Polio is a highly infectious diseases caused by different strains of polio virus. Although, it can strike at any age, but mainly affects children under the age of 5 years (Global Polio Eradication Initiative, 2010). According to WHO report, irreversible paralysis is the ultimate outcome in 1 of 200 cases. It attacks the nervous system and causes paralysis in a matter of hours. 5% to 10% of the polio inflicted patients die due to the paralysis of respiratory muscles. Since 1988, the incidence of polio cases have decreased by 99% due to the massive vaccination campaigns against polio. Now the struggle is down to three countries: Pakistan, Nigeria and Afghanistan where polio still remains endemic after 2013 (WHO, 2013).
Pakistan has a population size of almost 180 million and approximately two-thirds of the population lives in rural areas (World Bank, 2012). With Less than 3% of the country’s Gross Domestic Product (GDP) spent on health, immunization against childhood disease has been a low priority for country’s leaders (WHO, 2011). In the past few years, childhood immunisation has become a priority in Pakistan owing to the financial impetus from Polio Eradication Initiative, World Health Organisation (WHO), UNICEF, GAVI Alliance and Bill and Melinda Gates Foundation (Owais et al, 2013).
In April, 1994 the first National Immunization round was launched by the Prime Minister, Benazir Bhutto, who set an example by starting the campaign with administration of polio drops to her own daughter (UNICEF, 2012).This campaign led to a dramatic decrease of 20,000 cases per year to few hundreds.
Acute flaccid paralysis (AFP) surveillance began in 1997 but was fully functional in 1998. In 1999, surveillance officers were appointed by WHO, to provide training and technical support to the staff in all provinces. Groups of international health professionals called Stop Transmission of Polio (STOP) teams were deployed to provide assistance to the Ministry of Health staff with polio eradication and to improve surveillance quality (CDC, 2000).
The rising number of cases and the sustained transmission of poliovirus in Pakistan since 2008 turned into a national emergency. After the consultation with the Federal Government, Provisional Government and other partner organisations, National Emergency Action Plan (NAEP) was developed. The aim of this plan was to interrupt the transmission of poliovirus by the end of 2011 (UNICEF, 2012). But this goal could not be accomplished as Pakistan reported 198 polio cases in 2011(WHO, 2011). The main reason for not achieving this goal was due to inadequate implementation of NAEP strategies especially in high risk areas (UNICEF, 2012).
After the failure of NAEP, Augmented National Emergency Action Plan (NAEP) was launched in 2012, along with the consultation of stakeholders. The goal was to interrupt transmission of poliovirus by the end of 2013, but this plan wasn’t rewarding as well (UNICEF, 2012).