Accelerating Pakistan’s polio fight

Pakistan’s coordinated efforts to get polio in control have come a long way. There is a marked departure in the number of cases detected since the disease’s once historic surge, furthered by greater synchrony between government support and mobilization of frontline workers. Provinces have had plenty to show for their anti-polio performance measures, and what is seen as a concerning increase in the number of cases today is no cause for extreme alarm. Instead, it demands continuity of best practices from the past.

The need of the hour is to put the foot down, accelerate Pakistan’s anti-polio fight against isolated cases, and see it till the end. The recent exchange between philanthropist Bill Gates and the Pakistani government on anti-polio efforts builds on strengths of the past, allowing Pakistan to further leverage international expertise from long-time partners to ensure that hard-won gains against the disease are not in vain. Findings published by the Independent Monitoring Board of the Global Polio Eradication Initiative (GPEI) already confirmed that the highest level of ‘political commitment and engagement’ has been maintained in Pakistan, strengthening the case for stronger partner support to address potential disease flare-ups through better vaccine deployment. “In Pakistan, there have been uninterrupted vaccine rounds delivered, with pandemic virus protective measures, following the post-COVID-19 resumption. That has continued unabated through 2021 into 2022,” acknowledges the report, to the nation’s credit.

That sense of accessibility – including a focus on preventive measures against the crippling disease – needs to be prioritized for the long-term. The possible resurgence of polio noted in recent discourse has some merits because the disease’s spread could assume rapidity and shaper penetration among localities if placed on the backburner. The current spread to double-digits is entirely manageable, but caution must not arrive with a big dose of complacency on policy grounds. The two extremes of inaction and needless panic deserve to be avoided for a more accelerated approach to stamping out polio’s residual cases.

Pakistan’s demonstrated commitment to mobilizing and safeguarding the interests of its primary anti-polio assets – its frontline workers – strengthens the case for making new gains. We have witnessed official support for frontline workers in the context of the anti-polio effort late last-month, making it easier to pushback against the risks of an anti-polio triumph when some cases merit attention. A step-up from this position of strength requires stronger coordination between provincial expertise on polio eradication, particularly by district, and the local frontline workers tasked with making contact on the ground.

Understand, that it is in the interests of key provinces – particularly Khyber Pakhtunkhwa (KPK) – to prioritize parallel polio awareness campaigns that are necessary to promote initiative against vaccination refusals of the past. Though such refusals to polio vaccination came done marginally – from nearly 20,000 to under 18,350 – key localities at the centre of Pakistan’s current polio toll identify closely with highest-risk districts reported in the past. Moreover, it is in these districts that aversion to polio vaccination, after all these years, could still be pronounced. Thus, the conduction of anti-polio intervention needs to factor the rates of exposure per locality along historical trendlines. Experts should also determine the possible spread of isolated cases from these localities to others.

Interestingly, the Gates Foundation – an internationally respected foundation and long-time partner in Pakistan’s anti-polio effort – has converged with Pakistan on the shared concern of recent polio counts. This is a step in the right direction. Pakistan’s phenomenal display of political commitment to stamp-out once 20,000-strong case surges per year – in line with cultural and personal sensitivities – is a significant feat. But to be clear, those hard-fought gains are precisely why the nation cannot afford to read single and double digit case counts as those that will naturally subside. Pakistan has an opportunity to all-out eliminate this disease, and should see itself over the line.

“The [Pakistani] government is committed to eradicate polio from the country by strengthening operations at all levels of the polio eradication program,” said Prime Minister Shehbaz Sharif in an exchange with Gates over the weekend. He also affirmed that “providing safety and security to all members of the polio program, especially the frontline workers would be Islamabad’s highest priority.”

It is a fact that the disease, now easily seen as a formidable challenge of the past, was not easy to get a grip on. In the early phases of the 1990s, thousands of Pakistani children were crippled on an annual basis through its spread, making it a sea change for Pakistan to look at eradication in the eye and opt for an accelerated strategy focused on local flare-ups. More deeply, only by preserving the merits of past coordination, and by ensuring that the correct lessons are drawn from Pakistan’s multi-decade anti-polio partnerships, the country can accomplish what was once a mirage on healthcare performance.

The key is to understand that Pakistan’s healthcare system, its frontline workers, and vaccine deployment does not require some far-fetched revamp to suit a reported increase in cases. Instead, the key is to understand that the existing healthcare mechanism is robust enough to see these challenges through, because it is the same arrangement that got Pakistan where it is on its anti-polio fight.

The writer is a foreign affairs commentator and recipient of the Fulbright Award