House-to-house polio vaccination to resume in Afghanistan

The new Taliban government of Afghanistan has given the green light for house-to-house polio vaccination to resume across the entire country on 8 November.

The 18 October announcement is “huge,” says Hamid Jafari, who directs operations in the region for the Global Polio Eradication Initiative (GPEI). It will give the program access to 3.3 million Afghan children who have been out of reach for 3.5 years—and might bring the world closer to the ultimate goal of global polio eradication.

A decadeslong campaign against the disease has left Afghanistan as one of just two countries, along with neighboring Pakistan, to still harbor the wild polio virus. But the fight has been hamstrung there since 2018, when the Taliban, suspicious that vaccinators were helping the U.S. government target drone strikes, banned house-to-house vaccination in its stronghold in southern Afghanistan. Since then, roughly 85% of the country’s polio cases have occurred in areas that are off limits to the vaccinators.

The new government’s decision comes at an opportune time, polio officials say. After years of struggle and wildly fluctuating case counts, only one case of wild polio has been detected this year in Afghanistan, and one in Pakistan. (Despite the Taliban’s ban, polio surveillance across both countries has remained strong—as has vaccination outside of southern Afghanistan.) Cases resulting from vaccine-derived polio viruses are down, too. “It’s a unique opportunity,” says Aidan O’Leary, who directs GPEI at the World Health Organization (WHO) in Geneva. “We have to be sure we grab it.”

GPEI has quietly negotiated with the Taliban since it imposed the ban in 2018, and those talks intensified when the group began its dizzying blitz this summer and assumed power on 15 August.

Key discussions occurred in September, when WHO Director-General Tedros Adhanom Ghebreyesus and Ahmed Al-Mandhari, WHO’s regional director for the Eastern Mediterranean, toured the country and met with senior Taliban leaders. In those talks, says Jafari, who was part of WHO’s delegation, Taliban officials made clear that their first priority was to shore up the Sehatmandi Project, the backbone of Afghanistan’s health system. (Sehatmandi means “health” in Urdu.) Its major donors, including the World Bank, the European Union, and the U.S. Agency for International Development, froze funds when the Taliban took over. By 1 month ago, just 17% of the system’s more than 2300 health facilities were operating, and many of its 20,000 health workers had not been paid. The system was on “the brink of collapse,” Tedros and Al-Mandhari said in a 22 September statement, warning of “an imminent humanitarian catastrophe.” 

Routine childhood immunization has fallen off, says Godwin Mindra, a senior immunization specialist and deputy polio team lead for UNICEF in Kabul, Afghanistan, and measles outbreaks are raging. Many COVID-19 hospitals are closed, and COVID-19 vaccine is sitting unused and near expiration. With local facilities closed, people are crowding into regional hospitals, Mindra says. “I went to one regional hospital in Kandahar, and the patient load had increased three to four times. In the children’s ward, there were three to four children in one bed.”

On 20 September, the Global Fund threw Afghanistan a lifeline: $15 million to support Sehatmandi for the month of October. Two days later, the United Nations, through its Central Emergency Response Fund, kicked in $45 million to carry Sehatmandi through January 2022. Then on 24 September, the U.S. Department of the Treasury issued licenses that will allow organizations to provide humanitarian assistance to Afghanistan without violating U.S. sanctions. However, no new money has yet come through.

The November polio campaign will target 10 million children. It’s “our strong desire to vaccinate and protect as many children in Afghanistan as we can, and the persistently missed children in particular,” O’Leary says. As usual, the vaccinators will be women—under Afghan custom, only women can enter a home. This time they must wear hijabs, but most do anyway, Jafari says.

Jafari says the program intends to help address other health needs, too. Polio vaccinators will also administer vitamin A, and the program hopes to help deliver measles and COVID-19 vaccines when feasible.

GPEI will conduct a second campaign in December, synchronized with one in Pakistan. Polio has to be tackled in both countries at once, Jafari says. “If not, one will surely reinfect the other country.”

Six more polio vaccination campaigns are planned for Afghanistan in 2022. But with support for Sehatmandi assured only through January, their prospects are uncertain. “The global community needs to find a sustainable solution or Afghanistan will go into the next level of crisis,” Jafari says. And as for polio, “The risk of resurgence remains very high.”