Entry 4 from Chris Morry
Much better internet here than I had expected.
I am in the east and therefore haven't been able to look closely at what's behind the much improved polio numbers in the south. I expect the other half of our team will have much to say about Permanent Polio Teams (PPTs), improved access, and the extent to which the quality of campaigns has improved.
What I can say based on what I've seen so far and from previous reviews is that there has been continuing improvement in accessibility in the south which is no doubt due to dialogue, letters of support from a range of political and religious leaders, and positive behind the scenes action from community leaders at many levels. However, it is also important to remember that, at the end of 2012, the main issue was (as it always is) too many missed children! And 80% of the children missed were in accessible areas. While the hard and often dangerous work of negotiating access to the other 20% should not be underestimated, it's difficult to imagine getting to where we are today without significant improvements in campaign quality - accountability, management, social mobilization, and communication. Improvements that allowed the programme to reach more children in accessible areas also ensured that children in areas that became accessible actually got immunised when the opportunity arose.
None of the above means the issues in the south are solved. Serious gaps remain, pockets of under-immunised children remain vulnerable to infection, the virus may still be circulating at low levels, and the risk across the border has not gone away.
In terms of the 8 cases in the east, and without getting overly technical, they are all genetically linked to Pakistan, but there is clear evidence of circulation in Afghanistan. The outbreak in the east is related to groups denying access to vaccination in relatively few areas that, nevertheless, are home to enough young children to support internal circulation. The reasons for denying access vary, though they are not unrelated to what is happening in Pakistan and especially FATA.
I hope to be able to explore more on radio as we look at media over the coming day or two.
The Communication Initiative