Islamabad, Pakistan
28 February 2001

National EPI Conference, Islamabad

Your Excellency, President Mohammed Rafiq Tarar,

Distinguished Officials,

Colleagues,

Childhood immunization is the most cost-effective health intervention we have at our disposal. Through routine immunization programmes, we can provide lifetime protection against the six historical scourges - polio, diphtheria, tuberculosis, pertussis, measles and tetanus.

Immunization is an investment in the future. Healthier childhood means better mental and physical development and less absence from school. It means healthier and more productive populations.

In 1970, less than 5 percent of children around the world had been immunized against these six diseases. By 1990, the coverage had reached nearly 80%. Over the past decade, however, that number stagnated and may even have declined somewhat. Moreover, few children in the developing countries have access to vaccines for such diseases as hepatitis B, haemophilus influenza Type B (Hib) and yellow fever.

So despite the fact that vaccines exist, around 3 million children die each year because they had not been immunized. We need to act. We need to reach the children that are not yet reached. This is why we are all assembled here in this hall today - to make a difference!

One of the most important tools is the Global Alliance for Vaccines and Immunization, GAVI. Last year, which was the first year in operation, GAVI allocated approximately 310 million dollars, which will be spent over five years. That is likely to translate into half a million lives saved.

Pakistan is one of the countries whose application to GAVI was successful. With the help of GAVI, Pakistan will be introducing regular immunization against Hepatitis B, another milestone for public health.

All of you who are here today have the power and the privilege to save lives through your important work.

The power of vaccination to achieve the nearly impossible was proven more than 20 years ago, when smallpox was eradicated. We are about to see that power again.

On May 31st, 1988, when world health leaders voted to eradicate polio, polio permanently crippled around 1000 children every day.

Today, 13 years after the Global Polio Eradication Initiative was launched, less than 20 children fall victim to polio each day. That is an impressive success. But it is not enough. Twenty children are 20 children too many.

We all are dedicated to the eradication of this disease.

Poliovirus is still with us. But we are now witnessing the beginning of the end of this dreaded disease that has affected mankind for over 4000 years.

At the beginning of 2001, poliovirus transmission is occurring in no more than 20 countries, compared to more than 130 in 1988.

Three WHO Regions are already polio-free, with no transmission of indigenous wild poliovirus. The Americas were certified polio-free in 1994. The Western Pacific Region, including China, was certified polio-free in November of 2000. The European Region, stretching from the Atlantic to the Pacific, has been polio-free for over two years.

We are now entering the final stretch of polio eradication. We are cornering the virus. The remaining endemic areas are in Africa and here in South Asia.

Progress on the subcontinent has been rapid, particularly in India and Bangladesh. Similarly, the pace of the eradication effort has increased in Pakistan in 2000. The political commitment shown at all levels and the quality of technical work on the ground during 2000 was higher than ever before. As a result, virus transmission in Pakistan decreased significantly last year compared to 1999.

But Pakistan is not there yet. Virus is still transmitted more widely in Pakistan than in other countries on the sub-continent. Poliovirus does not respect national or regional boundaries. I would like to make clear that the epidemiological block represented by Pakistan and Afghanistan is one of the major global virus reservoirs. Exporting wild poliovirus into neighboring and distant polio-free areas also has political and economic implications.

To benefit the children of Pakistan and to avoid virus exportation to other countries in the Region and globally, Pakistan can now build on its progress and achieve a polio-free status.

Your challenge is to make it happen in 2001!

Polio eradication is a truly epic battle on many fields. You are the officers and soldiers in this fight.  am deeply impressed by the work you have already done here in Pakistan.

Improvements in National Immunization Day quality and surveillance through the year 2000 have been greater than for any previous year.

You have begun to zero in on what needs to be done to interrupt virus transmission once and for all: reach every child, every time.

We have seen in so many countries what this means in practical terms: It means finding and immunizing those children at highest risk of being missed by both routine and supplementary immunization. Children in the urban slums. Nomad children and other children on the move, whether Pakistani or Afghan children, whether inside your country, or crossing international borders. Children in remote, inaccessible areas.

Virus circulation in Pakistan during 2000 was much less intense than in 1999. But virus was still found in most populated areas last year. No doubt the quality of work can still be improved is some areas.

District level activities are crucial in Pakistan. Your dedication and input as district health officials make or break the quality of National Immunization Days. Unless all of you give your all-out support, the goal of a polio-free Pakistan may not be reached.

The only way you can finish polio this year is by further improving and fine-tuning National Immunization Days.

Vaccine delivery strategies have much improved. But we will need even more from you during 2001. No child must slip through the net. Immunization teams and their supervisors need to pay even more attention to assure thorough, accurate work in their assigned areas.

Coverage in large cities, the most important remaining virus reservoirs, has to be even tighter – it needs to be seamless.

The scope of work is huge – and far exceeds what the health departments can do alone. We all need to secure even greater multi-sectoral support for the upcoming immunization rounds.

The district coordinating and planning committees you have set up at all levels are a step in the right direction. This work is particularly crucial at district level – to ensure that all relevant departments of government and other civic groups are directly involved in making the campaigns a success.

Many governors have made a real difference in 2000 by making polio eradication activity a priority. Provincial government officials can contribute by mobilizing personnel and resources outside the Department of Health to support the polio eradication initiative.

And indeed, the personal involvement and leadership by the President himself and the Chief Executive is of prime importance.

But most of all, success depends on each of you as an active public health official. You must take on this task as your personal responsibility. We are all accountable to the children of Pakistan.

Polio must be highest priority for all of us until the job is done. But there are also other health priorities, particularly in the immunization field.

Routine OPV immunization is a crucial polio eradication strategy. We have got to balance effective implementation of polio strategies with the need to maintain and improve routine immunization.

As in many other countries, I am sure that routine immunization has already benefited from polio eradication activities. Polio work has delivered Vitamin A to millions of children and has boosted the vaccine cold chain, disease surveillance, and the training of health workers.

The coming GAVI support will, of course, strengthen routine immunization. But the transition from polio eradication to strengthening routine systems must be carefully guided, particularly over the next 12 months, when interrupting polio transmission here is so vital to success and to polio’s global eradication.

The investment in polio eradication made in Pakistan, in every polio-endemic country and by the international polio partnership has been enormous. Eradication is within our grasp.

But as you know the last few miles of the way will be the hardest. Our window of opportunity will not stay open forever; if we wait too long the goal will become more elusive and harder to achieve.

The quality of your work is crucial to wipe out polio in Pakistan, in the Region and globally. We must not fail the children of the world and the children of Pakistan. We must make polio history by the end of this year. The world’s eyes are on Pakistan in 2001.

Yet, I understand that for many of you, the local problems and challenges are what form your priorities and dominate you attention. But every time you drop the vaccine in a child’s mouth or watch the line of mothers holding their babies ready for immunization, you have reason to keep in your heart and mind: "I saved that child from disability. Perhaps I even saved its life." No task could be more worthwhile.

Thank you.