Annual Review of N-STOP Pakistan Reveals Successes and Challenges for Polio Eradication

Right: 11th annual N-STOP review meeting in Islamabad. From left to right, seated in the front row, are Dr. Mariana Mansur, Khurram Butt, and Shaina Azam of the TEPHINET Secretariat. (Photo credit: Tariq Sohotra)

From September 10-14, three representatives from the TEPHINET Secretariat attended the 11th annual review meeting of Pakistan’s National Stop Transmission of Polio (N-STOP) program held at the National Institute of Health (NIH) in Islamabad. The country stands within sight of polio eradication, with four cases reported so far this year.

Through funding from a cooperative agreement with the CDC’s Global Immunization Division (GID), TEPHINET provides logistical support to ensure that N-STOP officers, who conduct polio surveillance and immunization activities, are able to travel to areas throughout Pakistan that are difficult or dangerous to reach. The N-STOP workforce (which currently comprises 70 officers) is composed mainly of graduates of Pakistan’s national Field Epidemiology and Laboratory Training Program (FELTP).

“Pakistan is working towards full country coverage in terms of vaccinating children,” says Khurram Butt, a project management team lead for TEPHINET who attended the meeting. “In reality, they know that the magnitude of unrecorded children is greater than their estimates. This is why having FELTP graduates, who are experts in surveillance, is such an advantage for the N-STOP program.”

The annual review provided an opportunity for key N-STOP stakeholders (including the NIH and Ministry of Health, FELTP, National Emergency Operations Centre for Polio Eradication, U.S. CDC and TEPHINET) to review the program’s accomplishments through presentations by each district. These presentations were followed by discussions on performance indicators for each district, implementation challenges, and other considerations vital to the success of the program.

“N-STOP officers, being epidemiologists, have great potential to learn,” says Mariana Mansur, a project manager for TEPHINET who attended the meeting. “Empowering them to make decisions in the field is important for success, and having strong logistical support, which is where TEPHINET comes in, is just one component of this strategy.”

Currently, N-STOP officers work in all of Pakistan’s provinces and in 33 of its districts. They work alongside global partners including the Bill and Melinda Gates Foundation, the World Health Organization (WHO), and UNICEF. N-STOP conducts frequent meetings internally, as well as with partners, to stay up to date on the status of vaccinations. As they approach their goal of polio eradication in Pakistan, their focus narrows on specific issues—such as possible water contamination or the reasons why people decline vaccinations—in order to develop appropriate interventions. Achieving the N-STOP goals requires a combination of epidemiology, communication, and strategic thinking.