Afghanistan almost beat polio. Now the future is uncertain
for more than Within a week, global attention in Afghanistan has focused on the Taliban’s astonishingly rapid return to power, and the international airlift escorting diplomats, Western workers, and refugees. But a small group of disease experts are blown away by the political shift for another reason: They worry it could undermine the long-standing campaign to eradicate polio, which has hinged on this country — and where, after years of disappointments, success now appears close.
Since 1988, a fierce and very expensive international campaign has chased polio across most of the world. Afghanistan is one of only two countries where the spread of wild poliovirus has not been interrupted; Pakistan, with which it shares a long border, is another. Case numbers have declined and risen as religious and political factions stopped delivering vaccines to children, and rose again last year, to 140 cases in the two countries, after the Covid pandemic led to a three-month pause in the vaccination campaign.
But the numbers are now impossibly good: There was one case of polio in each country this year — both in January — and far fewer viruses in sewage, a key surveillance technology, than in previous years. It’s a fragile moment when a sweeping change of government must be faced, and the health officials who have led the campaign so far are collectively holding their breath.
“We are in an amazing epidemiological window now, in both Afghanistan and Pakistan,” says Hamid Jafari, a physician and director of polio eradication for the WHO’s Eastern Mediterranean Region, which stretches from North Africa through the Middle East to Pakistan. “We are seeing very, very low levels of wild poliovirus transmission in both countries – so low that it is unprecedented. It creates a tremendous opportunity for the program to swoop in and stop this low viral burden.”
To be clear, the polio campaign in Afghanistan has not stopped, and there is no indication that the Afghan Taliban leadership will ask them to. Last week, the Global Polio Eradication Initiative, the campaign’s official name, issued a statement that it is “currently assessing immediate disruptions to polio eradication efforts and the delivery of other essential health services, to ensure continued surveillance and immunization activities while prioritizing the safety and security of staff and line health workers.” frontal”.
Like the number of cases, the attitude of the Afghan Taliban towards eradication activities has ebbed and flowed as well. At the first turn of power in the 1990s, the Taliban allowed the campaign (a coalition of the World Health Organization, the Centers for Disease Control and Prevention, the Gates Foundation, and Rotary International) to begin operating in Afghanistan. But in 2018, it imposed a pause in areas it controlled, banning vaccination teams from going door-to-door in neighborhoods, and then banning mass vaccinations in public buildings such as mosques.
These bans, along with similar pauses in Pakistan as political parties vied for power, have been responsible for the rise in the number of polio cases: from a total of 33 cases in the two countries in 2018 to 117 in 2019. Long-term outages can be Long strokes are critical, because it takes several rounds of oral vaccine drops to immunize a child. (Even in the United States and Western Europe, which use an injectable formula, it takes three rounds to boost immunity, and a fourth school-age booster to install.)
“We estimate that about 3 million children did not really have access to services between 2018 and 2020,” says John Vertefeuille, an epidemiologist and chief of the polio eradication branch at the CDC. This would have left these children – some partially vaccinated and some born after the ban began – vulnerable to the virus and the flexible paralysis it causes, and would have amplified the amount of virus in the environment as the children would become infected and pass it on to others. .