Improving Immunization and Fighting Polio in Pakistan

Polio remains endemic in only two countries: Afghanistan and Pakistan. Apart from polio campaigns, broader support for immunization is essential to eradicate polio. Two weeks ago (on April 21, 2016), the World Bank approved an International Development Association (IDA) credit of $50 million to increase the availability of vaccines for infectious diseases, including polio, for children under two years of age in Pakistan.  Additional funding to the amount of $80 million is provided by a World Bank administered multi-donor trust fund, Gavi – the Vaccine Alliance, and the United States Agency for International Development. The Bill and Melinda Gates Foundation also participates through a buy-down mechanism (on what a buy-down amounts to, click here). Below is information on the project reproduced from the World Bank’s website (the original link for the information is here).


The National Immunization Support Project (NISP) is supporting the country’s Expanded Program on Immunization (EPI) that aims to immunize all children against eight vaccine preventable diseases:  tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B, haemophilus influenza type b (Hib), and measles. Strengthening EPI will also support Pakistan’s access to newer vaccines which are either in the process of roll out (pneumococcal vaccine) or under planning (rotavirus vaccine).

The Project is also receiving additional support of $80 million grant from a World Bank administered multi-donor trust fund, Gavi – the Vaccine Alliance, and the United States Agency for International Development. The Bill and Melinda Gates Foundation is also supporting the project through an innovative partial conversion of the IDA credit into a grant upon successful achievement of project objectives.

“Pakistan is grappling with the public health emergency of polio virus transmission. Ensuring strong routine immunization services is the first essential pillar in polio eradication”, says Illango Patchamuthu, World Bank Country Director for Pakistan. “The World Bank and other development partners are working with the Government of Pakistan to strengthen routine immunization services at the critical endgame stage of polio eradication, particularly as Pakistan introduces injectable polio vaccine into its routine schedule”.

The project will incentivize provincial government capacity for rigorous monitoring and effective implementation of its program, including strengthened vaccine logistics, and deploying and expanding qualified technical and managerial personnel.

“Pakistan’s performance in maternal and child health remains weak and inadequate immunization coverage is a major challenge. Childhood immunization against vaccine preventable diseases can help in significant reductions in disability and death”, says Robert Oelrichs, World Bank Task Team Leader of the Project. “The project will establish linkages of the federal and provincial EPI cells with private sector health providers and health-related civil society organizations (CSOs) working in low coverage catchment areas – especially urban slums.”

Children under two years of age in Pakistan are the main beneficiaries of NISP – particularly children belonging to the poorest households in which immunization coverage is lowest. In addition, all children will benefit from strengthened polio and measles interventions.

The credit is financed by IDA, the World Bank’s fund for the poor, with a maturity of 25 years, including a grace period of 5 years.

Polio Eradication: A Priority Investment?

by Quentin Wodon
Today is world polio day, the ideal day to launch “Rotarian Economist”. This blog will feature commentary and analysis to support Rotarians in their “service above self” mission. Given that polio eradication is a priority for Rotary International,  this first blog is about polio.

Polio image

Reports earlier this year have documented a polio outbreak. The wild poliovirus has spread in central Asia (from Pakistan to Afghanistan), in the Middle East (from the Syrian Arab Republic to Iraq) and in Central Africa (Cameroon to Equatorial Guinea). In May the World Health Organization declared that the spread of the virus constitutes an “extraordinary event”. The situation is most serious in Pakistan where most of the cases of paralysis observed to date for 2014 have been recorded.

Polio is preventable through vaccines. Yet polio eradication is at risk. The WHO Emergency Committee unanimously concurred that conditions for a Public Health Emergency of International Concern had been met, recommending among others to vaccinate all those traveling outside affected countries. While three in four people carrying the virus have no symptoms, they can all be highly contagious.

Polio used to be a devastating disease affecting 30,000 children per year in the United States alone in the mid 1950s. Thanks to vaccines and mass immunization campaigns reaching more than 2.5 billion children over the last 15 years, the number of polio cases worldwide has dropped to close to zero. But it is essential to reach the last mile. Unfortunately vaccination remains difficult in many conflict affected areas, and the risk of exportation of the virus from those areas to other countries is real.

The dramatic reduction in polio cases in the last fifty years has been a great success built on strong public-private partnerships. While many governments have funded the polio eradication campaigns, after the United States (with $2.2 billion in contributions and pledges) the two largest donors from 1985 to 2014 have been private foundations – the Bill and Melinda Gates Foundation ($1.9 billion) and Rotary International ($1.3 billion). Apart from financial donations, hundreds of thousands of volunteers – including many Rotarians from all over the world – have participated in polio vaccination campaigns.

In a February 2014 report, UNICEF and WHO estimated the price tag for polio eradication for the period 2013-18 at $5.5 billion. The available contributions amount to $1.8 billion, but the remaining funding gap is at $3.7 billion. Private partners such as the Bill and Melinda Gates Foundation and Rotary International are stepping up to the plate. But more needs to be done by donors and multilateral organizations.

As a Rotarian, I used to wonder whether it made sense to spend that much money on a disease that seemed to affect only a few children. But the available research suggests it does, not only from an ethical point of view but also from an economic or investment point of view. This is because the cost of a spreading virus could be much higher.

Another report for the Bill and Melinda Gates Foundation suggests that previous investments of $9 billion since the creation in 1984 of the Global Polio Eradication Initiative (GPEI) may have already generated $27 billion in net benefits out of $40-50 billion in potential benefits estimated by researchers in an economic analysis of the GPEI. While investments in polio eradication campaigns have higher initial costs than routine immunization, they have much greater long term payoffs.

In the case of polio eradication as in many other cases of investments in young children, investing what is required is not only the right thing to do: it is also the smart thing to do.