Afghanistan almost defeated polio. Now the future is uncertain.

For more than Over the course of a week, the global focus on Afghanistan has been on the Taliban’s spectacular return to power, and the international plane that is expelling diplomats, Western workers and refugees. But a small group of pathologists has been affected by the political change for another reason: they fear it could hurt the long-running polio eradication campaign, which depends on the country – and where. After years of frustration, success now seems imminent.

Since 1988, a large and expensive international campaign has pursued polio from most parts of the world. Afghanistan is one of only two countries where the polio virus has never stopped circulating. Pakistan, with which it has a long border, is second. The number of cases has risen and risen as religious and political factions have blocked the delivery of vaccines to children, and they have risen again in the past year, with 140 cases in both countries, followed by the vaccination campaign after the epidemic. I was forced to take a three-month break.

But right now the numbers are impossibly good: only one case of polio has been reported in each country this year – both in January – and fewer viruses found in sewers, an important surveillance technique, than in previous years. ۔ This is a critical moment in which a comprehensive change of government is taking place, and the health officials who have brought this campaign to this point are collectively holding their breath.

“We are currently in the window of an incredible epidemic in both Afghanistan and Pakistan,” said Hamid Jaffery, the World Health Organization’s director of polio eradication in the Eastern Mediterranean. “We are seeing very low levels of wild polio virus transmission in both countries – so low that it is unprecedented. This creates a tremendous opportunity for the program to carry this low viral load and prevent it.”

Clearly, the polio campaign in Afghanistan is not over, and there is no indication that the Afghan Taliban leadership will need it. Last week, the Global Polio Eradication Initiative, the campaign’s official name, issued a statement stating that it was “currently reviewing polio eradication efforts and the immediate impediments to the delivery of other essential health services, so that surveillance and protection Ensure continuity of immunization activities. Prioritize the safety and security of staff and frontline health workers.

As the case progresses, attitudes towards the Afghan Taliban’s elimination activities have weakened and faded. In his first term in power in the 1990s, the Taliban allowed the campaign (WHO Alliance, Centers for Disease Control and Prevention, Gates Foundation and Rotary International) to operate in Afghanistan. But in 2018, it was forced to stay in areas under its control, banning teams of vaccinators from going door-to-door in neighborhoods, and then not allowing large-scale vaccinations in public buildings such as mosques.

Along with these restrictions, political parties in Pakistan joked for power in similar intervals, responsible for the increase in the number of polio cases: from a total of 33 cases in 2018 in both countries to 117 in 2019. Critical blow, because it takes several rounds of oral vaccine drops to immunize a child. (Even in the United States and Western Europe, which use an injection formula, it takes three cycles to consolidate the immunity, and a fourth school age booster to discontinue it.)

“We estimate that approximately 3.3 million children did not have access to services between 2018 and 2020,” said John Verti Fuel, head of the CDC’s Polio Eradication Branch. This left these children – some were partially vaccinated and others born after the ban – suffered from viruses and floppy paralysis, and increased the amount of virus in the environment when children Were affected and passed it on to others. .

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