TEPHINET Joins Partners Committed to Fighting Polio at the Technical Advisory Group Consultation on Polio Eradication in Pakistan

For the first time, the TEPHINET Secretariat, represented by project manager Mariana Mansur, PhD, had the privilege of participating in the Technical Advisory Group (TAG) Consultation on Poliomyelitis Eradication for Pakistan held in Karachi on January 8-10 and Islamabad on January 11-12.

Consisting of experts from countries around the world, the TAG was established nearly two decades ago to formally review progress made toward polio eradication in specific countries and issue recommendations to national programs facing barriers to achieving their targets. It first convened in 2001, with subsequent meetings occurring once or twice per year. This year marks the first time the consultation included a field component outside of Islamabad.

January’s meeting brought together a wide array of global stakeholders to discuss the progress and challenges facing Pakistan’s program, review the epidemiological situation in country, and provide expert guidance and recommendations to the national and provincial polio eradication programs. The meeting was structured to allow for close analysis and discussion on specific geographic areas, featuring progress updates from, and TAG recommendations for, every administrative unit in Pakistan.

More than 100 participants were in attendance, including TAG members (global and national), officials from the government of Pakistan including the Ministry of National Health Services, Regulations and Coordination; the National Emergency Operations Center (NEOC); the Expanded Program on Immunization (EPI); provincial governments and tribal districts (health ministers, commissioners and deputy commissioners); representatives from the Pakistan Army; the National Stop Transmission of Polio (N-STOP) program, the Pakistan Field Epidemiology and Laboratory Training Program (FELTP) and the US Centers for Disease Control and Prevention (CDC). Other participating stakeholders included UNICEF, Rotary International, the Bill and Melinda Gates Foundation, USAID, the World Bank and the World Health Organization.

“TEPHINET expresses our strong commitment to supporting our partners in ending polio,” says Dr. Mansur. “We will continue working to ensure that the FELTP has the resources it needs to strengthen Pakistan’s polio workforce.”

Through a cooperative agreement with the CDC, TEPHINET has supported the operations of the Pakistan FELTP and N-STOP program since 2015. In February, 13 N-STOP officers—all FELTP-trained epidemiologists—were deployed in priority districts across Pakistan to oversee polio vaccination efforts. In collaboration with the NEOC, the FELTP and N-STOP program conducted ten days of pre-deployment and field training to prepare the N-STOP officers for the challenges that lay ahead and equip them with required knowledge and skills, including crucial “soft skills” like team-building and communication.

Today, Pakistan, Afghanistan and Nigeria are the only countries with ongoing transmission of wild poliovirus. Pakistan is making steady progress toward interruption, with 12 cases reported in 2018 and four in 2019, but transmission persists in hotspots and core reservoirs and has proven challenging to interrupt. The sustained level of high immunity required to stop transmission is impeded by an absence of sustained routine immunization in Pakistan, its population size and density, movement patterns of people from active reservoirs, and poor sanitation, among other factors such as security threats.

In high-risk areas of the country, and within mobile populations, unvaccinated children continue to remain vulnerable. Mobile populations include tribal groups, refugees from Afghanistan, and seasonal and agricultural workers. In January alone, 1.5 million children “on the move” were vaccinated at 353 permanent transit points set up across country and district borders and other important transit points such as bus stops, railway stations and highways.

At the conclusion of the TAG meeting, TAG chairman Dr. Jean Marc OlivĂ© stressed the absolute need to reach every unvaccinated child as crucial to eradicating polio, recommending that the program “obsessively focus on reaching still-missed children in core reservoir areas through continued improvement of operations.”

To achieve this goal, the TAG recommended that community health workers (CHWs), who are on the front lines of administering vaccines to children, be given maximum support, and that vaccine refusals be handled by CHWs’ supervisors or specialized teams that are trained specifically in negotiating with parents who refuse to vaccinate their children. The TAG also recommended the full integration of operations and communications across all aspects of the polio eradication program to help technical experts better understand the reasons for missed children and to develop contextualized approaches to build community engagement and trust based on local realities.

Despite continuous challenges, Pakistan’s polio eradication work forges ahead, backed by a committed government and a global network of dedicated partners including TEPHINET. In February, the FELTP launched the training of its fifth Frontline cohort in Punjab province. These 18 fellows—all District Surveillance Officers—will, like all Frontline FELTP fellows in the country, be given specialized training on polio surveillance so that they too can join the fight to save the lives of millions in Pakistan from this awful disease.