TEPHINET and the National Stop Transmission of Polio (N-STOP) Pakistan Program

After the Forty-first World Health Assembly resolved in 1988 to eradicate polio, worldwide eradication efforts have seen the number of reported cases of wild poliovirus (WPV) decrease by more than 99 percent. In 1988, the number of cases exceeded 350,000 across more than 125 endemic countries. The number of reported cases of WPV in 2015 was 74. Today, polio remains endemic in only three countries: Afghanistan, Pakistan and Nigeria1.

In Pakistan, polio eradication continues to be a national emergency with renewed commitment at all government levels to interrupt transmission of WPV within the country. Pakistan reported 54 cases of WPV in 2015, which represents an 82 percent reduction in cases since 2014. The number of infected districts also decreased from 43, in 2014, to 23 in 2015. While this is encouraging news, the country continues to struggle against four core reservoirs--Khyber Pakhtoonkhwa (KP), Federally Administered Tribal Areas (FATA), Sindh, and Baluchistan--that are closely intertwined with the core reservoirs in Afghanistan. The country’s polio eradication efforts are guided by the annual National Emergency Action Plan (NEAP).

To help eradication efforts in Pakistan, TEPHINET has been an implementing partner of the National Stop Transmission of Polio (N-STOP) program. Launched in 2011, N-STOP Pakistan provides technical assistance to immunization campaigns at the district level. It is a collaborative initiative of the Centers for Disease Control and Prevention, the World Health Organization, the Pakistan Field Epidemiology and Laboratory Training Program (FELTP), the National Expanded Program on Immunization in Pakistan, as well as the federal Ministry of Health and provincial health departments in the country. 

TEPHINET provides administrative and logistical support to N-STOP Pakistan by facilitating the travel of public health professionals and medical doctors associated with the program (called N-STOP officers) around the country. N-STOP officers, the backbone of this initiative, often work in dangerous conditions to investigate outbreaks, plan campaigns and conduct routine immunization.  N-STOP officers in Pakistan have been instrumental in helping bridge the gap between the health department, district administration and international partners before, during, and after immunization campaigns. They have played a key role in establishing and functionalizing 46 District Polio Control Rooms in high-risk districts/agencies. N-STOP officers actively participate in surveillance, routine immunization and post-campaign monitoring activities. This has resulted in enhancement of immunity status of children under five years of age in N-STOP-assigned districts over time from 77 percent in 2011 to 89 percent in 2015. 

One of the most important contributions of N-STOP in Pakistan has been to help establish polio eradication committees at the district and union council levels as per NEAP guidelines. This is in support of the country’s “one team under one roof” philosophy to accomplishing polio eradication. “TEPHINET has made possible logistical support to program personnel, which acts as a key motivator for them to work on the challenging task [of polio eradication] in the country,” says Malik Mamoon Munir of the Pakistan FELTP. TEPHINET currently supports 64 N-STOP officers assigned in 52 high-risk districts, agencies, and towns as well as eight Emergency Operations Centers (EOC) and response units across Pakistan. This number is expected to increase to 80 during the next year.

[1] Nigeria, which was declared polio-free in September 2015 after a 14-month period of no reported WPV cases, has seen two new cases of WPV since July 2016.