Taliban to restart house-to-house polio vaccinations in Afghanistan

The Taliban have agreed to lift a ban on house-to-house polio vaccinations in Afghanistan, which has been in place for more than three years.

Dr. Hamid Jafari, director of polio eradication at the World Health Organization’s office in the Eastern Mediterranean region, described the Taliban announcement, which was formalized Sunday, as the “culmination” of several yearslong negotiations.

Beginning Nov. 8, the polio vaccination campaign — to be conducted along with UNICEF and other partners — is expected to reach all children across the country, including about 3.3 million children who were affected by the ban on house-to-house vaccinations. A second vaccination campaign is expected to take place in December.

The decision comes at an opportune time for the country, Jafari said. Afghanistan has reported only one case of wild poliovirus so far in 2021, and there’s been “very, very low transmission” of the virus across the border in Pakistan, he added.

The Taliban have committed to providing protection and security for all health workers — including female health workers — and have asked provincial health directors to start preparing for the vaccination campaign, including mobilizing the support of provincial leaders, Jafari added. Polio vaccinators have previously been attacked, and some were killed, in parts of the country.

The last known attack was in June 2021, during which five vaccinators were killed in eastern Afghanistan, and four were wounded. It’s unclear who was responsible for the attack, but in March 2021, the Islamic State group took responsibility for killing three female polio vaccinators in the city of Jalalabad.

Female health workers comprise a large part of Afghanistan’s polio vaccination workforce, and play a crucial role in the success of the polio vaccination campaign given the trust communities extend to them and their access to households.

Jafari said WHO will have a better sense of female front-line health workers’ concerns once it starts planning for the implementation of the vaccination campaign and starts calling for female vaccinators to rejoin.

“Because remember, in some of the areas, particularly in the southern region, there hasn’t been house-to-house campaigns for more than three years … so we have to reengage the front-line workers,” he told Devex.

In other parts of the country, the last polio vaccination campaign was implemented in June. This was not, however, a house-to-house vaccination campaign.

Resuming house-to-house polio vaccination is going to take some work. Apart from reengaging health workers, WHO and their partners in polio eradication have to “redo” local micro plans to make sure they have the right number of teams and supervisors deployed in areas where this has not been done for years. In areas where the most recent vaccination campaign was carried out, they need to make sure their plans are updated.

In addition, Jafari said there’s a new group of provincial directors under the new administration that WHO and its partners need to engage with. They also have to make sure that they have a reliable mechanism to pay front-line health workers for the work they’ll be doing during the campaign, he said.

Experts warn that Afghanistan’s banking system is on the brink of collapse. The health sector has also been badly hit by donors’ suspension of funding for the Sehatmandi project, considered the backbone of the country’s health system. In September, WHO said only 17% of over 2,300 health facilities under the project remain fully operational.

If this continues, this will likely have an impact on the polio campaign in the long-run, Jafari said. The United Nations Development Program and the Global Fund to Fight AIDS, Tuberculosis and Malaria have arranged funding for the project to continue, and there are expectations that others in the U.N. system will fill the gaps in funding until early 2022. But Afghanistan’s health sector needs more long-term support to sustain essential health services beyond that time frame.

“It would become very difficult for any vaccination program, including polio vaccination campaigns, to be implemented if the rest of the essential health care system is collapsing around it,” he said.