Afghanistan recorded its first case of wild poliovirus this week for 2017 – an 11-month-old girl in Kandahar district. Still, the World Health Organization (WHO) says eradication is on the horizon, and Afghanistan is poised to lead the way.
In 2016, the WHO recorded just 37 cases of wild poliovirus worldwide, in Pakistan, Afghanistan and Nigeria. Although the four cases in Nigeria were a resurgence after two years free of the potentially paralyzing disease, Afghanistan and Pakistan have made steady and significant progress in recent years.
Afghanistan only had 13 recorded cases last year, down from 20 the year before and 28 in 2014. Pakistan’s improvements are even more dramatic – from 306 cases in 2014, to 54 cases in 2015 and finally only 20 cases in 2016.
“We have seen significant progress in our polio eradication efforts over the past year,” Hemant Shukla, director of the polio program at the WHO, said in a press release. “Most of Afghanistan is now polio-free, the circulation of the poliovirus is restricted to small areas in the eastern, southern and southeastern parts of the country, and we have seen huge improvements in vaccination campaign quality.”
Over 12 months, the proportion of areas that achieved the required immunization coverage increased from 68 percent to 93 percent. A new strategy to revisit homes where children were missed successfully vaccinated 75 percent of missed children in high-risk districts by the end of the year. New approaches like mobile technologies improved remote monitoring and Afghanistan’s surveillance capabilities are even better than global standards.
Most important, dialogue and engagement with the community has helped parents accept how critical immunization is for their children – something that a 2016 study found nearly 90 percent of Afghans now believe, the WHO reported.
In the face of insecurity, fighting and overt anti-vaccination campaigns by the Taliban, community engagement and support from religious leaders is crucial for health workers to effectively carry out campaigns. In 2016, not only was a National Islamic Advisory Group for Polio Eradication established, but the Ulama, Afghan religious and legal scholars, issued a declaration calling all Afghans to vaccinate their children.
Those improvements allowed Afghanistan to end 2016 polio-free in 99 percent of its districts, and they are what gives the WHO hope that eradication in Afghanistan in the short-term is a ‘realistic goal.’
“Now more than ever, Afghanistan has all the systems in place and tools it needs to achieve eradication,” the WHO said in an update Tuesday.
But when it comes to polio, countries do not exist in a bubble. In fact, certification of polio eradication by the WHO is given on a regional basis, after all countries in the region have been free of wild polio-virus for three consecutive years under certification standard surveillance.
Afghanistan and its neighbor Pakistan are therefore considered one epidemiological block. Thankfully, coordination between the two countries is strong, according the WHO, and 49 cross-border teams vaccinate children at 18 vaccination points along the porous border as they cross into or from Pakistan and Iran. Another 294 Permanent Transit Teams vaccinate children traveling in and out of insecure areas, and special campaigns make sure nomadic tribes are not overlooked either.
Assuming Nigeria can get itself back to zero, Afghanistan and Pakistan’s joint robust efforts suggest that global eradication could be achieved very soon.
Even with its first case of the year this week, Afghanistan is not deterred. Immunization campaigns began on Jan. 30, targeting 5.6 million children mostly in the southern, southeastern and eastern parts of the country close to Pakistan. The campaigns will continue monthly through the end of May during transmission’s low season, which the WHO says “provides the best opportunity to stop transmission country-wide.”
“With our collective efforts, we will be able to eradicate polio from the world,” Melissa Corkum, polio director for UNICEF in Afghanistan, said in a press release for the first immunization campaign of 2017. “Thousands of frontline workers visit every house in the country during campaigns. That’s not an easy task. Due to the hard work of these dedicated frontline workers, we are closer to polio eradication than ever.”