The polio program in Afghanistan has operated even during periods of insecurity and conflict, and will continue to do so, said Dr. Hamid Jafari, director for polio eradication in the eastern Mediterranean region at the World Health Organization.
Afghanistan is a key country for polio eradication. It’s one of the two remaining polio-endemic countries globally, along with Pakistan. While significant progress has been made in reducing polio cases in the country, the polio program has faced a number of setbacks in previous years. That included a Taliban ban on house-to-house polio vaccinations in areas under its control, which has been in place since 2018.
The Taliban has often been suspicious of vaccinators acting as spies. Some vaccinations have been allowed to take place in clinics and mosques, but house-to-house vaccinations are seen as most effective to reach every child. Eighty-three percent of polio cases in 2019 were from areas where house-to-house vaccination is banned.
Sign up for Devex CheckUp
The must-read weekly newsletter for exclusive global health news and insider insights.
As the Taliban seized control of Kabul on Sunday, effectively becoming Afghanistan’s de facto rulers, a key question is what that means for the polio program in the country.
But Jafari said the Taliban has historically been supportive of polio vaccinations.
“None of the key actors in Afghanistan, including the Taliban, are opposed to polio eradication and are expected to support the programme,” he wrote to Devex in response to questions.
“The ban on access to those areas controlled by the Taliban was a ban on house-to-house vaccinations, not a ban on polio eradication per se. The ban on vaccination was mainly for security reasons not in opposition to vaccination or polio eradication,” he added.
He said attacks on health workers, including polio workers in June, are part of the broader security situation in the country.
“There are many actors that impact security in Afghanistan and none have claimed responsibility for these attacks. Nevertheless, even in areas with complicated security situations, health workers must never be a target and any attack on health care providers remains completely unacceptable,” he said.
Amid the COVID-19 pandemic and even with the escalating insecurity and conflict, an extensive network of environmental surveillance sites across the country has allowed the polio program to detect wild poliovirus and circulating vaccine-derived poliovirus type 2 cases. The escalation of insecurity can complicate outbreak response and disease surveillance work.
However, the program has operated in similar contexts in Afghanistan over two decades, and lessons from those years are now supporting the development of plans for the polio program under “this next context,” Jafari said.
Amid Afghanistan’s political crisis, a health system at ‘breaking point’
Weeks of conflict have resulted in an increase in trauma injuries and demand for emergency medical and surgical services. And according to WHO field reports, Kabul and other large cities show an increasing need for medical aid.
This year so far, only one case of wild poliovirus has been reported in Afghanistan, and one case in Pakistan, creating an “unprecedented opportunity epidemiologically” to stop wild poliovirus in the two countries. Wild poliovirus types 2 and 3 have already been eradicated globally, so only the type 1 wild poliovirus remains in circulation.
“Historically, this is the lowest number of cases that either country has ever reported. But experience tells us that even one case is one too many, and polio has repeatedly shown that it’s one of the most difficult viruses to eliminate. This is a time therefore to sustain the gains by focusing on achieving high quality campaigns and intensifying surveillance,” Jafari said.
Several door-to-door vaccination campaigns are planned for later in the year, and the polio program “is maintaining flexibility [to] adapt our plans to the evolving context,” he said, adding that they are working with key stakeholders on contingency plans for polio eradication activities to continue while ensuring the safety of health workers, including women, who play an important role in the polio program.
“Historically women have played an integral role in the polio programme as they often enjoy greater trust and access within households and communities. Wherever possible the programme has increased the number of female participation and will continue to work with all parties to ensure this important contribution is maintained,” Jafari said.
About the author
Jenny Lei Ravelo@JennyLeiRavelo
Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.
