When Pakistan’s new government is sworn in on Wednesday it has a historic opportunity. The new administration under the leadership of Nawaz Sharif could be the government to eradicate polio from Pakistan, one of three countries where the crippling disease remains endemic.
But they must overcome critical challenges to succeed.
From providing security to health workers, to reaching children from marginalized groups, they face significant obstacles.
Not least in challenging deep-seated opposition among some religious leaders who are able to persuade parents not to vaccinate their children against the disease.
Those administering the vaccine take many risks. Just last week another of our female frontline polio workers was killed and one wounded on the outskirts of the main northwest city of Peshawar whilst they were delivering vaccinations.
No group has claimed responsibility for the attacks, which bring the death toll among health workers since December up to 12.
Remote areas are difficult to access and the free movement of nomadic populations across the vast and porous Pak-Afghan border also hampers the widespread delivery of the vaccination.
I became the government’s federal cabinet minister and the lead for health in the interim government two months ago and have been working to keep up the fight against polio in the country. Our resolve to do so is hardened in the light of recent attacks and we urge the incoming government to build on our work and take the chance to stamp out the disease.
Despite the difficulties the world is close to eradicating polio. It only remains endemic in Pakistan, Afghanistan and Nigeria.
At the Global Vaccines Summit in Abu Dhabi in April, $4billion was pledged to the Polio Eradication and Endgame Strategic Plan, a significant amount in this time of global financial crisis.
At that summit and at the World Health Assembly in Geneva in May, I outlined the progress we have made in Pakistan in the past two months.
Most notably, we have reinstated the federal level ministry of health that was abolished in 2010 when all health powers went to the four provincial Governments.
Without a federal ministry of health it was near impossible to respond quickly and effectively to emergencies and diseases that are no respecters of provincial borders.
The national ministry of health will enable the federal government to discharge its constitutional healthcare role and coordinate with the provinces, which now deliver health services.
I summarized the critical next steps in the eradication plan in a handover note to Mr. Sharif who will become prime minister Wednesday.
His government must follow up the health system restructure with measures to strengthen organizational governance in order to improve public service delivery.
Those administrating the vaccine lack effective institutional support and have little incentive to take part. They need better protection and to be incentivized to reach every child with the vaccine.
The failure of local governments to provide the basics — clean water and proper sanitation — is a problem for polio eradication and public health more broadly. The government needs to prioritize implementing these fundamentals.
They must also focus on winning support among the hierarchy of clerics through the ministry of religious affairs, so that messages about the positive impact of immunization can permeate to the grass-roots religious leaders throughout the country.
Coordinated support from agencies on the ground in areas that are difficult to reach, could also be game-changing.
There is a need for better accountability across all levels of government to counter ‘ghost vaccinations’, immunizations that are reported but have not taken place.
Polio eradication should be better coordinated with routine immunization programs in preparation for the introduction of the injectable polio vaccine. This should be coupled with initiatives to build awareness among parents of the positive impact of vaccinations.
At the same time as better coordination, polio requires stand alone high-level advocacy because total eradication requires a comprehemsive approach from government, where challenges can be identified and quickly overcome. But most of all, the Pakistani government needs to stay absolutely committed to polio eradication.
The interim government appeared to be taking a backwards step at the end of May by abolishing the Prime Minister’s Polio Cell, a team dedicated to monitoring Pakistan’s implementation of polio vaccination programs.
Since the team was set up in 2011, Pakistan reported a 65% reduction in polio cases in 2012 compared to the previous year. So far in 2013, 50% fewer cases have been reported than over the same period in 2012.
Disbanding the cell would have been a retrograde step. But following a presentation I gave on Sunday to caretaker-Prime Minister Mir Hazar Khan Khoso, relevant authorities have been directed to reinstate the Polio Cell immediately.
This is a critical decision, because a high-level body as part of the prime minister’s office is essential for advocacy and mobilization of the whole of the government’s response to polio.
By making polio history the new government will build a legacy that permeates across our health system. They will also honor our brave health workers who have given their lives in the battle to purge the country of this disease.
This blog first appeared on the Wall Street Journal Blog and has been cross-posted from http://blogs.wsj.com/indiarealtime/2013/06/04/pakistans-polio-priorities/