134th Executive Board (January 2014) [pdf]
Strategic Advisory Group of Experts on immunization (SAGE)

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Courageous Pakistani mothers, like polio survivor Saima, are key to ending polio’s paralysing effects on children for good – not just in Pakistan, but all over the world.

This is not the first time Saima Liaqat has shown her courage.

Stricken by polio at age two, Saima was partially paralysed. Yet already, as a girl, she refused to let the disease get the best of her. She limped down the long dusty road to school so often, and studied so hard, that she became the first woman in her family to go to college.

Saima’s native Pakistan is one of only three countries on earth where polio is still endemic; Afghanistan and Nigeria are the others. Polio, as Saima knows all too well, attacks children with devastating, paralyzing results. The disease can be prevented by swallowing two drops of polio vaccine. Yet in small pockets of Pakistan, some parents have refused to allow their children to take the vaccine. And the recent polio outbreak in Syria is a reminder that, whenever children anywhere go unvaccinated, every child is at risk.

It will take courage – and the efforts of unstoppable women like Saima – to rid Pakistan, and the world, of polio once and for all.

In this TV spot, which has reached nearly 70 million viewers across Pakistan, Saima stands up, once again, to the disease that left her partially paralyzed. Now a wife and mother of three herself, she shares her story as a polio survivor and urges parents to accept the vaccine:
“I think parents become their child’s worst enemy when they don’t vaccinate them. You will regret it, if something happens to your child.”

As a mother, Saima has always refused to let polio hold her back.
“When my children were young, we would go to the park. I would play all sorts of games with them… badminton, cricket. I would take care of them all by myself,” says Saima. “I wanted to prove to people that I was still my own person.” Her courageous example has not been lost on Saima’s own children.

“I wanted to become a doctor so I could treat my mother,” says her daughter, Hamna. “Now I know this disease has no cure.”

Saima has taught her daughter to focus on what can be changed, rather than on regrets from the past. Still, even as Hamna speaks of the polio vaccine that can free children all over the world from this tragic disease, her voice is wistful. It’s hard not to wonder how different her mother’s life might have been – if only she had swallowed those two tiny drops of vaccine. Says Hamna:

“I wish my grandparents had given my mother polio drops, so she would not be in so much pain today.”

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“I kneel before Allah. But I am unable to stand on my feet before any man.”

In Pakistan, Qari Aqeel teaches children the fundamentals of Islam and the Holy Quran. He also tells them, from his own painful experience, what it is like to live with polio.

A teacher at a Madrassa in one of Karachi’s poorest areas, Aqeel talks to parents and children about the importance of vaccination from an Islamic perspective. In this moving video, Aqeel takes the spotlight away from the politics and misunderstandings that can too often muddy the dialogue about polio vaccination. He brings the focus firmly back to what most matters: the heart-wrenching effects that polio can have on a young life – and the imperative to end this tragic and preventable disease, once and for all.

As a child, Aqeel so longed for an education and a connection to God that he braved pushing, shoving and being spit at by other children as he made his way on crutches through the streets of Karachi to learn at the local seminary.

Today, as a grown man, Aqeel might be speaking of his newly-acquired wheelchair, when he says:
“Now, when they push me, I just go faster.”

Or he might be speaking of the struggle to end polio itself.

Watch the video

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GENEVA/NEW YORK, 19 December 2012 – The World Health Organization (WHO) and UNICEF join the Government of Pakistan and the provinces of Sindh and Khyber Pakhtunkhwa in condemning the multiple attacks that have killed nine health workers this week.

The attacks took place in several locations in Pakistan – Gadap, Landi, Baldia and Orangi towns of Karachi city, Sindh Province and Peshawar, Khyber Pakhtunkhwa Province. Those killed were among thousands who work selflessly across Pakistan to eradicate polio.

The Government of Pakistan and the affected provinces have temporarily suspended the vaccination campaigns due to concerns over safety of health workers.

Such attacks deprive Pakistan’s most vulnerable populations – especially children – of basic life-saving health interventions. We call on the leaders of the affected communities and everyone concerned to do their utmost to protect health workers and create a secure environment so that we can meet the health needs of the children of Pakistan.

WHO, UNICEF and all their partners in Pakistan and globally express their deepest sympathy to the families of the health workers. We remain committed to supporting the Government of Pakistan and the people of Pakistan in their efforts to rid the country of polio and other diseases.

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19 September – With such a focus on vaccinating the last one per cent of the world’s children, it is easy to forget the work that is being done to help those children who have survived the incurably crippling poliovirus. For Najeebullah (18) and Naqeebullah (15), two brothers living in the polio sanctuary of Gadap Town, however, the Rotary Club of Karachi has been instrumental in enabling them to best overcome the virus and meet Pakistan’s cricketing legend, Shahid Afridi.

The two brothers, originally from Mazhar-e-Shareef in Northern Afghanistan, were afflicted with polio when they were 14 and 11 years of age respectively. The third child in the family has been vaccinated against the virus to ensure he does not suffer the same fate as his brothers.

After receiving treatment and therapy for 40 days at a rehabilitation hospital in Saddar Town, Karachi, the older brothers regained some mobility in their hands and legs. At Rotary Club of Karachi’s artificial Limb Project Community Centre, they were both fitted with prosthetic limbs free of charge thanks to the donations of Pakistani Rotarians.

The 5000 artificial limbs and calipers the centre provides free of cost every year to polio victims and amputees is not the only service offered by Rotary’s Community Centre. There is also a permanent limbs workshop at the centre, a gym, an eye clinic, a permanent immunization centre for the surrounding population, and activities such as computer classes.

At the end of July, the brothers were invited to a Polio workshop in Karachi, organized to inform Presidents of Rotary Clubs in Karachi of the current polio status in Pakistan. Here, they shook hands with Pakistan hero, Shahid Afridi. According to ESPN, ‘cricket never has and never will see another’ like Afridi. Indeed, ‘Boom Boom’ Afridi has already vaccinated children personally as part of the promotional campaign, which has seen the cricketer’s face displayed on the side of hundreds of rickshaws which roam all areas of Karachi.

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28 August 2012 – On the weekend of 31 August, prominent religious leaders from seven major sects in Pakistan who are supportive of polio eradication will travel to Saudi Arabia to attend a Conference on Children and Islam. These leaders represent religious leaders across Pakistan who are working to mobilise the community in support of polio vaccination and overcome widespread rumours that polio vaccination is anti-Islamic.

Refusals, and religious refusals in particular, are rare in Pakistan, with an average of only two per cent of the population refusing the vaccination during each campaign. However, in order to reach every last child, this is too high a figure, and one which polio staff and religious leaders are working hard to bring down.

When volunteers visit households on their vaccination rounds, they can find some families who persistently refuse to have their child vaccinated even when they are re-visited several times during the campaign. When parents cite religious reasons for refusing the oral polio vaccine (OPV), it is often due to a perception instilled by the teachings of an influential religious figure who has expressed reservations about the safety of the vaccine, or even the motives of the polio programme in general.

In some areas, localised resistance has been mobilised around the belief that the polio programme is a western plot to sterilise Muslims, or that the contents of the vaccine are not halal.

It is critical not only to provide correct information about the importance of polio vaccination, but also to help mobilise religious leaders to become advocates for the cause. In the high-risk areas of Pakistan, 1,085 social mobilisers are working to transform community perceptions.

Social mobilisers explain and dispel persistent myths about the vaccine and use passages from the Qur’an and the Hadith to emphasize the importance of children’s health . Fatwas from highly respected Islamic clerics also help to demonstrate that polio vaccine is not anti-Islamic. Once on board, religious leaders have the influence to successfully convince their followers to vaccinate their children and can call families from their mosques to vaccination points.

One such religious leader is the uncle of two-year-old Mehrama, from Quetta in Balochistan, who was diagnosed with polio in June this year. In this case the turning point came when he was shown a pro-vaccine video of Maulana Rafi Usmani, an influential religious scholar from his own Deobandi sect. In the July campaign, this influential leader inaugurated the vaccination campaign in his Union Council by vaccinating his one-year-old son and convincing eight other families who had previously persistently refused to vaccinate their children.

In areas that don’t have access to television or radio, the inter-personal connection that social mobilizers are able to establish is crucial: with persistent and appropriate interventions, one-to-one communication can not only change beliefs, but also behaviour. Across the 33 high risk districts in Pakistan, 1 out of every 2 parents who initially refuse the vaccine are later convinced of the importance of vaccination, according to UNICEF’s communications data. Thanks to the work of religious leaders, and increased commitment from the whole country towards the eradication goal, the total number of polio cases in Balochistan in the first half of this year was 3 compared to 19 by the same point in 2011.

There remains a lot of work to do, however. Children in Quetta Block continue to be missed – 16 % in Pishin in the March 2012 immunisation campaign. With the help of religious leaders and civil society to establish polio vaccination as a universal social norm, however, more children will enjoy a polio-free future.

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In the scenic Sanwan village, close to the Indus River in Thatta district, Sindh, melon growing is a common occupation for local farmers. Thirteen-month-old Sundar Lal’s family have been known for their melons for years. It takes three months to harvest the melons: “We have already gathered two crops and the final one will be ready in a month’s time,” Premi, Sundar Lal’s grandmother, explained. However, it is unlikely that Sundar will be able to play a role when he’s older in the harvesting of the melons: Sundar was diagnosed with polio in January of this year.

It is families such as Sundar’s that highlight the myriad logistical and operational challenges of nationwide vaccination campaigns.

The young boy got off to a difficult start in life, being born in an Internally Displaced Persons (IDP) camp after the 2010 floods in the Hyderabad district. Even so, his mother, Bhaga, was able to take Sundar for routine immunization at a nearby EPI centre. Polio drops, however, need to be administered at least four times and in places with poor sanitation, or a high incidence of malnutrition or diarrhoeal diseases, the vaccine can be less effective than elsewhere.

Because of this, supplementary immunization activities (SIAs) are used to boost the immunity of the population to as high a level as possible. However, an investigation into Sundar’s case showed that vaccination teams assigned to the area did not follow up after the child was registered as ‘not available’ during the campaign, citing fear of stray dogs loitering in the neighbourhood.

This was not the only flaw in the vaccination campaign which was supposed to reach Sundar. During the planning, three separate areas were reflected as one in the micro-plan and assigned to a single person, doubling the number of children for them to cover.
Although it is too late for Sundar, the Global Polio Eradication Initiative is moving faster to identify and solve these issues in order to ensure cases such as his do not happen again. For example, in West Africa, insecurity in Mali, the Sahel crisis and the upcoming rainy season have resulted in large scale population movements. Nevertheless, immunization campaigns continue to take place in refugee camps in countries bordering Mali, including in Mauritania and Burkina Faso, and in internally-displaced persons camps in Mali itself. Furthermore, population movements are actively tracked and mapped, with health posts set up at key border crossings, gathering sites and in hard-to reach areas.

Meanwhile in Pakistan, a WHO and UNICEF staff surge is actively reviewing vaccinator team performance and composition, improving micro-planning and fixing the ‘basics’ of good campaign operations. This new approach is already having an impact: there have only been two more cases of polio after Sundar in Sindh province for the first six months of this year, compared to 14 for the same period last year.

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KARACHI/NEW YORK/GENEVA, 21 July 2012 – The World Health Organization (WHO) and UNICEF are deeply saddened by the killing of Mr. Muhammad Ishaq, a local community worker supported by WHO, who was part of the polio eradication initiative in Pakistan.

Mr. Ishaq was shot and killed in the Gadap town area of Karachi on Friday evening.

Polio immunization activities were suspended in this area of Karachi earlier this week after a shooting incident injured two WHO staff members who were supporting the implementation and monitoring of a vaccination campaign.

Until activities were suspended, Mr. Ishaq had worked with the national polio eradication effort as a Union Council Polio Worker for several months, helping to plan and implement vaccination campaigns to protect the most underserved and vulnerable children against this debilitating disease.

Because of the dedication of heroes like Mr. Ishaq, Pakistan is this year closer than ever to the eradication of polio. He was known for his dedication and diligence to immunize all children against polio.

Polio is a highly infectious disease caused by a virus that can cause permanent paralysis in a matter of hours. There is no cure, but there are safe and effective vaccines. Polio can be eradicated if every child is immunized until transmission stops worldwide.

Currently the disease remains endemic in only three countries: Pakistan, Afghanistan and Nigeria. Mr. Ishaq was one of the thousands of people across Pakistan who worked selflessly in the battle to eradicate polio.

WHO, UNICEF and all of the polio partners in Pakistan and globally express their deepest sympathy to his family for this tragic loss. The partners of the Global Polio Eradication Initiative remain committed to supporting the Government of Pakistan and the people of Pakistan in their efforts to eradicate this devastating disease.

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