Pakistan Polio Eradication Initiative National Emergency Action Plan: July 2024 - June 2025

"Encourage a spirit of adaptive programming that is responsive to the local context - local solutions to the local challenges."

The Global Polio Eradication Initiative (GPEI) has worked hand in hand with governments and global partners to eradicate poliovirus worldwide. Wild poliovirus (WPV) remains endemic in Afghanistan and Pakistan, and interrupting virus transmission in this one epidemiological block is critical to reaching zero polio. The Pakistan Polio Eradication Initiative (PEI) National Emergency Action Plan (NEAP) July 2024-June 2025 was developed in alignment with the GPEI's Polio Eradication Strategy 2022-2026 and is based on recommendations from the May 2024 meeting of the Technical Advisory Group (TAG).

Following a promising period of nearly 15 months without a single WPV case from January 2021 to April 2022 and minimal virus detection in environmental samples, the country began experiencing a rapid and widespread escalation of WPV1 infections. several challenges persist in Pakistan, leaving a significant number of children with suboptimal immunity due to the complex socioeconomic and security environment in the country's polio high-risk areas. Examples of challenges include inconsistent access to all vulnerable children on account of insecurity, vaccine hesitancy, refusals, demand-based boycotts (used strategically by communities as bargaining chip for getting due attention from the government for their problems), community resistance and campaign fatigue, and collusions and fake finger marking. To address these issues, Pakistan's polio programme has developed this roadmap to enhance operational and managerial capacities to eradication levels and ensure that the circulation of poliovirus is interrupted across the country by June 2025.

The roadmap consists of 3 phases:
 

1. Resetting the Programme to Eradication Level (2 Months: July and August 2024)
2. Reversing Current Virological Trends (4 Months: September to December 2024)
3. Targeting Remaining Virus Pockets (6 Months: January to June 2025)

To ensure high-quality implementation of the roadmap and to enhance access to all activities, programme oversight and accountability will be strengthened, together with a focus on improving security and access, as well as migrant and mobile population (MMP) tracking and vaccination and improved coordination with the Afghanistan programme in all 3 phases of the roadmap.

Each phase will address key programmatic components, which include:
 

• Community engagement: Enhancing communities' trust in vaccination and promoting it as a collective societal responsibility (social norm) using integrated human-centred design (HCD) and behavioural insights to create social and behaviour change (SBC) interventions that are grounded in strategic communication, media, advocacy, and partnerships. To address vaccine hesitancy and resistance, targeted community engagement initiatives through validated influencers will be implemented. This work will involve working closely with community leaders, religious figures, and local influencers to promote vaccinations. Recognising the impact of influencers and building their capacities through an intensified training programme will help garner more support for access to communities in the remote regions, followed by an understanding of underlying communication challenges.
• Gender mainstreaming: Training programme staff on anti-Harassment and gender mainstreaming at all levels, conducting a study on intersectional gender analysis for the polio programme, implementing co-design solutions with female frontline workers (FFLWs), holding periodic listening sessions with FFLWs for their feedback, and more.
• High-quality polio supplementary immunisation activities (SIAs): Implementing multiple nationwide and sub-national polio vaccination campaigns, reaching missed children through additional complementary activities, addressing operational gaps, resolving community boycotts, and addressing the overall mistrust in the population. Priority will be given to ensuring the full synchronisation of SIAs with the Afghanistan programme, in part by: (i) improving communication strategies and jointly monitoring border vaccination through regular exchange of information, data, and strategies focusing on bordering populations; and (ii) drawing on identified religious, community, and tribal leaders to build trust within communities on both sides of the border.
• Renewed oversight and accountability: Revitalising and empowering a strong core group empowered to take decisions, fostering data-driven and participatory decision-making by multidisciplinary task teams (comprised of multiple organisations) across priority areas of work, and undertaking critical reviews on the part of the National Polio Management Team, where performance is linked with accountability.
• Rapid outbreak response activities and prevention of importation of the virus: Conducting aggressive risk-based outbreak response for each poliovirus detection, amplifying vaccination for special populations, preventing re-establishment of virus transmission, enhancing cross-border coordination with Afghanistan, and increasing the scope and reliability of campaign monitoring.
• Efforts to address gaps on the critical path to achieving and sustaining polio eradication: Fostering focused Expanded Programme on Immunization (EPI)-Polio Eradication Initiative (PEI) synergy, reducing the number of zero-dose and defaulter children for routine immunisation in the highest-risk union councils and districts for polio eradication, and pursuing integrated service delivery (ISD), including health camps.
• Sustenance of gains: Pursuing relapse prevention strategies from the second half of 2025 to 2026 by maintaining high surveillance sensitivity, implementing a robust polio SIA calendar, mounting a rapid outbreak response, ensuring outbreak preparedness, and achieving and maintaining high routine immunisation coverage throughout the country.

To ensure efficient and high-quality implementation of the NEAP, each of the 3 phases of the roadmap will be closely monitored with clear performance indicators; these indicators are results-based for each area of work. In addition, mid-term and end-of-NEAP evaluations will be carried out to ensure the roadmap is on track and to pave the way for sustaining the gains and moving forward.