Afghanistan Almost Beaten by Polio. Now the Future Is Not Clear

For more on for a week, worldwide attention in Afghanistan focused on the surprise of the Taliban’s rapid return to power, and the international airlift that released diplomats, Western workers, and refugees. But a small cohort of disease experts are surrounded by political change for another reason: They worry it could damage the long -running campaign to eradicate polio, which depends on the country – and where, after years of frustration, success is now imminent.

Since 1988, a dogged and costly international campaign has been chasing polio from much of the world. Afghanistan is only one of two countries where the circulation of wild poliovirus has never been disrupted; Pakistan, which in it shares a long border, is another. The case count is wasted and declining due to religious and political factions blocking the delivery of vaccines to children, and they also rose last year, to 140 cases in both countries, after the forcing of the Covid pandemic three -month suspension in the vaccination campaign.

But today’s numbers can’t be good: There’s only one case of polio in every country this year-they were the same as in January-and many fewer viruses have been found in feces, an important precautionary measure, than in previous years. This is a vulnerable moment in the face of a comprehensive change of government, and the health officials who have led the campaign so far are just as reluctant.

“We are in an incredible epidemiological window right now, in both Afghanistan and Pakistan,” said Hamid Jafari, a physician and director of polio eradication for the Eastern Mediterranean Region at the World Health Organization, from in North Africa to the Middle East to Pakistan. “We’ve seen much lower levels of wild poliovirus transmission in both countries-so low that it’s never been done before. This creates a huge opportunity for the program to take on this small viral burden. and stop it. “

To be clear, the polio campaign in Afghanistan has not stopped, and there is no indication that the Taliban leadership in Afghanistan needs it. Last week, the Global Polio Eradication Initiative, the formal name for the campaign, released a statement that it has now “examined the immediate implications of polio eradication efforts and the delivery of other essential health services, to ensure the continuation of surveillance and immunization activities while prioritizing safety and security in staff and frontline health workers. “

As the case counts, the Afghanistan Taliban’s attitude towards extermination activities is once again taking over and flowing. In its first power in the 1990s, the Taliban allowed the campaign (a coalition of WHO, the Centers for Disease Control and Prevention, the Gates Foundation and Rotary International) to begin operating in Afghanistan. But in 2018, it forced the closure of areas it controlled, banned groups of vaccinators from house -to -house in neighborhoods, and subsequently allowed vaccination in public buildings such as mosques.

Those bans, along with the same halt in Pakistan as political parties seek for power, are responsible for spikes in polio cases: out of a total of 33 cases in the two countries 2018 to 117 in 2019. Disruptions that last a long time can be critical plagues, as it takes several rounds of three to three oral vaccines to immunize a child. (Even in the U.S. and western Europe, which use a viable punch formula, three rounds are needed to strengthen resistance, and a fourth school-age booster to lock it in.)

“We estimate that about 3 million children will never have access to services between 2018 and 2020,” said John Vertefeuille, a physician and chief of the CDC’s polio eradication branch. Those children – some are vaccinated and others are born after the ban begins – are more susceptible to the virus and the floppy paralysis it causes, and can increase the amount of virus that is around because the children are infected and brought by others. .

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