Polio eradication: getting the basics right

Abstract

www.thelancet.com Vol 381 April 20, 2013 1359 and integration of polio vaccination into routine health and immunisation programmes. This viewpoint and other analyses have rightly high lighted the worsening security conditions and increasing inacces sibility to vaccination in Pakistan as the root cause of failure in polio eradication. Recent eff orts by WHO also focused on signifi cantly boosting the number of polio eradication offi cers at national, provincial, and district levels. Yet this overall focus on polio, security, and winning hearts and minds has taken focus away from the role of the crumbling routine immunisation programme itself. Poor governance, staff absenteeism, and corruption have all weakened the public infrastructure through which polio eradication initiatives are delivered. Routine immunisation services fail to vaccinate nearly a third of children, and, in recent months, more than 200 infants have died in Sindh province from measles alone. Strengthening of the routine immunisation programme is crucial because: (1) it is not possible to provide security to 90 000 lady health workers during country-wide vaccin ation campaigns—they are an obvious soft target for terrorism; (2) in the run-up to the forthcoming parlia mentary elections, polio does not have a big role; and (3) high-risk population groups (mainly of Pashtun ethnicity) resist polio vaccination campaigns owing to their religious and cultural beliefs. If the world does not want to miss another public health deadline, it is imperative to address the systemic problems that have plagued the routine immunisation programme in Pakistan. This will require accurate, context-specifi c communication, and perhaps integration with vaccination against other diseases the com munities consider more important than polio.