New Delhi: The Taliban takeover of Afghanistan during the Covid pandemic has come as a blow not just to the global efforts to defeat the SARS-CoV-2 virus, but also plans to eradicate another virus — poliovirus.
Afghanistan is one of just two countries in the world where polio remains endemic. Since 2018, the vaccination efforts have suffered as the Taliban enforced bans on door-to-door vaccinations in areas where they were strong.
The Covid-19 lockdown added to the challenges and the takeover of the country could put the country back by several decades in terms of polio eradication.
In 2020, 56 cases of ‘wild’ polio were reported in the country and one in 2021, according to data available with the Global Polio Eradication Initiative (GPEI). Polio infection can happen either from a ‘wild’ virus — which means circulating in the population — or be vaccine-derived. A country is declared polio-free after it records three years without any case of the wild virus.
Afghanistan’s National Emergency Action Plan (NEAP) for Polio Eradication 2021 acknowledged the challenges in polio vaccination efforts especially in areas controlled by anti-government elements (AGE).
“It is important to recall that the AGE’s ban on vaccination was mostly limited to high-risk provinces of the south region (with active polio transmission) in 2018. Since the beginning of 2019, the ban has been gradually expanding, initially to other parts of the south region, then to south-east region and finally to everywhere in April 2019. After a complete cessation of vaccination campaigns (due to ban) from April to July 2019, the vaccination gradually resumed in the accessible areas in August 2019 and onwards,” the document stated.
Towards the end of September 2019, the ban on house-to-house campaigns was partially lifted in some areas.
“House-to-house campaigns continued to be banned in the AGE areas and only health facility-based vaccination was allowed. The three campaigns implemented during the last quarter of 2019 (one nationwide and two sub-national rounds) could not reach the areas in the south region with ongoing intense WPV-1 transmission. As per the reported administrative data, the health facility-based campaigns could reach a maximum of 20 per cent of targeted children (the least being 3 per cent in some high-risk areas of south region) in 2019,” added the government analysis.
C.K. Mishra, former health secretary to the Government of India and former co-chair of Partnership for Maternal Neonatal & Child Health (PMNCH), said: “It is critical for the world to remember the importance of child health and maintaining the efforts the world has made in eradicating polio. Afghanistan is one of the countries still struggling with polio.”
Long-held apprehensions about the polio programme
In June this year, unidentified gunmen shot dead polio vaccinators in the eastern Afghan province of Nangarhar, in a suspected Taliban attack. The incident took place on the second day of a four-day national campaign on polio vaccinations.
In April, three women frontline health workers were killed in Jalalabad, also by unidentified gunmen. In a piece in January this year, The Lancet estimated that, since 2018, fear and insecurity had caused some one million Afghan children to miss out on their polio drops. The NEAP 2021 estimated that “more than three million children are inaccessible in all the regions of the country”.
Putting the global fears in black and white, an article earlier this month in Science said: “The US troop withdrawal from Afghanistan — along with the surge of the Taliban there — is imperiling the 3-decade global quest to eradicate polio. The Taliban has blocked house-to-house polio vaccination in areas under its reign for the past 3 years, putting up to 3 million children out of reach of the campaign and leaving Afghanistan one of only two countries, along with Pakistan, where the wild polio virus survives.”
Saad B. Omer, epidemiologist and Director at Yale University’s Institute for Global Health, tweeted: “A potential consequence of events unfolding in Afghanistan is the threat to progress in global polio eradication. In 2021, there’s been only 1 case each of wild poliovirus in Afghanistan & Pakistan; the last two polio endemic countries. Children of the world deserve better.”
Drawing on the WHO’s experience of working in the conflict-ridden country, Dr. Luo Dapeng, WHO Representative in Afghanistan, however, told ThePrint that the polio programme in Afghanistan has operated for many years – during insecurity and escalating conflict – and will continue to do so.
“The programme has never really stopped and, as we have seen in the past, has adapted to the nature of the conflict. The programme continues to work with all actors, agencies and organisations who deliver humanitarian aid to populations in affected areas. None of the key actors in Afghanistan, including the Taliban, are opposed to polio eradication and are expected to support the programme. All solutions are local and we will continue efforts to go wherever the children are,” Dr Dapeng said.
Low Covid-19 vaccinations
The scenes from Afghanistan of mob frenzy after the fall of Kabul and the photos of Taliban members in the presidential palace had one thing in common — the complete lack of masks and social distancing. Nothing perhaps could be farther from Afghan thoughts at the moment, but the country has an abysmally low rate of vaccinations — just 0.6 per cent people are fully vaccinated against a global average of 23.6 per cent.
Last week, the Taliban reportedly banned Covid-19 vaccination in the Paktia province.
Only last month, the country had received 1.4 million doses of the Johnson & Johnson Covid-19 vaccine as part of its share from the global vaccine consortium for Covid-19, Covax. Between 3 January 2020 and 16 August 2021, there have been 152,142 Covid cases in the country and 7,025 deaths.
Till 10 August, 18,09,517 vaccine doses had been administered in the country. The country went through a virulent third wave in June when daily cases touched a high of 2,313 on 17 June. Numbers are currently down to 99 daily new cases (on 16 August).
“Afghanistan has seen a decline in Covid-19 cases over the last few weeks with a 51 per cent decrease in cases and 45 per cent decrease in deaths observed last week (8-14 August) compared to the week before. While this is good news, the crisis is far from over,” said Dr Dapeng.
“Internal displacement and international migration of Afghans trying to escape the conflict, combined with low Covid-19 vaccination rate and lack of adherence to public health measures can increase the risk of Covid-19 transmission and disproportionally affect already vulnerable groups of people,” he added.
With the country in turmoil, experts fear, both reporting of pandemic cases and deaths, and the vaccination programme, are likely to be seriously affected.
“We are especially concerned about the risk of Covid-19 transmission among the newly internally displaced people in Kabul and other cities as they are living in often crowded and unsanitary conditions, with little to no access to health facilities and implementation of infection prevention measures,” said Dr Dapeng.
An increase in cases in Afghanistan can also impact neighbouring countries, he said.
“Diseases and health outbreaks do not respect borders. Health crises catalysed by the ongoing conflict will impact neighbouring countries too. Covid-19 has shown us that when it comes to health, no one wins unless everyone wins. The international community must work together to mitigate and control health emergencies in Afghanistan to alleviate the suffering of people who have already been battling decades-long humanitarian crises,” Dr Dapeng added.
(Edited by Poulomi Banerjee)
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