Abstract
ABSTRACT Introduction: Established in 1994, Pakistan’s polio program demonstrated early success. However, despite over 120 supplementary immunization activities in the last decade, polio eradication efforts in Pakistan have been unable to achieve their objective of halting polio transmission. Variable governance, and inconsistent leadership and accountability have hindered the success of the polio program and the quality of the campaigns. Insecurity and terrorism has interrupted polio activities, and community fears and misbeliefs about polio vaccinations continue to persist. Areas covered: The article consists of a systematic review of the barriers and facilitators associated with the delivery of polio eradication activities in Pakistan. We also provide a comprehensive review of the policy and programmatic decisions made by the Pakistan Polio Programme since 1994. Searches were conducted on Embase and Medline databases and 25 gray literature sources. Expert opinion: Polio eradication efforts must be integrated with other preventive health services, particularly immunization services. Addressing the underlying causes of polio refusals including underdevelopment and social exclusion will help counteract resistance to polio vaccination. Achieving polio eradication will require building health systems that provide comprehensive community-centered care, and improving governance and systems of accountability.
Highlights
Established in 1994, Pakistan’s polio program demonstrated early success
Policy & program overview Since 1994, a variety of programs and policies have been implemented as part of polio eradication efforts (Figure 3)
The plan builds upon the strategies highlighted in the Global Polio Eradication Initiative (GPEI) Strategic Plan 2012-2012, and was focused on developing appropriate leadership, oversight, accountability and surge capacity at global, national and sub-national level to support a transformational change
Summary
Despite over 120 supplementary immunization activities in the last decade, polio eradication efforts in Pakistan have been unable to achieve their objective of halting polio transmission. Achieving polio eradication will require building health systems that provide comprehensive community-centered care, and improving governance and systems of accountability. The Global Polio Eradication Initiative (GPEI) was launched in 1988, with the goal of eradication and containment of all wild, vaccine-related and Sabin polioviruses worldwide [1]. The Pakistan Polio Eradication Programme is a public–private part nership led by the federal government, and supported by GPEI partners including WHO, UNICEF, BMFG, and CDC [3]. Despite national efforts to eradicate polio, the transmission of wild poliovirus is ongoing in Pakistan [4]. Between 1985 and 2019, the Government of Pakistan con tributed roughly US$387 million and US$121 million to the GPEI through loans provided by the Islamic Development Bank and Japan International Cooperation Agency, respec tively, and roughly US$ 58 million through assistance from other national governments [6]
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