ISLAMABAD: Though the increasing polio cases in the country are embarrassing the government at the international level, health departments are doing nothing except convening meetings and giving suggestions to each other.
On Wednesday, Minister for National Health Services (NHS) Saira Afzal Tarar again held an emergency meeting of all stakeholders to discuss the rising polio cases. The participants said provinces should double their efforts for the eradication of the crippling disease.
A participant of the meeting requesting not to be identified told Dawn that rather than fixing the responsibility on the officials concerned for failing to curb the disease, once again a team — headed by Secretary Health Mohammad Ayub Sheikh — was formed to visit the provinces frequently and look into their deficiencies.
It may be noted that on Tuesday the United Nations General Assembly described Pakistan as a major hurdle in declaring the world as polio free.
Director General World Health Organisation (WHO) Dr Margaret Chan told an informal meeting on polio at the United Nations General Assembly: “Pakistan is the single most important stumbling block along the road to ending polio, once and for all. Right now, a massive polio outbreak is sweeping across the country.
Health ministry holds another meeting, asks provinces to double efforts to eradicate the disease
“Worldwide, nearly nine out of every 10 children paralysed by polio live in Pakistan. Out of the global total of 178 cases this year, 166 (now 171) are from Pakistan. Think about it. These figures are dramatic.”
Dr Chan highlighted the efforts of the KP government and the army by saying: “Political and local leaders in Peshawar proved last spring that OPV campaigns can be run without a security incident. Military commanders in Khyber Agency showed that all children could be reached and vaccinated in that area.
This past summer, hundreds of thousands of Waziris were vaccinated in transit posts. However, those local success stories still have to be coordinated and scaled-up into a national eradication effort, conducted in a full-force emergency mode.
Without that, the risk that Pakistan will seed outbreaks and set back progress elsewhere is great, she said.
But the meeting presided over by Minister Saira Afzal Tarar once again decided to make efforts to eliminate the virus.
According to an official statement, the minister said while the federal government was ensuring uninterrupted supply of polio vaccines there was a need for the provincial and district governments to re-double their efforts and fix gaps in the campaign quality.
An official of the ministry on the condition of anonymity said though the participants of the meeting stated that vaccines would be provided all over the country and there would be no issue of operational cost, the ground realities were just the opposite.
“For over one year, the government has not approved a PC-I to get loan from the Islamic Development Bank (IDB) to meet the operational costs. As a result, polio campaigns have been delayed in Sindh and Balochistan as there were issues of delivery of the vaccines. Polio workers also faced difficulties because of the delay in the payment of their stipends,” he said.
At the meeting, he added, the participants tried to defend themselves by saying that out of the 171 cases 158 had been reported from Fata and KP. But they failed to find a solution to the national issue.
“In fact, the participants only expressed the hope that after ensuring peace in Fata, the issue of polio would be resolved,” he added.
A number of parents refused to vaccinate their children but the government never took action against them. A special legislation should be done and refusal should be declared a crime, he said.
When contacted, the technical head of the PM’s polio cell, Dr Altaf Bosan, who also attended the meeting, said all the stakeholders had decided that an intense campaign against polio would be launched all over the country from November.
The low transmission season starts from November so it will be the best time to attack the virus. Moreover, a strategy is being prepared to involve the provinces in the decision-making process, he said.
“On Thursday, we are going to hold another meeting chaired by the focal person of the PM’s polio cell, Ayesha Raza Farooq, in which representatives of all the provinces will participate,” he said.
Polio emergency
IT’S hard to say what it will take to shake the state out of its apathy towards polio. There’s not a shadow of doubt that the crippling disease is not just on the upsurge, but rapidly accelerating.
In recent days, almost 20 new cases have been reported across the country — 13 on Sept 16 alone. The number of confirmed cases so far this year has reached 166.
Punjab and Balochistan, earlier thought to be polio-free, have had that myth shattered; and the less that is said about the situation in Khyber Pakhtunkhwa, the better.
In terms of the tribal areas, the authorities can to some extent hide behind the excuse of the remoteness of the area and the lawlessness that prevails. But what of Karachi, where a shocking number of cases have been confirmed?
What greater indictment could be imagined of a country that has spent over two decades, and millions upon millions of rupees — much of it from global aid and polio-eradication initiatives — on the effort?
Given that Pakistan-specific strains of the virus have been found in several other countries, there is growing fear that this country stands to re-infect the global population at large. Considering this scenario, it could be argued that in merely issuing the advisory for unvaccinated travellers that was issued by the WHO in May, the world has shown a degree of forbearance towards Pakistan and invested confidence in its ability to put its house in order in this regard.
But Pakistan has simply failed to make enough of a push. Consider, for example, the government’s decision that individuals would be required to produce vaccination certificates before travelling: in reality, such screening is being done sporadically, if at all. Then, there’s the problem of those who refuse to let the vaccinations be administered.
With a WHO review meeting due on Sept 30 regarding the travel advisory, it may well be time to start mulling mechanisms that penalise the refusal to vaccinate; at the very least, we need to seriously step up the vaccination effort.
Health ministry running out of funds for polio campaign
ISLAMABAD: If new funds are not arranged soon for the faltering anti-polio campaign in the country, it is likely to halt after two months, according to sources in the Ministry of National Health Services.
An official of the ministry told Dawn on condition of anonymity that the ministry was running out of funds.
The Economic Coordination Council (ECC) was supposed to approve PC I for the campaign in second week of August, but has not met owing to political crisis.
Under the PC I, the Islamic Development Bank, Japan and other organizations were to provide loan of $326 million, with the interest on the amount to be paid by the Bill and Melinda Gates Foundation, the official said.
“If the funds are not arranged in next two months, the ministry would be left with no option but to halt the countrywide polio campaign,” he added.
In November the World Health Organization is to review the temporary travel restrictions it imposed on Pakistan in May 2014, on the recommendation of the International Health Regulations, which made it mandatory for every person intending to travel abroad to produce polio vaccination certificate at airport.
For now, it is obligatory on the government to vaccinate each person going out of the country, the official said.
Lack of funds may jeopardize countrywide polio campaign
“In 2012, Central Development Working Party (CDWP) gave approval to the loan. In June 2013, PC-I was revised but still it could not be approved because of one objection after another,” he said.
“Once the PC-1 is approved, the funds will be transferred to World Heath Organisation (WHO) and the United Nations Children’s Fund (UNICEF) which are supervising the campaign,” the ministry official said.
“The financial problem is more for Punjab, Sindh and Balochistan than Khyber Pakhtunkhwa (KP) and Federally Administered Tribal Area (Fata) where funds are provided through United Arab Emirates Pakistan Assistance Program (UAE PAP),” he said.
“In case of unavailability of funds it will become impossible to pay salaries to almost 2000 highly paid communication officers who are raising awareness of polio vaccine among parents,” he said.
“Most of the officers have been working for the last two years and once they leave because of delay in payment of salaries it will become difficult to hire trained officers. Moreover, stipends to polio workers have also been delayed,” he said.
“Vaccine could not be provided at Chaman border due to which people coming from Afghanistan could not be vaccinated for the last many days,” he said.
When contacted, the minister of NHS, Saira Afzal Tarar, claimed that she had been trying her best to arrange funds from alternative sources.
She told Dawn that she was aware of the increasing operational cost and issue of funds.
“Central Development Working Party (CDWP) approved the PC I but the Planning Division insisted that since health is a provincial subject after 18th Amendment the matter should be referred to Council of Common Interest (CCI).
However, the provinces gave in writing that they had no objection on PC I so Finance Minister Ishaq Dar agreed to discuss the issue in Economic Coordination Committee (ECC) of cabinet,” she said.
“Meeting of ECC was scheduled in second week of August but because of political crisis representatives of different provinces did not come,” she said.
“I am also trying to get the funds and resolve the issue or call a meeting of ECC only on PC I for polio,” she said.
While replying to a question regarding non-provision of vaccine at Chaman border, Ms Tarar said although it was provincial issue, she will inquire into it.
Shortage of funds may hamper campaign against polio
ISLAMABAD: Even after about two years, a PC-I to obtain loans from the Islamic Development Bank (IDB) and Japan to purchase polio vaccine and bear the administrative cost of the anti-polio campaigns could not be approved.
As a result, with each passing day it is becoming difficult to hold the anti-polio campaigns, an official of the Ministry of National Health Services (NHS) told Dawn on condition of anonymity.
Minister NHS Saira Afzal Tarar confirmed that there was an issue of operation cost of the campaigns, adding that she had been trying to approve the PC-I that has been pending due to various reasons since November 2012.
The ministry official said the international community had expressed concerns that Pakistan was not spending even a single rupee on the eradication of the crippling disease so it should be forced to reserve fund for the campaigns to bring a sense of responsibility to the government.
In November 2012, the Central Development Working Party (CDWP) approved a plan to obtain a $326 million loan from the IDB, Japan and other organisations. The Bill and Melinda Gates Foundation announced that it will pay the interest on the loan, he said.
PC-I to obtain loan from international agencies not approved even after two years
The IDB initially released some funds but after that it has been waiting for the approval of the PC-I. In June 2013, the PC-I was revised but it is yet to be approved.
“The amount of the loan has to be transferred to the World Heath Organisation (WHO) and Unicef for utilisation on the eradication of the disease due to which no one is interested in getting the loan,” the official said.
On the other hand, in the near future availability of polio vaccine can become an issue due to lack of funds. Even if the vaccine is made available, there would be the issue of operational cost of the polio campaigns, the official said.
It may be noted that the demand for the polio vaccine is increasing all over the country. On July 15, the first polio case of the year was reported from the rural area of Sindh. On July 26, the first case from Balochistan in the last two years was reported from Qilla Abdullah. On August 7, the first case of Punjab was reported from the tehsil of Kallar Kahar in the district of Chakwal.
The health ministry official said whenever a polio case was reported a case response emergency campaign (CRC) has to be conducted in the nearby area.
“The CRCs have been announced in Sanghar and Qilla Abdullah and the local management is waiting for the vaccine. Moreover, vaccine is being given to the internally displaced persons of North Waziristan,” he said.
District Health Officer (DHO) Qilla Abdullah Dr Abdul Ghaffar Baloch told Dawn: “It has been decided to hold a campaign in 27 union councils where 130,000 children will be covered.”
DHO Sanghar Dr Shagufta Nasreen said a vaccination drive was carried out in the five kilometre radius of the area from where the polio case was reported.
“I have announced the CRC on August 18 and hope we will get the vaccine on time,” she said.
When contacted, Minister Saira Tarar said though the demand for vaccine had increased all over the country, at the moment there was no issue of vaccine shortage. However, she added, there was an issue of the operational cost.
“Saudi Arabia has provided us 10 million doses of vaccine to give to the persons who intend to travel abroad,” she said.
“Sindh has demanded the vaccine to hold campaigns in Karachi, Hyderabad and Sanghar, which will be sent to them soon,” she said, adding that provinces had reserves of vaccine and can use it for the CRS.
In reply to a question, she said Balochistan missed the Lot Quality Assurance Sampling (LQAS) and should ensure the usage of the vaccine. However, the case from Kallar Kahar was different as the affected child had received seven doses but might have complaint of low immunity.
Ms Tarar said in 2012 the PC-I was submitted to the planning division without taking an input from the ministry of health. As a result, the planning division raised an objection. So a revised PC-I with the input of the ministry was submitted.
“The planning division objected again and said it should be approved by the Council of Common Interest (CCI). But the ministry informed the commission that polio was a federal subject so there was no need to get approval from the CCI,” she said.
“I have personally talked to Federal Minister for Planning Ahsan Iqbal and Finance Minister Ishaq Dar to resolve the issue and I am sure that the PC-I will be approved in the current month,” she said.
