Mary-Anne Land – PHAA
Adapt, stay, deliver – Afghanistan’s Polio Eradication Initiative will continue operations amid ongoing instability in the country.
“Poliovirus circulation does not stop during conflicts, it does not stop during emergencies. If anything, it makes children and families even more vulnerable by adding a layer of risk”, says a Polio Provincial Officer from Balkh province.
At the recent Polio International Health Regulations Emergency Committee meeting it was confirmed that wild poliovirus type 1 (WPV1) continues to fall, with no new cases since January 2021, when two cases occurred, one each from Pakistan and Afghanistan, compared to the 94 WPV1 cases during the same time period in 2020. Similarly from environmental surveillance, the overall proportion of specimens that are positive has reduced from almost 60% in 2020 to less than 15% in 2021 to date with no detection in Afghanistan since 23 February and only ten isolates in Pakistan since 31 March.
While the Committee noted the commendable progress being made, it noted that there is no room for complacency, and the ongoing inaccessibility in many provinces of Afghanistan coupled with increasing military conflict remains a major risk. Population displacement brought about by the current situation could further impact the programme’s access to children and increase immunity gaps against polio, triggering a rise in transmission. It is also feared that the mixing and movement of unvaccinated populations due to the upheaval faced by thousands of Afghans may spur polio transmission.
Despite risks and challenges due to the recent insecurity, the polio programme is staying and delivering for the children of Afghanistan. Polio vaccinations are continuing through permanent transit teams in most regions and at cross- border sites, including Friendship Gate (between Afghanistan and Pakistan).
“We are working with all actors to ensure there are no delays or disruptions to polio vaccination campaigns and overall routine immunization. The gains of the past 20 years cannot be lost. Children need immunization now, they must not bear the brunt of conflict and instability. We are calling for unimpeded access to all children,” says Dr Dapeng Luo, WHO Representative in Afghanistan.
While the current situation is a challenge, it is by no means the first the polio programme has faced.
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months. Currently there are two active PHEIC’s COVID-19 and Poliovirus.
A PHEIC is defined in the International Health Regulation (2005) as, “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. This definition implies a situation that is:
- serious, sudden, unusual or unexpected;
- carries implications for public health beyond the affected State’s national border; and
- may require immediate international action.
Dr Hamid Jafari, Director of Polio Eradication, WHO Eastern Mediterranean Region has said that despite challenges “I say this with absolute conviction: We WILL achieve a polio-free world.”
Eradicating polio has been a worldwide effort over many years – the table accessible here shows the last recorded case of wild poliovirus (WPV) by country. In Australia, this was 1972.
Until polio is completely eradicated, all countries remain at risk of imported WPV, as has happened in a number of countries.
Photo credit: WHO EMRO