H.E. Minister of Health Dr Feroz delivers a speech during the meetingKabul 6 April 2017 - The Technical Advisory Group (TAG) on polio eradication convened in Kabul on 4-5 April to review Afghanistan’s progress in polio eradication and provide recommendations for further interventions and areas of focus to stop the circulation of wild poliovirus. The TAG commended the tremendous progress made in polio eradication in Afghanistan and noted several improvements achieved by the polio programme since the Group last met 9 months ago.
The first TAG meeting of 2017 brought together senior leaders from the Ministry of Public Health, the Global Polio Eradication Initiative, donor agencies and national and provincial polio teams as they presented the recent gains and achievements of the programme.
“We commend the strong political commitment at the highest level of the government for polio eradication and the strong partnership and coordination between the government and polio partners,” said TAG Chairman Jean-Marc Olive. “There has been significant progress in the implementation of the Polio National Emergency Action Plan 2016-17 which has helped the country to focus on major gaps and remaining challenges.”
Minister of Public Health H.E. Dr Ferozuddin Feroz underlined the government’s commitment to stopping the circulation of wild poliovirus and accelerating efforts to reach the finishing line for polio eradication.
Tremendous progress towards a polio-free Afghanistan
The TAG noted that Afghanistan has witnessed significant progress in its polio eradication programme as demonstrated by polio epidemiology, improvements in population immunity, strengthened surveillance system and the quality of vaccination campaigns.
Most of Afghanistan is now polio-free and the number of infected districts has reduced from 16 in 2015 to only four in 2016. Currently only three districts are infected. No wild poliovirus was detected in environmental samples for 11 months in 2016, showing a reduced virus load in country. Since December 2016, four sewage samples have tested positive for poliovirus, each with separate lineages.
The TAG noted that poliovirus transmission detected in Afghanistan in the past year illustrates the importance of population movement for poliovirus transmission in the common reservoir with Pakistan, highlighting that Afghanistan is successfully implementing strategies to identify and vaccinate high-risk mobile population groups such as nomads and returnees.
The TAG underlined that Afghanistan’s outbreak response plan is commendable, as witnessed for instance in the speed and scope of response to a recent poliovirus transmission in Kunduz province.
The expert group also recognized that Afghanistan maintains and continues to expand a sensitive surveillance system for polio, including in areas affected by conflict. Last year alone, 458 new surveillance reporting sites were introduced and the AFP reporting volunteer network expanded by 18%. Three new sewage sampling sites were added in Kandahar, Nangarhar and Khost provinces to boost environmental surveillance.
“We observe improved quality of polio campaign activities in accessible areas as well as a reduction in the proportion of children missed during campaigns, particularly in Kandahar,” said Dr Olive. “The TAG appreciates that the access situation has improved in the Eastern and Northeastern regions with the number of inaccessible children reduced from more than 300 000 in May 2016 to less than 100 000 in the March 2017 campaign.”
Despite the tremendous achievements, many challenges remain on the road to reaching a polio-free Afghanistan. There are clusters of missed children due to children being absent and caregivers refusing vaccines in the Southern region. Although the access situation has improved in the Eastern and Northeastern regions, access challenges continue to hamper vaccination efforts in the Southeastern, Eastern and Southern regions.
The recent transmission detected in Kunduz province has the potential of spreading, and the risk of continued poliovirus transmission in Bermal district of Paktika province as well as Helmand and Kandahar cannot be ruled out.
Sustaining gains in a challenging environment
In 2016, 13 polio cases were reported, down from 20 in 2015 and 28 in 2014. Three cases have been reported so far this year. In the coming months the programme will focus on further strengthening vaccination campaign quality, ensuring mobile populations are reached, and gaining access to inaccessible areas as key priorities.
The TAG urged the programme to continue identifying areas with possible immunity gaps and take preventive measures.
Technical Advisory Group meeting participants in KabulRecommendations were also made to to intensify efforts to engage more women as frontline workers across Afghanistan and to implement specific focused interventions to address clusters of refusals and children marked as ‘not available’ during vaccination campaigns.
"We need to continue and strengthen our focus on very high-risk districts, identifying every pocket of unreached children and ensuring we are reaching them consistently," said Dr Richard Peeperkorn, WHO Country Representative in Afghanistan.
“We must maintain strict neutrality of the polio programme. Every Afghan child, irrespective of where she or he lives, should have access to polio vaccines and all polio workers should be able to carry out their duties safely,” he added.
UNICEF Representative Ms Adele Khodr also highlighted the invaluable contributions and efforts of Afghanistan’s frontline polio workers: “Vaccinators and social mobilizers, in addition to community elders, religious leaders, teachers, doctors, the media and thousands of other committed stakeholders are the very heart of our eradication effort,” she said.
“We must draw confidence from the road already travelled and have patience to see the implementation of our strategies to the end. The last miles are always difficult and the challenges are enormous and they will remain so until we finish the job to eradicate polio,” said Dr Rana Safdar, Coordinator of the Emergency Operations Centre for polio eradication in Pakistan.
About the Technical Advisory Group
The Technical Advisory Group (TAG) was established to review progress towards polio eradication in specific countries, assess implementation of previous TAG recommendations, discuss planned activities and issue recommendations to address constraints facing national programmes in achieving their targets. TAG meetings are attended by country-specific TAG members, national representatives and partner organizations, both international and regional. The TAG meets twice a year in Pakistan and Afghanistan to review progress and provide expert advice on the final road to polio eradication.