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Thursday, February 22, 2024

Tale of two emergencies: Polio and Covid-19 through IMB lens (Part 1)

The current report of IMB of July 2020 apart from Polio specific has also taken account of the COVID 19 pandemic situation vis a vis its impact on health in Pakistan and Afghanistan.

Independent monitoring board for Polio (IMB) is a neutral, independent high profile London based entity that is mandated to scrutinize and judge the Polio program situation in the world and provide expert analysis of the problem and possible solutions.

Independent monitoring board for Polio (IMB)

Since its inception in 2011, IMB had published 18 annual analysis report on the world Polio status, the efforts undertaken, the failures, reasons of failure and how to ensure a free Polio globe through cutting edge and break through strategies.

Unfortunately for reasons Polio has remained endemic in the two last reservoirs of the world that is Pakistan and Afghanistan, the report main focus has been on these two countries albeit Nigeria- declared Polio free already- is also part of the report.

IMB reports are written in Shakespearian style English and appeal to the taste of English literature lovers though it touches on more intricate technical issues yet the style, language and choice of words and idioms is worth a read even for the non-technical people.

All its annual report has attracted the global eye due to its critical analysis, incisive dissection of the problems and tantalizingly innovative and out of the box solutions.

Read More: Polio eradication a matter of national pride, says KP minister Jhagra

IMB: Report on COVID 19 pandemic situation

The current report of IMB of July 2020 apart from Polio specific has also taken account of the COVID 19 pandemic situation vis a vis its impact on health in Pakistan and Afghanistan. It is heartening to note that the Pakistan COVID19 response was greatly hailed for concrete scientific and social reasons while Polio situation again was termed  serious and grave.

It provided a detailed account of why Polio has reached a frustratingly poor level and is bold enough to touch some scared cows . It’s the only entity which has held the Global Polio Eradication Initiative (GPEI) accountable for their poor management of the problem. Many still does not know that how Polio program works in Pakistan and naively think that the government is in charge which is far from reality.

The program is designed, managed, implemented and monitored even its surveillance system is with this “Billion Dollars partnership- GPEI”, government is only used as “punch box” when things – orchestrated and implemented by this partnership- doesn’t work.

GPEI consists of WHO, Bill gates Foundation ( BMGF), UNICEF, CDC Atlanta and Rotary international , all strategies , funds , Human resource, key decision making are with this partnership.  In India and Bangladesh when this partnership was managing the program the results were poor and Polio was inflicting paralysis in children but after careful analysis when their governments woke up to the realities and took charge of the program, Polio was Eradicated in two years, unfortunately in Afghanistan and Pakistan they still manage and control all Polio work and the results bespeak the value ?

Read More: Government sounds alarm after two new cases of Polio emerge in Punjab

IMB sending wake up calls to GPEI 

It was bold enough of IMB to keep on sending wake up calls to GPEI ever since its creation in 2011 but of particular interest is the year 2020 report where it has criticized  GPEI for serious leadership, technical, managerial, operational  lapses.

The report much to the anguish of GPEI asks it for poor management and accountability of the program, at page 5 of the report it says. “At the Polio Oversight Board meeting, that immediately followed the Abu Dhabi Pledging Conference, on 20 November 2019, donor countries made an unprecedented demand that the GPEI should review and reform its governance and accountability structures.

This did not reflect a reduced determination by these donors to get the job done, but rather the depth of their concern that there was no clear end in sight for polio eradication, and a lack of clear accountability in a $1 billion a year spending program.”

Read More: Pakistan and Afghanistan: last battlegrounds of Polio eradication

Plight of polio cases in Pakistan

Regarding the plight of persistent polio cases in Pakistan IMB mentions “Cases of poliovirus had increased fivefold between 2018 and 2019. There was uncertainty and doubt surrounding the effectiveness of strategies and tools.”

Regarding the funds management , spending and transparency that the bilateral, multilateral, philanthropies pumps in to this partnership for Polio the report on page 5 states, “ With the coronavirus’s savage impact on national economies, the case that polio dollars are safe in GPEI hands will, in future, need to be more convincingly made to the governments and taxpayers of these countries”

Further the report criticize the Polio program leaders for their inability to arrest the circulation despite all resources at their disposal the report says ,

“Each year of failure to eradicate polio results in enormous health, opportunity, and economic costs. The budgetary needs of the program are increasing steeply. They will increase further if vaccine-derived poliovirus outbreaks continue to occur on a wide scale. Also, conducting polio campaigns in a COVID-19 environment will be much slower, will need many more precautions (such as personal protective equipment), and, as a result, will be more expensive.”

For sensitizing GPEI on their overwhelming costs and the need to be extremely cost effective, it warns that Funding gap for  2021 would be anywhere between $234 million and $890 million, depending mainly on how the outbreaks evolve.

Read More: “West’s Anti-Vaxxers” and Pakistan’s “Anti-Polio Mullahs”?

Transparency and efficiency in communication

Regarding the need for transparency and efficiency in communication to the stakeholders primarily the Government  the report says on Page 18, “ The IMB welcomes the amount of work that the GPEI is putting into its communications strategy for the new vaccine introduction but is concerned that the depth and complexity of the task is not being fully appreciated.

It will be very important to have top quality modern communications specialists involved at strategic level, reliable sources of advice on cultural knowledge and beliefs, and strong feedback loops prepared to “speak truth to power” when things are going wrong.”

Expressing its frustration with GPEI governance, capacity and accountability systems of this 1 B USD a year program  of polio program it says, “ More broadly, the IMB feels that the GPEI is not yet on top of the complexities of communicating in relation to the type 2 vaccine-derived poliovirus challenge.”” In its 8th Report, published in October of 2013, the IMB made the following comment:

Any major enterprise spending $1 billion a year with an important and clearly measurable outcome should have clear and rigorous ‘board-like’ arrangements to govern its work – including setting priorities, making considered judgements on policy (particularly those that are mission-critical), dealing swiftly with major crises and unexpected events, understanding who has overall responsibility for ensuring that delivery occurs, and securing important decisions that are widely owned and clearly communicated.

“The IMB has constantly been struck by the lack of clarity in many of these aspects of accountability, governance and strategy formulation within the GPEI. Indeed, many of the comments made by senior IMB sources have a distinctly despairing and long-suffering tone on this issue.”