Afghanistan almost beat polio. Now the future is uncertain

For more than that this week, Afghanistan’s overall focus has been on international air transport that brings the Taliban back to power and takes out diplomats, Western workers and refugees. But a small cohort of disease experts are embracing political billing for another reason: they worry that the country lies in weakening the long-running campaign to eradicate polio, and where, after years of despair, success now seems imminent.

Since 1988, a hard and very expensive international campaign has been chasing polio from all over the world. The circulation of wild polioviruses in Afghanistan is one of only two countries that has never been interrupted; Pakistan, which shares a long border, is the other. Case accounts have dwindled and escalated as religious and political factionalism stopped vaccinating children, and last year they rose again to 140 cases in both countries after the Covid pandemic forced them to do so. a three-month stoppage in the vaccination campaign.

But right now the numbers can’t be good: there has been only one case of polio this year – both in January – and fewer viruses found in sanitation, a key surveillance technique, than in recent years. It is a fragile time to face a comprehensive change of government and the health officials who have brought this campaign here are breathing collectively.

“We are still in a huge epidemiological window, both in Afghanistan and Pakistan,” says Hamid Jafari, director of medicine and polio eradication at the Eastern Mediterranean Region of the World Health Organization, which extends from North Africa to the Middle East to Pakistan. “We are seeing a very, very low level of transmission of wild polioviruses in both countries because it is so low that it has no precedent. It creates a tremendous opportunity for the program to start and stop from this low viral load.”

Clearly, the Afghanistan polio campaign has not been interrupted, and there is no indication that the Afghan Taliban leadership will demand it. Last week, the Global Polio Eradication Initiative, the formal name of the campaign statement “It is currently assessing immediate disruptions in efforts to eradicate polio and the provision of other key health services to ensure the continuation of surveillance and vaccination activities, prioritizing the safety and security of workers and primary care workers.”

As the case was told, activities to eradicate the Taliban’s stance in Afghanistan have also declined. In his first round in power in the 1990s, the Taliban authorized the campaign (WHO Coalition, Centers for Disease Control and Prevention, Gates Foundation, and Rotary International) to begin operations in Afghanistan. In 2018, it forced a break in controlled areas, banned vaccination groups from going from house to house in neighborhoods, and then banned mass vaccinations in public buildings like petty.

These bans, along with similar interruptions by political parties to seize power in Pakistan, were responsible for the numbers of cases of polio: from 2018 there were a total of 33 cases in both countries to 117 in 2019. critical blows, because many drops of oral vaccine are needed to immunize a child. (Even in the U.S. and western Europe, which use the injectable formula, three rounds are needed to boost immunity, and to block a fourth school-age promoter.)

“We estimate that about 3 million children will actually have no access to services between 2018 and 2020,” says Dr. John Vertefeuille and head of the CDC polio eradication branch. This would leave these children — some vaccinated and others born after the ban began — in the face of the discourse of the virus and the paralysis it causes, and the number of viruses in the environment would increase as children became infected and transmitted to others. .