Pakistan's business, particularly exports, which are already creeping, may get badly hit in case the Independent Monitoring Board's (IMB's) recommendations to impose a world wide travel ban is implemented, on the assumption, that Pakistanis carry polio germs.
On the basis of fabricated conjecture, the Independent Monitoring Board (IMB), a subsidiary of Global Polio Eradication Initiative (GPEI) has recently recommended a unique world-wide travel ban on Pakistanis stating that every child and adult from Pakistan, being a polio endemic state, carry polio germs.
Chairman, Towel Manufacturers' Association, Mehtabuddin Chawla said that the business community of Pakistan particularly export oriented industry is stunned on this recommendation of GPEI and strongly protested against this "illogical and baseless demand since ours is a country where polio vaccination drops are provided to every child on a quarterly basis. Resultantly no polio case surfaces except a few cases which may occur in every country."
Independent Monitoring Board without realising the home ground reality of a country like Pakistan where the cost of doing business has already increased to a certain extent, the travelling advisory on foreigners visiting Pakistan off and on not to travel to Pakistan is a crude attempt to stifle business activities. Due to these advisory Pakistani exporters would be forced to travel to Dubai and Singapore, etc; to meet their buyers for finalising business deals. They may not be able to display their in-house facilities to foreigners as well as face difficulty in branding their products, he said.
Under the prevailing circumstances, recent recommendations of IMB would be the last nail in the coffin of our country's business which is already creeping. IMB has given May, 2013 its implementation month on the following grounds:
(i) Since 2013 is election year of Pakistan, all government agencies would be busy in election campaign accordingly; implementation of polio eradication scheme will be in jeopardy.
(ii) The country is already facing challenges of security and access particularly in Waziristan due to political unrest. As such, polio vaccination would not yield desired results in near future, particularly in Waziristan, Karachi and Quetta.
In view of the above, Chawla requested the government to check its authenticity first and then prepare a strategy to counter such restrictions of the IMB as a few cases of polio reported does not mean that the entire nation carries the polio germs.
The Independent Monitoring Board was convened at the request of the World health assembly to monitor and guide the progress of the Global Polio Eradication Initiative's 2010-12 Strategic Plan.
Global polio transmission will not be stopped by end-2012, but this year has brought the world a great stride closer to that goal. India has been removed from the list of polio endemic countries: a great achievement in the history of global public health. Angola and DR Congo have not had a polio case for over 10 months. Chad has reported only five cases this year. All four remain vulnerable to future polio importations and outbreaks: surveillance must be sensitive, and immunisation coverage high. The Programme in Pakistan has improved significantly: Less than half the number of polio cases this year than last. This trajectory of improvement must continue. The potential disruption of upcoming elections is of grave concern.
The IMB report makes ten recommendations, which are summarised as under:
-- Any child or adult travelling out of Afghanistan, Nigeria and Pakistan should be certified as vaccinated against polio, to reduce the substantial risk of the virus spreading to polio-free countries. A standing recommendation under the international health regulations should be issued by May 2013.
-- Extensive country action plans are impressive but priorities unclear. The upcoming low transmission season is a golden opportunity. Country programs should list no more than five priority goals that they will achieve by the end of April 2013 and communicate these to all their staff.
-- Can too many vaccination campaigns mean not enough time for between-campaign improvements? An urgent analysis should be commissioned to find the answers.
-- Parental demand for the vaccine would transform the Program. Currently parents do not have a voice within the Program's power structures. Every endemic country district-level task force should include a parent, representing parents of the community.
-- Too many communities see polio vaccination as an imposition with no benefit yet they are in desperate need of other services. To increase polio vaccine uptake and improve health, every opportunity should be taken to 'pair' polio vaccine with other benefits.
-- Vaccine supply is vital, but has recently been disrupted. Manufacturers have a great responsibility. The IMB requests a report on vaccine supply at all future meetings,
-- Learning from polio eradication is a vital and distinct part of the Program's legacy. Other health initiatives can gain a lot from the polio experience. Capturing this learning must be accelerated - with minimal disruption to current work.
-- Whilst the Program is right to focus on stopping transmission in the remaining four polio-affected countries, it must not lose sight of vulnerabilities elsewhere in the world. An intensive Polio Watch' should be established in the highest risk countries and an action plan drawn up to improve surveillance and vaccination coverage.
-- It vital that India maintains its Polio-free status. To ensure the readiness of emergency response plans, a simulation exercise should be conducted in 2013.
-- The establishment of an Emergency Operations Centre in Nigeria to support the current response is welcome and a great opportunity to bring all expertise. A live audio-visual feed should be broadcast online with a facility for the world's polio experts to provide input.
Each of Pakistan's affected provinces faces different challenges. Two thirds of cases originate from the two provinces - Sindh and Balochistan. In Sindh, the problem is particularly concentrated in the four districts. Three of the four are in Karachi, the largest city in Pakistan. Similarly in Balochistan, polio is disproportionately seen in three districts. Almost 90% of the cases are amongst Pashto-speaking people. Both provinces have suffered from ineffective management. Zonal supervisors have often fielded inappropriate vaccination teams, or no team at all. The program has acted decisively, replacing this entire supervisory tier. Balochistan and Sindh remain crucial.
IMB said: We have previously highlighted strong performance in Punjab, which had just nine cases last year. But nine cases is still nine too many. The province leapt more energetically than the rest into implementing last year's National Emergency Action Plan. It must now systematically work through the obstacles that are preventing nine from becoming zero.
In the Federally Administered Tribal Areas (FATA) and Khyber Pakhtunkhwa (KP), one concern predominates. A challenging security situation means that vaccination rounds are not reaching tens of thousands of children. We are not at all convinced that enough is being done to deal with this obstacle. As we discuss later, this is the case in several countries. We recognise the dedication of those working in these difficult circumstances. But this is a challenge that the program needs to find stronger ways around if transmission is to be stopped. Security is not the only concern in FATA and KP. Cases are still arising in areas where access is not a problem. The management challenge is to focus on inaccessibility, whilst not allowing it to be an excuse for suboptimal performance in other domains.
Although the challenge is highly concentrated in a small number of areas, this is not to say that the rest of the country is clear. Environmental surveillance continues to detect polio transmission in all major cities in all provinces. Pakistan's program has been sliding in the wrong direction. Last year's emergency action plan gained little traction. The recently augmented action plan gives us greater cause for hope. The hard work started must be sustained and must show results. We congratulate the program for this step up in its approach. We now need to see clear evidence of a step up in vaccination coverage, and a meaningful drop in case numbers.
Pakistan's polio program progressed strongly over its first 12 years. The country suffered 20,000 cases per year in the early 1990s. In 2005, it reported Just 28. But transmission was never stopped. The number of cases rose again. Uniquely amongst the endemic countries, Pakistan has seen cases rise for the last three years in succession. Balochistan had six times as many cases in 2011 as in 2010. We have previously expressed severe concern about Pakistan's program. We saw deep flaws preventing success and insufficient corrective action. In October 2011, we recommended that Pakistan fundamentally re-think its National Emergency Action Plan.
The program has made real improvements over recent months. It has clearly identified some crippling systemic weaknesses. Its National Emergency Action Plan has been considerably revised, providing credible solutions to many of the problems identified. The program has revitalised energy. A sense of meaningful accountability is starting to grow.
We should be in little doubt, though. Pakistan's problems remain deeply entrenched. The numbers are what matter and these have not yet shifted in any meaningful way. CDC's objective assessment still shows vaccination performance to be weak, and risk of ongoing transmission to be high. The current solutions need to be rapidly and comprehensively implemented. The low season window is closing fast. If significant transmission continues beyond April it will be nigh impossible to stop it during this year's high season. As time goes on, sustaining political commitment and energy will be a challenge, IMB said.
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