58 - Evaluation of Global Health Security in militancy hit areas of Pakistan bordering Afghanistan – Lessons Learnt

Abstract Information: Global health security is the existence of strong and resilient public health systems that can prevent, detect, and respond to infectious disease threats, wherever they occur in the world. In this proposal, evaluation of global health security and lessons learnt from polio program in militancy hit areas of Pakistan bordering Afghanistan can provide insight on novel approach to be adopted to overcome vaccine hesitancy, build community engagement and conduct risk assessment for better health outcomes.

Relevance Statement: Public health programs evaluation in general and Global Health Security in particular, especially in militancy hit areas, has been a major challenge in resource constrained country like Pakistan. A concerted propaganda campaign by militants operating from the Pakistan-Afghanistan border region, and supported by some religious clerics, has spun a narrative linking vaccination programs to a Western plot to sterilize Muslims and painted vaccinators as spies for the US especially after revelations that a fake vaccination campaign in Abbottabad to trace Osama bin Laden. This has led to a deep suspicion of the polio eradication campaign, especially in tribal areas of Pakistan bordering Afghanistan, which have the highest vaccine refusal rates and present with the most poliomyelitis cases and jeopardizing Global Health Security initiatives in the country. Vaccinators operating in these militancy hit areas of the country report significant hostility, partly because they are perceived to be following a foreign agenda. Survey data from FATA showed that only 25 % of residents trusted vaccinators compared to 61 % in low-conflict areas, highlighting how pervasive this narrative has become (SteelFisher GK, Blendon RJ, Guirguis S, Brulé A, Lasala-Blanco N, Coleman M, Petit V, Ahmed M, Mataruse N, Corkum M, Nisar M. Threats to polio eradication in high-conflict areas in Pakistan and Nigeria: a polling study of caregivers of children younger than 5 years. Lancet Infect Dis. 2015;15(10):1183–92). This proposal will highlight the novel approach of evaluating indicators of Global Health Security as well as polio programs in tribal areas by community engagement and overcoming barriers to vaccine hesitancy. This will help to guide policy makers and other stakeholders for informed decision making in the light of evidence based and actionable data available through findings of this evaluation. This will ultimately help to achieve better health outcomes and relevant sustainable development goals (SDGs). This work will also add value to audience with similar conflict hit areas and situation to develop techniques of evaluation specific to their areas and help to improve indicators of health in compliance of Global Health Security as well as International Health Regulations (IHR). The proposal in this abstract adds unique knowledge in evaluation field by highlighting the peculiar dynamics of evaluation of public health programs in militancy hit areas with religious and sociocultural barriers attached to it. It also reflects on standards of quality in evaluation theory, method and practice by encompassing a wide array of factors associated with polio eradication program in Pakistan.