Drs. Rahim Agha and Shahid Ahmad, Pakistan

In 2021, Drs. Rahim and Shahid’s joined IGH to help lead a newly initiated program in collaboration with CDC’s Global Immunization Division (GID) and Pakistan’s National Stop Transmission of Polio (NSTOP) program. With the rest of the NSTOP leadership team, they were deployed to South KP, a high security risk zone in Pakistan that is one of the few global regions where polio is still endemic, where they established the first polio hub. Once in operation, the hub functioned to support a wide range of activities, including outbreak investigations, surveillance, and vaccination.

About Dr. Rahim Agha

Dr. Rahim Agha currently serves as IG/RIZ’s Senior Field Support Officer based in the Khyber Pakhtunkhwa (KP) province of Pakistan where he leads surveillance efforts as well as vaccination campaigns and monitoring activities. After 15 years working on WHO emergency and polio programs, he has spent the last 10 years supporting surveillance efforts in Pakistan’s country office – what is now one of the largest environmental surveillance systems in the world, with over 100 active sites to date. In addition to working in the lab analyzing stool samples coming from both Pakistan and Afghanistan, Dr. Rahim is proud to have authored the current environmental surveillance guidelines, which were published in 2021.

About Dr. Shahid Ahmad

Dr. Shahid Ahmad has 13 years of public health experience, with 9 years exclusively contributing to polio outbreak investigation efforts in Pakistan. In his current role as IG/RIZ’s Senior Epidemiologist, he works to provide technical assistance through operational support as well as monitoring and evaluation activities including designing process indicators, collecting quantitative and qualitative data, and producing impact evaluation reports. Dr. Shahid’s work additionally involves performing crucial data quality assessments, from which he has notably improved data accuracy by identifying blind spots and strengthening practices of data recording, sharing, collection, and validation.

Within two months of deployment, the CDC/IG team was the first group to respond to a polio outbreak in the North Waziristan district of the South KP province. As a part of this response, Drs. Rahim and Shahid investigated 10 out of 16 total cases, all of which were located in hard-to-reach areas with compromised security. This investigation also led them to the Bannu district where positive environmental samples were reported. A year later, the team aided in the investigation of another polio outbreak in Bannu in April 2023. For the last six months, the NSTOP team has been deployed in North Waziristan, where implementation of outbreak investigation and disease detection efforts have been notably successful. Given that these two outbreaks occurred after a period of 15 months of zero polio outbreaks or detection, Dr. Rahim’s hope is to curtail circulation of the virus by the end of the year.

While in Bannu, Drs. Rahim and Shahid found that local health facilities were missing cases of acute respiratory paralysis, a severe indicator of poliovirus infection. Given this clear gap, they spent some time in Bannu to conduct capacity building activities to strengthen the district’s surveillance systems. Across South KP, the NSTOP team similarly worked to strengthen and expand surveillance systems by tracking low-level virus circulation. Not only were these efforts a novel strategy in the region, but they allowed the team to recognize future outbreaks in a timely manner. Once the circulation of the virus is minimized and outbreaks are no longer a major threat, Drs. Rahim and Shahid plan to direct the hub’s efforts towards continuing to strengthen surveillance systems at the district level.

In addition to addressing gaps in surveillance systems, Drs. Rahim and Shahid have identified critical weaknesses in the management of vaccines. After discovering a significant volume of fake fingerprints and ghost teams in records tracking who had been vaccinated, the NSTOP team implemented a training for district store workers focused on keeping accurate and complete vaccination records as well as maintaining a consistent vaccine stock. In addition to their focus on polio immunization, similar efforts led to a 50% increase in the rate of BCG vaccination against tuberculosis in Bannu.

Drs. Rahim and Shahid note that their success has not come without pushback from local militancy across South KP that are threatened by the presence of outsiders. Encounters with such groups and the fear of being followed or kidnapped adds significant stress to the job and is undoubtedly disturbing for NSTOP leaders and their families. Nevertheless, the team maintains that they never feel defeated by these barriers – to Dr. Rahim, this perseverance is part of what it means to be a field worker.