The dramatic return of the Taliban to power and the international airlift to get diplomats, workers and refugees out of Afghanistan have been the focus of global attention for more than a week. A small group of disease experts are focused on the political turmoil for another reason. They fear it could undermine the long-term campaign to eradicate polio. Since 1988, a relentless and expensive international campaign has fought polio from almost all parts of the globe. Afghanistan is the only country where wild poliovirus circulation has not been stopped. Pakistan, which shares a long border with Afghanistan, is the other. The case counts have fluctuated as religious and political factionalism has prevented vaccine delivery to children. Last year, there was only one case of poliovirus in Afghanistan. Pakistan, with which it shares a long border, had two. There are also fewer viruses in sewage, which is a key surveillance technique. It is a delicate moment to face a complete change in government. Health officials who have made this campaign so far are holding their breath. Hamid Jafari is a doctor and director of polio elimination for the World Health Organization’s Eastern Mediterranean Region. This region stretches from North Africa through to the Middle East and Pakistan. “We are seeing very low levels of wild Poliovirus transmission in both countries, which is so low that it is unheard of. This gives the program a great opportunity to attack the low viral burden and stop it. There is no indication that the Afghan Taliban leadership will request it to. The Global Polio Eradication Initiative (the official name for the campaign) released a statement last week stating that it is “currently reviewing immediate disruptions to Polio Eradication efforts and the delivery other essential health services to ensure continuity of surveillance, immunization activities, while prioritizing safety and security of staff members and frontline workers.” Like all cases, the attitude of the Afghan Taliban toward eradication activities has also fluctuated. The Taliban, a coalition of the WHO and the Centers for Disease Control and Prevention, allowed the campaign to begin operations in Afghanistan in 1990s. In 2018, the Taliban forced a halt in areas it controlled. It banned teams of vaccinators going house-to-house in neighborhoods and disallowed mass vaccinations at public buildings. This caused a spike in polio cases, from 33 in 2018 to 117 in 2019. Because it takes many rounds to immunize a child, interruptions that last a while can be devastating. It takes three rounds to build immunity in the US and Western Europe. The injectable formula is used in Europe. A fourth booster at school locks it in. John Vertefeuille is a doctor and chief of the CDC’s polio eradication division. This would have made those children, some partially vaccinated and others born after bans, more vulnerable to the virus and the floppy parlysis it causes. It would also have increased the amount of virus in the environment and caused it to spread to others.

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