Pakistan to be the last place where polio will exist, WHO meeting told

Recent reports have painted a bleak picture of Pakistan’s fight against poliovirus.

“Pakistan which currently stands at the top in the last three polio endemic countries in the world for housing big wild poliovirus (WPV) reservoirs, will be the last place on earth in which polio exists,” is a disturbing information shared at a meeting of the Strategic Advisory Group of Experts (SAGE) held in the first week of this month in the World Health Organisation’s headquarters at Geneva.

SAGE is the principal advisory group to the WHO for vaccines and immunisation.

A senior government official told Dawn that a brief of the meeting, released this week, depicted the level of concern of the world about the persistent emergence of the wild poliovirus in Pakistan.

The full meeting report will be published in the WHO Weekly Epidemiological Record on May 23.

The SAGE meeting was called in the aftermath of the resurgence of polio cases in the polio-endemic countries — Pakistan, Nigeria and Afghanistan. Pakistan is at the top among other endemic countries, with 50 wild poliovirus cases in the current year so far.

Earlier, he said, the WHO had predicted India as the last ‘polio-endemic country’ because of the size of its population and ‘unmanageable’ health infrastructure but it surprised the world by getting the polio-free nation status.

Peshawar, Fata and Karachi remained the centre of discussion at the meeting due to persistent wild poliovirus transmission.

“The current situation in Pakistan is a powder keg that could ignite widespread polio transmission,” the official quoted the report as saying. The government has been slow to grasp the fundamental seriousness of the situation. “If the current trend continues, Pakistan will be the last place on earth in which polio exists,” it said.

Another report compiled by local offices of the international polio eradication partners, including Unicef and WHO, last week revealed an alarming situation in respect of refusal cases and the increase in the number of polio cases. “Pakistan continues to be the country with most polio cases in the world this year followed by three in Afghanistan and one in Nigeria,” said the report.

The official said this week five new cases were reported in Pakistan (two wild poliovirus type 1 — WPV1, and three circulating vaccine-derived poliovirus type 2 —cVDPV2). Four of the cases were from Fata and one from Gadap in Karachi. The officials were shocked to learn that out of the total 50 children who were paralysed by the wild poliovirus in Pakistan so far, 44 were reported with zero-dose.

Forty-one of the cases were reported from Fata, eight from Khyber Pakhtunkhwa, and three from Sindh. Balochistan and Punjab reported no polio case.

In the report, Unicef and the WHO noted that the number of unvaccinated children in Pakistan had shot up to an unexpectedly high level. The calculations showed that KP reported 700 refusal cases, Punjab 404, including 250 in Rawalpindi, Sindh 386, Fata 269 and Balochistan reported 251 refusal cases during the last round of polio vaccination.

Giving comparison of the cases with the last years, the report said, one polio case was reported in Pakistan by the end of April in 2011, two in 2012 and 12 cases in 2013 but the cases reported in the same months in the current year were hundred times more.

Rawalpindi has been forecast second ‘Peshawar’ for housing a large number of migrant families who come from Fata, Bajaur Agency, North and South Waziristan, Mohmand Agency and Afghanistan.

Peshawar had again been declared a major reservoir for poliovirus transmission.

According to the WHO the densely-populated Peshawar valley is considered to be the main ‘engine’ of poliovirus transmission, alongside North Waziristan, due to large-scale population movements through Peshawar from across this region, and into other areas of Pakistan.