World Polio Day 2021
World polio day 2021
© UNICEF | In Afghanistan, a father cradles his child as female health workers administer polio vaccines
“Polio eradication is closer than ever: stay committed”
Wrishmeen Sabawoon MD, PhD (Senior Adviser, LIAISON)
Ex-epidemiologist, Office of Senior Advisor to President in Political Affairs and President Focal for Polio Eradication in Afghanistan
I am Dr. Wrishmeen Sabawoon from Afghanistan, one of the two remaining polio endemic countries in the world. After graduating from Kabul Medical University in 1999, I started a medical practice in a rural and remote district of Nangarhar province. I then started work in Primary Health Care with the Ministry of Public Health and then with a non-governmental organization. The focus of the was on the management of common diseases, maternal and child health, nutrition, and vaccination services including polio eradication. I observed and learned how difficult the access to medical care was for the public and how socio-demographic, environmental, political, and behavioral factors influence access to medical care. There were several questions in my mind about how such factors contributed to the occurrence of diseases and their sequelae in the Afghan context.
To answer these questions, I applied to the MEXT Japanese government scholarship through a competitive process, got the scholarship, and enrolled at the University of Tokyo in 2005 to study medical sciences, health policy, and global health. After receiving my Ph.D. in 2010 and completing my three year position of research in Japan, I joined the Global Polio Eradication Initiative (GPEI) in 2013 as an epidemiologist in the office of the "Ministry for Advising the President on Health and Education Affairs and President's Focal Point for Polio Eradication" based in the Presidential Office in Kabul city, Afghanistan. After a few years, the task of polio eradication was shifted to the "Senior Advisor to President in Political Affairs", who became the new President Focal Point for Polio Eradication and I started work with him in the same position. The main terms of reference of the President Focal Point Office for Polio Eradication were 1) to seek support of the President of Islamic Republic of Afghanistan, other relevant ministries, governmental bodies, and provincial governors to the polio program and 2) to oversee polio eradication initiatives in the country. For these purposes, the office was updating the president from the polio context regularly; organizing agenda for National Polio Steering Committee chaired by the president; organizing ministerial meetings, the Afghanistan High Council for Polio Eradication; contacting ministries and provincial governor offices to support polio; and actively engaging in the polio and routine immunization programs by attending technical and higher level meetings inside and outside the country, conduction of field visits, analyzing program data, and leading task teams for evaluation of new interventions.
Based on my experiences in a complex war torn Afghanistan, it is safe to say that the GPEI has made remarkable progress toward polio eradication. Specifically, by eradicating Type-2 and Type-3 wild polioviruses (WPV); and reducing the number of reported WPV cases through polio vaccine from over 350,000 to 140 recorded cases (Afghanistan 56, Pakistan 84) in 2020 and to 2 cases (Afghanistan 1, Pakistan 1) in 2021 (as of October 20, 2021). The onset of each WPV case from Afghanistan and Pakistan was in January 2021, since then there have been no cases, which is also an indication of significant progress of the program in the two polio endemic countries. The world needs to stop wild poliovirus circulation in the two polio endemic countries and vaccine derived poliovirus transmission -- circulating Vaccine Derived Poliovirus (cVDPV) cases -- in both endemic and non-endemic countries. Non-occurrence of WPV cases in the past 9 months is promising news to the entire world to stay committed and fight the disease until its eradication.
In Afghanistan, house-to-house polio campaigns had been halted for over three years, resulting in non-vaccination of hundreds of thousands of under-five year old children in areas under the influence of Taliban, the single major issue for global polio eradication in the world. After the collapse of the previous Afghan Government to the Taliban, the Islamic Emirate of Afghanistan in August 2021 created a humanitarian crisis in the country. However, this has also produced a golden opportunity for GPEI to launch house-to-house polio campaigns in the entire Afghanistan everywhere. Access to children for vaccination is no longer a significant challenge for polio eradication under the current Taliban administration. I recommend launching two Inactivated Polio Vaccine (IPV) massive campaigns in the two endemic countries -- at least in their high and/or medium risk areas -- together with technically sound and culturally accepted social interventions and strengthening of routine immunization programs. This would expedite the eradication of polio from the world.
Polio eradication is closer than ever: stay committed.
