Progress and Challenges in Polio Eradication: Areas Requiring Additional Funding in Afghanistan

Dr. Wrishmeen Sabawoon, senior advisor at LIAISON, visited Afghanistan during July 18 to September 5, 2024. The visit was aimed to assess the polio eradication efforts and identify critical areas requiring enhanced support. The mission included consultations with managers from the National and Regional Emergency Operation Centers for Polio Eradication, representatives from the Global Polio Eradication Initiative as well as field monitoring of the polio case response campaign (August 10-14, 2024) and sanitation efforts in Kandahar and Helmand provinces. Key findings from the mission include:

Need for primary and secondary healthcare services and nutritional support: 

Despite recent progress in expanding physical access for program staff and securing permission for house-to-house vaccination campaigns in southern Afghanistan, the program recorded 18 polio cases as of September 8, 2024, compared to just 6 cases in 2023. This permission has proven fragile, with opposition from religious scholars and community leaders leading to a reversion to mosque-to-mosque campaigns in September 2024, posing a significant setback. Contributing factors include inadequate healthcare and nutritional services, alongside cultural barriers that prevent male vaccinators from administering the oral polio vaccine in the absence of male caregivers. To successfully resume house-to-house campaigns, it is crucial to address these challenges by enhancing staff selection processes, optimizing micro-planning, and ensuring the provision of comprehensive primary and secondary healthcare services, along with nutritional support. These efforts are essential to building trust and securing the cooperation of community leaders, religious scholars, and local authorities.

Sanitation and Infrastructure: Dr. Sabawoon observed areas with poor sanitation, which pose a significant obstacle to eradicating wild poliovirus transmission. Improvements in access to clean drinking water and sewage systems in polio-endemic areas could play a crucial role in disrupting the virus transmission cycle.

Vaccine and Cold Chain Shortages: Ongoing shortages in vaccine supply and essential cold chain equipment have undermined the efficiency and sustainability of both routine vaccination and polio eradication programs, threatening the continuity of smooth operations.

Laboratory Capacity: The mission highlighted the need to strengthen laboratory capacity, particularly the newly established polio laboratory. Technical and financial support from international partners will be required to further enhance the laboratory's capabilities.

Community Engagement and Gender-Specific Strategies: Increased engagement with local religious and community leaders is essential to overcoming vaccine hesitancy. Additionally, expanding female vaccination teams in certain regions is crucial to ensure the full coverage of all children.