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Until recently, the staff of the poliovirus eradication campaign call centre in Islamabad would have received around 4,000 daily calls at the height of a vaccination push. The phones now ring as many as 70,000 times a day as staff instead hand out advice and information about Covid-19.

Likewise a nationwide surveillance network of doctors that once sought telltale signs of childhood polio paralysis now searches for suspicious coughs and fevers that could signal coronavirus infection.

Pakistan's internationally funded polio eradication programme has swung behind the country's efforts to tackle the pandemic.

Earlier this month, the Global Polio Eradication Initiative (GPEI) announced it would halt vaccination operations to stop door-to-door teams spreading the new illness, and instead dedicate staff and resources to tackling the pandemic.

The programme has for years received huge international investment and interest. Despite struggling to finally stamp out poliovirus, it is considered one of the best organised and most accountable parts of Pakistan's health infrastructure.

The poliovirus eradication campaign call centre in Islamabad receives as many as 70,000 calls a day as staff instead hand out advice and information about Covid-19

But its re-tasking also means the country is bracing for a spike in polio cases later in the year, following a disappointing 18 months which had seen the campaign stumble while apparently on the brink of success.

Global health chiefs hope the programme's surveillance network, communications experts and army of community workers can bring much needed rigour, energy and expertise.

So far the country has had surprisingly few cases, but in a nation of 220 million where the healthcare system is patchy or beyond reach for many, and cities are packed, the prospects of a runaway outbreak are grim.

Dr Mike Ryan, the World Health Organization's top emergencies expert, himself spent nearly three years on the polio programme in Pakistan.

“Pakistan continues to carry out good surveillance and has had one of the most effective surveillance systems for polio in the world,” he said last week. “And not only a surveillance system for the virus but has been doing extremely good environmental surveillance and other surveillance for polio viruses over a large number of years.”

The call centre has been boosted from 55 staff to more than 250. The network of 20,000 full time front line community workers is being used for community surveillance, spotting those with respiratory problems and encouraging them to take tests. Communications teams used to countering polio misinformation are switching their focus to Covid-19.

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“There has been a lot of investment made in the polio programme and it's good to use existing programmes and not duplicate, said Dr Mishal Khan, an associate professor at the London School of Hygiene and Tropical Medicine.

“Ideally if there is more money coming, the same programmes are strengthened.” But she warned the polio programme existed in its own isolated silo from the rest of the healthcare system and could be difficult to integrate.

“If Covid ends up being not as widespread and as bad as we fear in Pakistan, we don't also want to end up in a situation where we have dismantled some other critical health programmes and you have saved yourself the worst of Covid, but are having a resurgence in say vaccine preventable deaths,” she said.

International officials admit that the pivot to Covid-19 is very likely to produce an increase in cases of polio. The World Health Organization's Michel Zaffran, who heads GPEI, said in early April that he was “devastated” to have to stop polio operations.

Health workers in Pakistan expect that change of focus to last at least six months. When the GPEI announced the switch it said it would monitor the situation to “be prepared to fire up campaigns as soon as safely possible”.

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