GPEI-Serious Security Incident in Karachi, Pakistan

17 July 2012 – One WHO staff member and one international consultant were injured, when their vehicle was shot at by armed men.

The two men working for WHO are in stable condition.

WHO is grateful to the Pakistani medical professionals for the rapid and high-quality medical aid provided.

Both men were supporting the currently-ongoing polio National Immunization Days (NIDs). At this point, there is no evidence to suggest that this was a deliberate or targeted attack against polio eradication efforts or WHO. WHO is grateful to the Pakistan authorities for launching an investigation into this event, to determine more clearly the circumstances.

Incidents like these highlight the incredible bravery of the more than 200,000 mainly Pakistani volunteers who run every vaccination campaign. The vaccinators, social mobilizers and frontline staff are the heroes of this campaign.

WHO, UNICEF and all polio partners remain committed to supporting the Government of Pakistan and the people of Pakistan in their efforts to eradicate polio. This incident will not distract from the progress Pakistan is making this year, as the country is closer than ever to eradication.

New Polio Champion joins renewed drive to eradicate the crippling disease from Pakistan

It is a noble cause and I am happy to be part of smashing polio from Pakistan which has crippled many children,” said Shahid Afridi. UNICEF Pakistan/2012

9 July 2012 – World famous Pakistani cricketer Shahid Afridi took a break from defeating bowlers last weekend to become the new champion for polio eradication in Pakistan. Holder of the record for the fastest One Day International century, the former Pakistan international captain will hope this speed is translated into making sure no child is left unvaccinated in the country.

Afridi joined representatives of the national polio eradication initiative from the Prime Minister’s Monitoring and Coordination Cell for Polio Eradication, Rotary International, UNICEF, and WHO to sign a memorandum of understanding on Saturday 7 July. Speaking like a true champion, Afridi vowed, “I will do my best to take the message to every doorstep of Pakistan. Reaching every child, every time with the polio vaccine is not only necessary, but it is our duty.” Afridi hails from Khyber Agency in the Federally Administered Tribal Areas and is from a Pashtun family. In 2011, Pashtuns accounted for nearly 77 percent of all polio cases in Pakistan, but making up only 15% of the population.

This is the first time in Pakistan that a celebrity of this stature has endorsed the eradication programme. Afridi is already a Goodwill Ambassador for the UN Office on Drugs and Crime, and his tagline for polio eradication will be ‘Bat or Crutches’ (‘Balla Ya Besaakhi’). The campaign, launched this week, will support the next National Immunisation Days from 16-18 July when over 34 million children under five years will be vaccinated.

Ms Shahnaz Wazir Ali, the Focal Point for the Prime Minister’s Monitoring Cell, expressed her delight that Afridi has joined the polio eradication team: “He is a true Pakistani hero and will help us deliver important messages to some of the hardest to reach areas of the country.”

Pakistan has had 22 confirmed polio cases in 13 districts in the first 6 months of 2012 – down from 58 in 24 districts during the same period in 2011. Rotary National Chair for Polio Plus in Pakistan Aziz Memon, who personally brokered the deal, is convinced that Afridi’s participation will extend this progress, commenting: “We have seen the support that celebrities of this stature can bring to national awareness efforts in other countries, and we have no doubt that Mr Afridi will boost interest in the campaign.”

Speaking at the unveiling of the campaign, Afridi set down his commitment to eradication with the message: “I have faced many tough opponents in my cricketing career and have seen that through perseverance, one can surmount any challenge.”

The Fight Against Polio – an opinion piece in The News

1 July 2012 – The progress of the polio eradication campaign in Afghanistan and Pakistan from 2006 to 2011 has come under focus in a recent journal article by scientists from Imperial College, London. Published in the Lancet, the study found that declines in vaccination coverage led to a rise in the number of new cases between 2006 and 2011. This decline in coverage was partially offset by the use of new monovalent and bivalent vaccines that have proven to be more effective against the main circulating strain of the virus.

The study found that vaccine coverage in southern Afghanistan and parts of Pakistan, including Balochistan and the Federally Administrated Tribal Areas (FATA), declined from 2006 through 2011. Dr Kath O’Reilly from the Medical Research Council (MRC) Centre for Outbreak Analysis and Modeling at Imperial College London, who led the study, commented: “The new (bivalent and monovalent) vaccines appear to be more effective than the trivalent vaccine, which offers encouragement that polio eradication is achievable. But the best vaccine in the world will not work unless it reaches the children it is intended to protect.”

In 2012 both countries are implementing national polio emergency action plans to reverse the trend of declining coverage. Efforts are focusing on addressing the underlying challenges which prevent all children being systematically reached with polio vaccine. The emergency plans focus on increasing technical support for worst performing areas; making district-level leadership more accountable; increasing the demand for immunisation through social mobilisation; identifying and reaching mobile populations and underserved groups; and sensitive planning for immunisation campaigns to more accurately map out where children live and how best to reach them.

Early indications from the first half of 2012 indicate that these activities are beginning to improve the situation, with 22 reported cases in Pakistan to date compared to 58 in the same period in 2011. It is anticipated that Imperial College will conduct a follow-on analysis in the second half of 2012 to more clearly determine the full impact of the national emergency action plans on vaccination coverage.

Related resources

Intense outbreak in Pakistan, related cases in China

Sub-national Immunization Day in Pakistan, Northern Sindh – WHO

Wild poliovirus type 1 (WPV1) genetically linked to virus currently circulating in Pakistan has been isolated in China. Pakistan is affected by nationwide transmission of WPV1, and is the location of the only wild poliovirus type 3 (WPV3) case in Asia in 2011 (a strain on the verge of elimination on the continent). As at 13 September 2011, Pakistan had reported 84 cases, compared to 48 cases for the same period in 2010.

In 2011, supplementary immunization activities (SIAs) in Pakistan have been inadequate in quality in key high-risk areas. In security-compromised parts of the Federally Administered Tribal Areas (FATA), and in particular in Khyber agency, upwards of 200,000 children have been regularly missed during SIAs conducted during the last two years. In addition to challenges relating to reaching children in insecure areas of Khyber Pakhtunkhwa and FATA, significant operational challenges continue to mar the quality of SIAs in accessible areas of Khyber and in other key transmission areas of the country, notably in the provinces of Balochistan and Sindh. At the same time, undetected circulation cannot be ruled out due to persistent subnational surveillance gaps. Given these factors, the widespread transmission of WPV1, documented spread internationally, and the detection of the only WPV3 in Asia in 2011, the World Health Organization (WHO) rates as ‘high’ the risk of further international spread of WPV from Pakistan, particularly given the expected large-scale population movements associated with Umrah and the upcoming Hajj (pilgrimage to Mecca, Kingdom of Saudi Arabia) in the coming months.

To urgently address the widespread transmission of wild poliovirus affecting the country, the Government of Pakistan has this year launched a National Polio Emergency Action Plan, under the auspices His Excellency the President. However, the impact of the Plan is not yet being seen at the critical programme implementation level. To rapidly build up population immunity levels to both serotypes, staggered subnational immunization days are planned for 19-21 September, to be closely followed by further activities in high-risk union councils in 54 districts of the country. However, key to success will be to overcome remaining operational challenges in fully-accessible areas and implemented special outreach strategies with full community participation to increase access to populations in security-compromised areas. To achieve this, full and consistent engagement and accountability at provincial, district and union-council level is urgently needed.

It is important that countries across Asia and the Eastern Mediterranean strengthen disease surveillance for acute flaccid paralysis (AFP), in order to rapidly detect any poliovirus importations and facilitate a rapid response should importation occur. Countries should also continue to boost routine immunization coverage against all strains of polio to minimize the consequences of any introduction.

As per recommendations outlined in WHO’s International travel and health, travellers to and from Pakistan should be fully protected by vaccination. Travellers to Pakistan who have in the past received three or more doses of OPV should be offered another dose of polio vaccine before departure. Any unimmunized individuals intending to travel to Pakistan should complete a full course of vaccination. Travellers from Pakistan should have a full course of vaccination against polio before leaving Pakistan, with a minimum one dose of OPV before departure. Some polio-free countries may also require travellers from Pakistan to be immunized against polio in order to obtain an entry visa.

With Hajj and Umrah season already started, the Kingdom of Saudi Arabia has issued vaccination requirements for travellers (all ages) for Umrah and Hajj. These requirements are in line with recommendations outlined in WHO’s International travel and health, with the addition that travellers of all ages from polio endemic countries are required to show proof of vaccination with OPV six weeks before travel to the Kingdom of Saudi Arabia, and will receive a further dose of OPV upon their arrival.

4.9 billion Japanese Yen (JPY) loan from JICA to support polio eradication in Pakistan through 2013

Ms. Sadako Ogata, President of the Japan International Cooperation Agency (JICA), and Mr. Bill Gates, co-chair of the Bill & Melinda Gates Foundation, today announced a strategic partnership to ensure continued progress in the fight against polio. As the first step in this formal partnership, Ms. Ogata and Mr. Gates also announced an innovative financing agreement to support the polio campaign in Pakistan.

The announcement represents a significant contribution towards the goal of eradication of polio in Pakistan. Based on the Global Polio Eradication Initiative’s (GPEI) current cost estimates, this 4.9 billion JPY (approximately $65 million) Official Development Assistance (ODA) Loan[i] to the government of Pakistan will help ensure that polio eradication activities in Pakistan are financed through 2013.

“This partnership comes at a critical time for Pakistan and will help us achieve our shared goal of a polio-free world,” said Gates. “Japan’s remarkable commitment will benefit generations of children in Pakistan and throughout the world.”

Although polio has been successfully reduced by 99 percent worldwide over the past 20 years, Pakistan is one of four countries where polio transmission has never been stopped. A recent report by GPEI’s Independent Monitoring Board commended Pakistan’s heightened commitment to polio vaccination, yet with polio cases in Pakistan on the rise, the report warned that the country “risks becoming the last global outpost of this vicious disease, jeopardizing the global effort.”

At the launch of the National Emergency Action Plan 2011 for Polio Eradication in January, Gates commended the Pakistani government’s expressed commitment to eliminate polio and pledged to work closely with officials there to ensure success. President Asif Ali Zardari and Prime Minister Syed Yusaf Raza Gilani are leading the national effort and working closely with the WHO, UNICEF and Rotary International to ensure Pakistan meets the milestones set out in the National Emergency Plan 2011 for Polio Eradication.

Japan’s ODA loan will provide the country with funds for oral polio vaccine, immunization workers, and vaccination activities across the country and along the Pakistan/Afghanistan border. It will also involve working in partnership with stakeholders such as the World Bank for co-financing as well as the United Nations Children’s Fund (UNICEF) for vaccine procurement and the World Health Organization (WHO) for service delivery of the polio campaign.

Japan has been a long-standing donor to polio eradication and has funded initiatives and broader immunization in Pakistan since 1996. “We are delighted that JICA’s strong relationships with partner countries and valuable experience implementing a wide range of critical projects enable us to play a proactive role in harnessing innovation to benefit global aid delivery through collaborations with emerging private donors,” said Ms. Ogata. “We believe that JICA’s new Strategic Partnership with the Gates Foundation reflects JICA’s interest in playing a leading and catalyzing role in development issues.”

The loan is underpinned by an innovative financing approach referred to as a “Loan Conversion” mechanism. According to this model, the Gates Foundation will repay the credit to JICA on behalf of the Pakistani government if the project is successfully implemented. The aim of this mechanism is to support the government of Pakistan’s commitment to polio eradication without imposing a financial burden.

The Global Polio Eradication Initiative
The Global Polio Eradication Initiative is a public-private partnership led by national governments and spearheaded by the World Health Organization (WHO), Rotary International, UNICEF, and the US Centers for Disease Control and Prevention (CDC). Since 1988, more than 20 million volunteers have supported the Global Polio Eradication Initiative in its goal to end polio worldwide.

Japan International Cooperation Agency
The Japan International Cooperation Agency (JICA) assists and supports developing countries as the executing agency of Japanese ODA. In accordance with its vision of “Inclusive and Dynamic Development,” JICA supports the resolution of issues of developing countries by using the most suitable tools of various assistance methods, such as technical cooperation, ODA loans and grant aid in an integrated manner.

Bill & Melinda Gates Foundation
Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to ensure that all people—especially those with the fewest resources—have access to the opportunities they need to succeed in school and life. Based in Seattle, Washington, the foundation is led by CEO Jeff Raikes and Co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett.

For high resolution images and broadcast quality footage, please visit http://www.gatesfoundation.org/press-room/Pages/news-market.aspx.

[i] On August 15, 2011, Japan International Cooperation Agency (JICA) signed a Japanese ODA Loan Agreement with the Government of the Islamic Republic of Pakistan to provide a loan of up to 4,993 million yen for assistance for the Polio Eradication Project. The objective of the project is to optimize immunization of polio vaccine to children under 5 years, by procuring vaccines and providing services necessary for polio immunization activities, thereby contributing to the eradication of polio in Pakistan.

Rotarians are in the forefront of the drive to implement Pakistan’s National Emergency Action Plan for Polio Eradication 2011.

The Rotary Club of Lahore Sharqi (East) distributed posters throughout the city to announce the NIDs. – Photo courtesy of Mohammad Hanif Khilji

The government launched the emergency plan in January, in response to a sharp increase in polio cases in the country in 2010.

Turning the tide against the disease in Pakistan is pivotal to the success of the Global Polio Eradication Initiative . Pakistan was the only one of the world’s four polio-endemic countries – the others are Afghanistan, India, and Nigeria – to see an increase in cases last year: 144 compared with 89 in 2009.

Rotarians assigned by the Pakistan PolioPlus Committee are mobilizing Rotary clubs to provide support in the country’s four provinces. Rotarians are helping to immunize children against polio and to raise public awareness of the disease.

Club members are working “to cover every nook and corner of the country,” says Aziz Memon, chair of the committee. “We are committed to a polio-free Pakistan.”

Rotarians are also advocating for polio eradication among officials at all levels of government, as well as religious leaders and others.

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Significant implications, as Asia is on verge of eliminating circulation of this strain.

Child being vaccinated during polio campaign. WHO

Pakistan has reported wild poliovirus type 3 (WPV3) isolated from a 16-month old child with onset of paralysis on 9 June 2011, from a conflict-affected, inaccessible area of Khyber Agency, Federally Administered Tribal Areas (FATA). This is the only case of WPV3 detected in Asia in 2011. WPV3 transmission in Asia is on the verge of elimination, with the last case occurring more than six months ago, on 18 November 2010 (also from Khyber Agency, FATA).

Confirmation of continuation of WPV3 transmission in tribal areas of Pakistan has significant implications for the global effort to eradicate WPV3, particularly as Asia is on the verge of eliminating circulation of this strain. The detection of WPV3 in Pakistan represents the risk that it may spread from this transmission focus to other WPV3-free areas of Asia and beyond. Globally, WPV3 transmission is at historically low levels in 2011, with other circulation of this strain restricted to parts of west Africa (17 cases in Côte d’Ivoire, Guinea, Mali and Niger), Nigeria (five cases) and Chad (three cases). The risk of onward spread of WPV3 is deemed as high by the World Health Organization (WHO), particularly given large-scale population movements within Pakistan, between Pakistan and Afghanistan, and expected large-scale population movements associated with Umrah and the upcoming Hajj (pilgrimage to Mecca, Kingdom of Saudi Arabia) in the coming few months.

In 2011, supplementary immunization activities (SIAs) in Pakistan have been inadequate in quality in key high-risk areas and a significant proportion of children remained inaccessible in conflict-affected tribal areas. In FATA, particularly in Khyber agency, nearly 50% of children have been regularly missed during SIAs for the last two years. In addition to challenges relating to reaching children in insecure areas of Khyber Pakhtunkhwa and FATA, significant operational challenges continue to mar the quality of SIAs in accessible areas of Khyber and in other key transmission areas of the country, notably in the provinces of Balochistan and Sindh. In addition to confirmation of the only WPV3 case in Asia in 2011, Pakistan is affected by country-wide geographic transmission of wild poliovirus type 1 (WPV1), with 57 confirmed WPV1 cases in 2011 (as at 5 July 2011), compared with 14 WPV1 cases for the same period in 2010.

To urgently address the situation, the Government of Pakistan has this year launched a National Polio Emergency Action Plan, under the auspices of His Excellency the President. However, the Independent Monitoring Board (IMB), set up at the request of the World Health Assembly (WHA) in 2010 to independently monitor progress towards a polio-free world, in April 2011 expressed alarm that the Plan is taking too long to implement, a conclusion echoed by the Technical Advisory Group (TAG) of the Eastern Mediterranean in June 2011.

To rapidly build up immunity to both wild poliovirus strains, a Short Interval Additional Dose Strategy (SIAD) SIA with bivalent OPV is being conducted in Khyber Agency, the first passage on 4 July and the second on 12 July. It is expected that, as during the most recent SIAs in mid-June, 45% (89,449) of target children in Khyber Agency (80% in Bara Tehsil, i.e. approximately 73,000) will remain inaccessible during the SIADs. National Immunization Days (NIDs) will be conducted in the country on 18-20 July, using bivalent OPV (containing type 1 & 3 serotypes). However, key to success will be to overcome remaining operational challenges in fully-accessible areas and implement special outreach strategies with full community participation to increase access to populations in security-compromised areas. To minimise the risk of WPV3 re-infecting Afghanistan, Subnational Immunization Days (SNIDs) – including in border areas with Pakistan – will be conducted in the country on 10-12 July, also using bivalent OPV.

As per recommendations outlined in WHO’s International travel and health, travelers to and from Pakistan should be fully protected by vaccination. Travelers to Pakistan who have in the past received three or more doses of OPV should be offered another dose of polio vaccine before departure. Any unimmunized individuals intending to travel to Pakistan should complete a full course of vaccination. Travelers from Pakistan should have a full course of vaccination against polio before leaving Pakistan, with a minimum one dose of OPV before departure. Some polio-free countries may also require travelers from Pakistan to be immunized against polio in order to obtain an entry visa.

With Hajj and Umrah season already started, and Umrah expected to increase during Ramadan (in August) and Hajj in early November, the Kingdom of Saudi Arabia has issued vaccination requirements for travelers (all ages) for Umrah and Hajj. These requirements are in line with recommendations outlined in WHO’s International travel and health, with the addition that travellers of all ages from polio endemic countries are required to show proof of vaccination with OPV six weeks before travel to the Kingdom of Saudi Arabia, and will receive a further dose of OPV upon their arrival.

Polio eradication was a hot topic at the 38th Session of the Council of Foreign Ministers of the newly renamed Organisation of Islamic Cooperation (OIC – formerly known as the Organisation of Islamic Conferences).

A resolution resulting from the session urges, among other things, that “the member states affected by polio, AIDS, tuberculosis and malaria … undertake necessary steps to fight these dangerous communicable diseases and requests the potential donors to give generously to the GPEI [Global Polio Eradication Initiative] and the Global Fund”.

The resolution also recognizes the ongoing efforts by Afghanistan, Nigeria and Pakistan to eradicate polio, reminds the other member states to ensure their children are immunized against the virus, and requests that the Islamic Development Bank consider funding polio vaccine for Afghanistan.

The OIC Secretary-General’s address to the Council.

As part of efforts to prepare for the polio post-eradication era, the World Health Organization (WHO) and its partners have facilitated the development and transfer of new polio vaccine technology to vaccine production facilities in India and the Republic of Korea.

In collaboration with the Netherlands Vaccine Institute (NVI), and more recently the National Institute for Public Health and the Environment (RIVM) in the Netherlands, clinical lots of inactivated polio vaccine (IPV) produced from Sabin poliovirus seed-strains have been prepared. Traditional IPV is manufactured using wild poliovirus and an inadvertent biocontainment failure could be associated with serious consequences in some areas of the world in the post-eradication era (ie areas with high population density, inadequate sanitation infrastructure and low population immunity levels). Sabin seed strains for IPV have the advantage over wild polioviruses that they are attenuated, and hence are safer for handling and IPV production in developing country settings in the post-eradication era.

In this first phase of a broader intended technology transfer programme, two manufacturers have been selected to receive this new technology for vaccine production: Panacea Biotech, Ltd in India, and LG Life Sciences, Ltd in the Republic of Korea. Both manufacturers have confirmed their intention to use all reasonable efforts to apply for registration of their Sabin IPV products in the country of production within four years from the dates of conclusions of the bilateral agreement with RIVM. WHO and RIVM will continue the technology transfer programme this year with further manufacturers.

This transfer of technology is a significant milestone in preparations for the polio post-eradication era. Following the eradication of wild poliovirus globally, use of all oral polio vaccine (OPV) in routine immunization programmes will need to be stopped due to the risks associated with the continued administration, in the post-eradication era, of the live (attenuated, but not inactivated) polioviruses contained in OPV. These risks include vaccine-associated paralytic polio and the generation of new, circulating vaccine-derived polioviruses. Therefore, after the eradication of all wild polioviruses, and the eventual cessation of OPV for use in routine immunization programmes, any country choosing to continue to immunize its population against polio will need to do so with IPV, the only option which will be available to do so at that time.

Recognizing that the manufacturing costs and price of IPV are currently substantially higher than that for OPV, the Global Polio Eradication Initiative (GPEI) is studying a range of approaches to establish affordable strategies for IPV use in low-income settings following OPV cessation. The development, manufacture and distribution of a safe, effective and affordable Sabin IPV that can be produced securely in developing country settings is a key landmark in this programme of work. This technology transfer will also help to boost more broadly the domestic production capacity for vaccines and the strengthening public of health systems to ensure more equitable access to vaccines.

The development of Sabin IPV and the related technology transfer work has been generously supported by the Bill & Melinda Gates Foundation.

The GPEI is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. Since 1988 (the year the GPEI was launched), the incidence of polio has been reduced by more than 99%. In 1988, more than 350,000 children were paralysed each year in more than 125 endemic countries. In 2010, 1,291 cases were reported worldwide, from 20 countries. Only four countries remain endemic: Afghanistan, India, Nigeria and Pakistan.

The Crown Prince of Abu Dhabi joins the Bill & Melinda Gates Foundation to purchase and deliver polio vaccines for Afghan and Pakistani children and protect them from paralysis.

His Highness Sheikh Mohammed bin Zayed Al Nahyan and Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation, announced today they are working together to provide life-saving vaccinations to children in Afghanistan and Pakistan. The partnership commits a total of US$100 million – US$50 million from each partner – for the purchase and delivery of vital vaccines that will save Afghan and Pakistani children and prevent disease for a lifetime.

Of the total funds, two-thirds will be given to the GAVI Alliance for the purchase and delivery of the pentavalent vaccine and for the introduction of the new pneumococcal vaccine in Afghanistan. The remaining US$34 million of the allocated funds will be directed to the World Health Organization and UNICEF to deliver polio vaccines in Afghanistan and Pakistan. Although worldwide polio has been reduced by 99 percent during the past 20 years, Afghanistan and Pakistan are two of only four countries where polio transmission has never been stopped. To date, there has been a cycle of re-infection of this crippling disease between the populations of the two countries.

The partnership will help polio eradication workers reach approximately 35 million children in Afghanistan and Pakistan with oral polio vaccines.

New health partnership in Middle East: Bill Gates blogs about the new cooperation.
Full press release

The only polio-endemic country where case numbers rose in the past year, Pakistan has developed a national emergency action plan that outlines area-specific strategies and accountability mechanisms.

President Zardari gives polio vaccine to a child at the launch of a national emergency plan to get the country back on track for polio eradication. WHO Pakistan

On 24 January, the President of Pakistan Asif Ali Zardari formally launched an emergency response to the explosive outbreak of polio in Pakistan. The only polio-endemic country with an increase in cases in 2010, Pakistan has struggled in the past six months to keep a lid on transmission of poliovirus. The number of children paralyzed by the virus jumped by 60% (from 89 in 2009 to 144 in 2010, as of 25 January 2011).

Giving polio vaccine to children present, in advance of the first national polio vaccination campaign of the year, President Zardari called it “criminal negligence” not to eradicate polio. He cautioned that the rise in cases called for urgent and concerted action and noted the presence at the ceremony of Federal Ministers, the Special Advisor to the Prime Minister on Social Sector, Provincial Ministers and Secretaries of Health, parliamentarians, members of the diplomatic community and heads of international developmental partners and civil society organizations. “I assure you”, he added, “that there will be strict oversight of the plan at the national and provincial levels through monitoring cells.”

The president said Pakistan is “committed to banish polio from Pakistan,” reminding the audience that polio eradication efforts in Pakistan were first launched by the government of his deceased wife Benazir Bhutto. He said she was the first prime minister to have personally administered polio drops, to a Pakistani child: “That child was no less than our own daughter, Aseefa Bhutto Zardari.” Ms Zardari is now Pakistan’s Ambassador for Polio Eradication. “Together she will work with you to end polio. Together we will end polio from the country,” the President said.

The president said the comprehensive plan for polio eradication, prepared by health managers and professionals, was clear and actionable.

Mr Bill Gates, Co-Chair of the Bill and Melinda Gates Foundation, sent a special video message to the gathering. Mr Gates had met President Zardari in Washington DC on 15 January, where they had discussed in detail the emergency plan and its implementation.

The Secretary Health highlighted salient features of the Emergency Plan with emphasis on ownership and accountability of the administrative arms of the government.

The President also announced awards for Mr Bob Scott, Chairman of the Rotary International Polio Plus Committee and Mr Aziz Memon, Chairman of the National Polio Plus Committee for their services to polio eradication in Pakistan.

Written statement and video address from Mr Bill Gates on the occasion of the launch of the emergency plan.

Health system could take years to recover following flood damage “beyond imagination” – polio strategies adapted to protect polio-free areas of the country

Polio eradication staff and resources have been mobilized en masse to support the response to the devastating floods directly affecting one in 10 people in Pakistan. All polio-funded technical staff – polio epidemiologists and surveillance officers – have relocated to the worst-affected areas of the country to assist in the recovery. These staff are focused on three main areas: a rapid assessment of the extent of damage to health facilities; the establishment of early warning systems for disease outbreaks; and, the planning, delivery and monitoring of broad immunization activities in internally-displaced persons camps.

Pakistan polio team leader Dr Ni’ma Abid said the extent of the flood damage was “really beyond imagination” and had had an enormous impact on health systems in the country. He said the immunization cold chain system had been severely affected, and would take “a long time” to be rehabilitated. While controlling outbreaks of disease and conducting immunizations were a necessary focus, “the priority is still for food and shelter more than anything else”. Dr Abid said that within the health industry, a “significant number of health workers are affected, their houses are affected – it’s very difficult, a very big challenge”.

Currently, the Ministry of Health’s strategy is to vaccinate all displaced children under 5 years with measles vaccine and oral polio vaccine (OPV), and to distribute Vitamin A. Other routine antigens have been distributed, but not in all camps. In the areas of Khyber Pakhtunkhwa (previously known as North West Frontier Province) where flood waters have receded – Peshawar, Charsada, Dir Lower and Swat – mass campaigns administering measles vaccine, OPV and Vitamin A have been conducted in all affected Union Council administrative areas. To date, 340,081 children have been immunized with OPV in flood-affected areas, 316,540 with measles and 255,920 have received Vitamin A. BCG, pentavalent, TT and Hepatitis B have also been given.

Recognizing the potential for spread of disease, the Ministry of Health has put in place a plan to vaccinate children in all flood-affected districts with measles vaccine and OPV in three phases: the 1st phase will commence in September, targeting 7.28 million children in the 40 worst-affected districts; continuing with moderately affected districts in October and finally, non-affected districts in early 2011.

The UN has launched a flash appeal for the flood relief effort, and as part of this, funds would go to support emergency measles/polio campaigns. The global polio eradication network is uniquely equipped with both international and national professional staff, allowing for immediate support to emergency response. The network is able to provide rapid assessment and early logistical and operational support. With local knowledge of communities, health systems and government structures, the polio network’s technical capacity in disease surveillance and planning of large-scale operations is often at the forefront of international and national relief efforts.

In Pakistan, polio eradication staff and resources are being used to help in the response to the devastating floods affecting the country. Polio eradication epidemiologists and surveillance officers in the worst-affected areas of North West Frontier Province (NWFP, now known as Khyber Pakhtunkhwa) and Punjab are equipped with vehicles, radio equipment, satellite phones, vital medicines and potable water tanks. The immediate focus has been on conducting a thorough assessment of the extent of the devastation, and communicating these findings back to Islamabad to enable more effective relief planning. Staff have also been engaged in helping establish an early warning system for diseases and potential outbreaks, a key concern in the relief effort.

Polio supplementary immunization activities (SIAs) initially scheduled for 3-5 August have been postponed in the affected areas of NWFP and Punjab. Emphasis is on monitoring population movements, including to internally-displaced persons camps, and implementing special strategies to reach these groups with polio vaccine.

The global polio eradication network is uniquely equipped with both international and national professional staff, allowing for immediate support to emergency response. The network is able to provide rapid assessment and early logistical and operational support. With local knowledge of communities, health systems and government structures, the polio network’s technical capacity in disease surveillance and planning of large-scale operations is often at the forefront of international and national relief efforts.

Police and students band together to build support for polio eradication in Pakistan

All around the world they’re much the same… they’re red and round with big bold lettering.

But in Islamabad, Pakistan, drivers may have cause to pause and look again. For on these signs, that insistent ‘STOP’ is followed by the word ‘polio’.

These unique stop signs are part of a broader initiative launched by the Inspector General of Police, Sikander Hayat, in Islamabad last month. Called ‘Signs of Life’, it is a campaign developed by Islamabad Police to educate the public on the importance of immunizing children against polio.

The Inspector General explained that this initiative is taking Islamabad Police’s commitment to ‘protect and prevent’ one step further:

“Just as polio drops protect you against life-long paralysis and death, wearing seatbelts and helmets also provides protection by saving one’s life.”

Signs carrying the image of a child being vaccinated now appear alongside signs encouraging road users to buckle their seatbelts or reduce speed. And while parents wait at police-run security checkpoints, their children can be immunised. Fifteen vaccination booths have been set up near these checkpoints, with students from Bahria University assisting local health workers to reach every child under five who passes by.

“It is my first time being a volunteer and I feel very proud to contribute to help Pakistan to eradicate polio,” said student volunteer Zubaria. “This is definitely a very valuable experience of my life which I will never forget.”

Pakistan is the only one of the three polio-endemic countries to have seen an increase in cases this year.

Integral to the success of Pakistan’s polio eradication effort will be the commitment of the Pakistani people and how far they will go to ensure that every child is protected against this disease. Initiatives like this are helping to build the groundswell of public support needed to finally topple this disease.

Message on British Houses of Parliament to celebrate 103 years of Rotary

The Rotary wheel logo and the “End Polio Now” message is beamed onto the Houses of Parliament, UK
Rich Hendry, courtesy of Rotary International

A giant Rotary wheel – the organization’s logo – and the words “End Polio Now” were beamed onto the side of the House of Commons to the left of Big Ben on Rotary International’s 103rd Birthday on Saturday, 23rd February – to start a challenge to raise US$ 100 million to help finally eradicate polio from the world.

Polio eradication has been Rotary’s top priority since 1985, inspiring the launch of the Global Polio Eradication Initiative, a partnership which has cut the number of polio cases by 99 per cent since then. The disease is now only endemic in four countries: India, Pakistan, Afghanistan and Nigeria. Recently, the Bill and Melinda Gates Foundation gave Rotary a US$ 100 million challenge grant, which Rotary will match over the next three years.

The BBC aired images of the display, along with interviews with DG Colin Mathews and Gautam Lewis, a 30-year-old polio-survivor who immunized children on behalf of Rotary in his birthplace of India in November 2007. More