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Notes from the field - Pakistan December 2013


Notes from the field - Pakistan December 2013

Entry 1 for this trip from Chris Morry

A few days ago, I finished being part of Polio Technical Advisory Group (TAG) meetings for Pakistan and Afghanistan, respectively, and am now in Nigeria, the other remaining polio endemic country. The following notes flow from a few reflections during this travel but let's start with Pakistan.

It has been a difficult year for Pakistan's polio programme. I was last here in mid-December 2012 just before the horrific and targeted killings of polio vaccinators. At the time, Pakistan was talking about the 'last low season' and hoping that the first 6 months of 2013 would see it interrupt polio transmission and set it on the road towards eradication. Due to: those killings; the resulting cancellation, delayed and/or lower quality vaccination campaigns; the transitional upsets of the election of a new government; and a ban on vaccination campaigns in areas of North and South Waziristan in FATA , that 'last low season' was not to be.

Pakistan is now at the start of another low season and finds itself in the unenviable position of being the worst performing of the three remaining endemic countries. It hopes to do better this time, and there are a few reasons to be optimistic. Its programme is stronger than it was last year, its new government more settled and very supportive of eradicating polio, and attacks on polio workers reduced (though still far too high). However, the ban in the Waziristans continues, leaving many thousands of children unimmunized and vulnerable to getting and spreading the virus; polio workers must travel with police escorts in many places (known as a 'protected' campaign, though those police escorts are also being targeted and killed); and campaign quality continues to be substandard in too many places.

Whether Pakistan is able to succeed this year will depend on several things, such as: gaining access to the children being missed in inaccessible areas; ensuring better quality campaigns where there is access (largely through holding the responsible government officials accountable for campaign quality in their locales); maintaining good surveillance to ensure that no polio case goes undetected; not relaxing in any of the polio free parts of the country; and communication and social mobilisation strategies that function to build a widespread supportive and positive environment at the national and provincial level while also engaging caregivers and community leaders at the local level to build demand. It will also depend on vaccinators risking their lives to go out into their communities to immunise children as often as twice per month for the next six months.

Is this possible? The Pakistan TAG felt it was and said so but with caveats. There are many challenges, but two core questions will likely determine what happens in 2014: can campaign quality and commitment in southern Khyber Pakhtunkhwa and Peshawar be improved quickly and significantly, and can the programme find ways to immunise the children being missed in the inaccessible areas of FATA? The answer to the overarching question of whether this will be the 'last, last low season' hinges on both.


Chris Morry
Programme Director
The Communication Initiative
mobile (when travelling only) +250 884 7045

Polio Networks
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