Polio Eradication in Pakistan: Innovation and Digitalization—the Key to Crossing the Finish Line

this program saw huge success as indigenous polio was eradicated in all but 6 countries in the world 2 .The current situation in 2024 is that, polio has been eliminated in all, but 2 countries of the world, the exceptions being Pakistan and Afghanistan. Nigeria was the last country, to achieve the elimination status as recent as 2020 3 . . This signifies continuous transmission of the virus in the communities, due to presence of unvaccinated "missed children". In order to achieve elimination status, the country's focus should be on reaching and vaccinating these missed children which are the hidden foci of transmission, which can be achieved by improving the quality of our SIAs rather than the quantity contrary to the current norm 6 .As mentioned earlier, we are in unprecedented times facing problems unknown to mankind, at the same time, it is the best time to experiment with digital technology.The tool used to bring forth the introduction of our proposed innovation is the Framework for Public Health Innovation 7 . The innovation being proposed is introduction of GIS mapping in micro planning phase and using GPS technology to track paths of vaccinators is SIAs and NIDs. Nigeria being the last country to eliminate polio in 2020, had introduced this GPS/GIS technology in their NIDs 8 .As the country has failed to achieve the elimination target, and with the impending threat of funding withdrawal, it is evident that the world agrees, that the current elimination efforts in Pakistan are not enough and the efforts need to be supplemented by innovative methods. Thus, this climate provides an ideal playground to introduce an evidence based innovation.Mapping of areas for outreach activity using Geographic Information system:-GIS mapping has been identified as an effective strategy to identify remote and hard to reach areas. UNICEF and GAVI recommend GIS mapping to identify zero dose and missed children.GIS technology would also assist in identifying chronically missed settlements and would help in concentrating efforts to these high risk areas during the SIAs 9 .As shown in figure 1, maps are hand drawn by polio teams during the microplanning phases at union council level. These maps are of low quality and do not provide information like geographical complexity or hard to reach areas. Thus, these maps have low utility in practice and serve no other purpose than filling a formal requirement by WHO. On the contrary, GIS maps used for immunisation in Chad, gave exact location of settlements and planners have identified location of missed populations using this map 10 .GPS system would aid in monitoring of the campaigns. A web based tracking dashboard was developed in Nigeria, which tracked the vaccinators through GPS tracking system during campaigns, which can be simulated in Pakistan's polio SIAs. Such a tracking system would aid in supervision of vaccinators as well as in identification of missed pockets 8 .The GIS/GPS tracking process can be introduced in a sequential manner.The innovation should be piloted in high-risk districts of Sindh and Baluchistan where most polio cases have been reported.A nationwide SIA should be planned targeting the high risk mobile population (HRMP).This would include the nomadic population which do not come under formal health systems. A targeted campaign would be launched all over the country using the results and gains achieved in the first stage.Digitalization would be formally incorporated into the polio program.WHO and UNICEF being the main partners, would work in collaboration with the districts. However, the main ownership of the initiative, would be of the governmental bodies.Ownership of the innovation is essential to achieve sustainable gains, as seen in India and Nigeria polio elimination.The introduction of technology would involve use of resources, thus strict accountability should be introduced in the program for governmental agencies. Independent third party with no conflict of interest should be involved in the accountability process 8 .The presence of missed children and zero dose children is a major barrier to polio eradication.Weak routine immunization in the country is a gap that can be filled by operational innovation in NIDs.There is a good system of polio teams at union council levels in the country with predefined roles. The teams have experience of using apps for data entry in the past in various pilot projects and in routine as well. Thus, the introduction of the innovation recommended in the report seems feasible in the current circumstances. Digitalization is the last step Pakistan's polio initiative needs to take, in order to cross the finishing line.