Strategy to eradicate polio in Pakistan
Context
Pakistan has active and widespread transmission of polio, and is the only country in Asia with confirmed Wild Polio Virus type 3 (WPV3) transmission, a strain on the verge of eradication in this continent. The majority of cases occur in three main areas: Balochistan (Killa Abdullah, Pishin and Quetta Districts); Sindh (Karachi and northern Sindh); and parts of the Federally Adminstered Tribal Areas (FATA) and Khyber Pakhtunkhwa (KP). In 2011, Pakistan was responsible for international spread to China, where it caused an outbreak in the western Xinjiang province.
During SIAs, children are missed due to operational challenges due to poor management and inadequate commitment at district and union council level and, in some areas, due to security-related lack of access (notably some areas of FATA).
Communication in Action: overview of community engagement
Strategic approach in Asia
In Asia, persistent poliovirus transmission is highly localized in a few districts. The approach in Asia therefore focuses on district- and sub-district-specific plans to achieve exceptionally high coverage with very frequent supplementary immunization activities to boost population immunity to >95% – the threshold required to stop transmission in Asia.
Engaging local political and administrative leaders to ensure the quality of supplementary immunization activities is also important.
Strategic approach in Pakistan
Interrupting the remaining poliovirus transmission in Afghanistan has been declared an emergency by the World Health Assembly. In response, the National Polio Emergency Action Plan has been developed which recommends the following emergency approach.
- Technical support increased to clearly-identified, worst-performing districts and union councils
- District Commissioners held responsible for overall operational implementation; Union Council Medical Officers responsible for local planning and implementation.
- Systematic and targeted social mobilization to increase demand.
- Special strategies to identify and reach mobile populations and underserved groups, particularly Pashtun populations.
- Active review of vaccinator team performance and composition.
- Expansion of target age group and increase use of Short Interval Additional Dose approach in newly-accessible areas or population groups.
- Engagement with new partners, such as eminent social worker Abdul Sattar Edhi.
- New emergency approach already having impact in 2012: decline in cases over 2011, and improved coverage in some worst-performing areas of Karachi and Quetta.
Eradication targets
- Minimum 80% of all LQAS lots assessed nationally in every supplementary immunization activity (SIA) accepted at greater than 95% coverage.
- Refusals in High Risk areas are less than 5% of missed children.
- At least 85% of caregivers in key under-performing districts of Balochistan and Sindh believe that oral polio vaccine (OPV) is safe.
- Mechanisms in place to access more than 90% of children in SIAs in FATA.
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