Polio debacle: global regulatory body extends travel restrictions on Pakistan
By Asma Ghani
Islamabad (TP) October 6, 2019: Concerned over the ongoing poliovirus outbreaks and the current status of the management of the polio programme, the global regulatory body has extended travel restrictions on Pakistan for another three months.
“The progress made in recent years appears to have reversed and the risk of international spread of poliovirus is at the highest point since 2014 when the Public Health Emergency of International Concern (PHEIC) was declared,” said the international body in its statement issued on Thursday.
The Emergency Committee under the International Health Regulations (IHR-2005) regarding the international spread of poliovirus that met on September 16, 2019, at WHO headquarters blamed Pakistan for the exportation of virus in 2019 from Pakistan to Iran and to Afghanistan and the ongoing rise in the number of polio cases and positive environmental samples in Pakistan.
For failing to stem the spread of poliovirus, Pakistan was imposed with global emergency health restrictions in May 2014 making it mandatory for all residents to show proof of vaccination before they leave the country. Since then, the IHR committee has been extending restrictions on Pakistan after reviewing the situation.
As the risk of exportation from Pakistan and Afghanistan through air travel was also greater than in recent years, it urged both countries to ensure adequate funding and monitoring of airport and travel vaccination was in place.
The committee was gravely concerned by the significant further increase in wild poliovirus cases globally to 73 in 2019 to date, compared to 15 for the same period in 2018, with most of the increase due to the ongoing outbreaks in Pakistan. “In Pakistan transmission continues to be widespread, as indicated by both AFP (acute flaccid paralysis) surveillance and environmental sampling, although the Khyber Pakhtunkhwa province was of particular concern,” it said in the statement.
The number of polio cases has swelled from 8 in 2017, 12 in 2018 and 72 in 2019, with the majority of the cases — 53— coming from KP. Pakistan and Afghanistan will be the only two polio-endemic countries as Nigeria with no poliovirus detected for the last three years and possibly to be certified WPV free in early 2020.
“The increasing refusal by individuals and communities to accept vaccination is a serious setback to eradication,” the committee said. It was also very concerned about the current status of the management of the polio programme in Pakistan but understood that steps are being taken to get the programme back on track.
Highlighting these concerns, the committee noted that based on sequencing of viruses, there were new and recent instances of international spread of viruses from Pakistan to Afghanistan, in addition to the earlier reported exportation of the virus to Iran.
The resumption of poliovirus international spread between Pakistan and Afghanistan suggests that rising transmission in Pakistan correlates with increasing risk of virus exportation beyond the single epidemiological block formed by the two countries.
The committee noted the continued cooperation and coordination between Afghanistan and Pakistan, particularly in reaching high-risk mobile populations that frequently cross the international border and welcomed the all-age vaccination now being taken at key border points between the two countries.
The committee was apprehensive that after five years of vaccinating travellers as a means to limit the risk of international spread, there was some evidence of complacency about this aspect of the programme particularly at airports, and this must be addressed to prevent further international spread.
The committee recommended overhauling the polio programme in Pakistan ensure that all residents and long-term visitors of all ages receive a dose of oral or inactivated poliovirus prior to international travel, and intensify efforts to increase routine immunization coverage.