Afghanistan | Programme areas | Polio Eradication Initiative


Polio Eradication Initiative

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polio_childA child receives two drops of the oral polio vaccine during a National Immunization Days campaign in KandaharThe polio eradication initiative (PEI) is a global-scale public health intervention that has made significant progress by sparing millions of children from lifelong paralysis. The number of endemic countries decreased from 123 in 1988 to two in 2015 as a consequence of global efforts. Currently, Afghanistan and Pakistan are the only two remaining polio-endemic countries in the world.

Polio in Afghanistan

Most of Afghanistan is polio-free but wild poliovirus is still circulating in parts of the country, particularly in the Eastern and Southern regions. The transmission in the East illustrates the importance of common reservoir transmission between Pakistan’s Khyber Pakhtunkhwa and FATA and the area bordering Afghanistan.

As of July 2016, six polio cases have been confirmed: four from Kunar province, one from Helmand and one from Kandahar. In 2015, Afghanistan reported 20 confirmed polio cases, compared to 28 cases in 2014 and 14 cases in 2013.

Polio high-risk districts or low-performing districts (LPDs) are areas with the greatest risk of polio transmission and outbreaks in Afghanistan. The areas share unique challenges such as low vaccination coverage and immunity gaps, large migrant population, poor sanitation and insecurity. Conflict, hard-to-reach populations, harsh terrain and poor infrastructure pose major challenges to polio teams who are working relentlessly to eradicate polio.

No wild poliovirus has been detected in environmental samples through surveillance in 2016 and Afghanistan maintains a strong surveillance system for acute flaccid paralysis (AFP). An external AFP review conducted in July 2016 concluded that the circulation of wild poliovirus is unlikely to be missed in Afghanistan.

WHO’s response

WHO works closely with the Ministry of Public Health of Afghanistan, UNICEF and other key partners to make Afghanistan polio-free. During four yearly National Immunization Days (NIDs) campaigns, around 9.4 children under 5 years of age are vaccinated against polio while 3.6 million children are targeted during Sub-national Immunization Days (SNIDs) campaigns through a house-to-house vaccination approach.

Case-response polio vaccination campaigns are conducted in areas where confirmed polio cases are reported. Together with other partners, WHO also supports the vaccination of children on the move at cross-border points with Pakistan through permanent transit teams.

WHO supports a sensitive surveillance system to detect cases of acute flaccid paralysis (AFP) through a countrywide network and works to strengthen links and coordination between polio eradication and routine immunization services. WHO also supports environmental surveillance for the poliovirus in Southern, Eastern and Central regions. In addition, WHO supports the training of polio vaccinators, micro-planning, vaccination campaign monitoring and post-campaign assessments.

Emergency Operations Centres (EOCs) have been established at the national level as well as in key regional centres with the support of WHO and partners to oversee implementation of the National Polio Emergency Action Plan (NEAP) for Polio Eradication.

Currently the programme focuses on high-risk areas with district-specific plans for 47 high-risk districts. In the past year the programme stepped up polio eradication efforts by revising micro-plans, modifying the re-visit strategy to ensure more children are reached during immunization campaigns, training frontline health workers on a newly-revised curricula, improving vaccination campaign quality and intensifying interventions in areas of poor performance.

In its meeting in Kabul in July 2016, the Technical Advisory Group (TAG) on Polio Eradication noted that Afghanistan has witnessed significant progress in its polio eradication programme, as demonstrated by polio epidemiology, improvements in population immunity and the quality of supplementary immunization activities and vaccination campaigns.

WHO is grateful for the support provided by partners and donors, including Bill & Melinda Gates Foundation, the Department of Foreign Affairs, Trade and Development (DFATD) of Canada, USAID, Rotary International, KfW Development Bank and US Centres for Disease Control and Prevention (CDC).

Related Links:

Polio Eradication Initiative

2015 Annual Report of the Polio Eradication Initiative, Afghanistan

Photo story: The people at the heart of polio eradication in Afghanistan

WHO Fact Sheet on Poliomyelitis

National Emergency Action Plan for Polio Eradication July 2015 – June 2016 

Uruzgan province is one of three high-risk provinces for polio in the southern region: four districts of Uruzgan reported five cases of paralysis due to poliovirus in 2011.
WHO is  committed to creating and promoting synergies with other vaccination programmes, such as the measles programme, in order to make the best use of the network of human and financial resources.
Although insecurity remains the major challenge, there is significant improvement in term of access, particularly in Tirinkot and Chora districts where three areas were missed for more than three years.
Local access negotiators and the International Committee of the Red Cross made it possible to access areas affected by insecurity. Previously unaccessible communities were reached in all vaccinations rounds from January to September 2012.
Although progress has been made in Uruzgan, the number of drop-outs among children remains high; this calls for the strengthening of community-based models of monitoring.
Ensuring continuity of the cold chain remains essential in Uruzgan: the progress achieved is being challenged by decreased funding and gaps in the resources necessary to accelerate eradication.
The polio programme needs to make sure that all vaccinators are safe during campaigns and post-vaccination rounds in Uruzgan province and elsewhere.
The progress achieved so far is being challenged by the progressive decreases in funding and by the gap in funding necessary to accelerate the eradication process.
In Afghanistan, the funding gap of the Polio Eradication Initiative emergency action plan is estimated at US$ 2.5 million in 2012;  and is projected to be US$ 12.8 million in 2013.
WHO and its partners in polio call for security and peace in order that every child can be reached not only in Uruzgan province, but elsewhere.
The World Health Organization (WHO), in coordination with the Ministry of Public Health of Afghanistan and UNICEF have undertaken eight rounds of vaccination during campaigns in 2011, thanks to the support of AusAID.
As a consequnces of intense efforts, no child has been reported as having paralysis due to poliomyelitis in Uruzgan this year, 2012.
In Uruzgan, polio vaccinators have reached almost 200 000 children below 5 years of age in each house-to-house vaccination round. More than 1300 service providers have been trained to conduct these campaigns.
WHO believes that the involvement of provincial governors, shuras and religious leaders of Uruzgan province, along with other provinces from the southern region, is essential in assisting and monitoring vaccination activities.
From September 2012 onwards, WHO and its partners will establish district polio management teams in Trin Kot, Dehrawood and Shaeed Hassas districts, thus reinforcing district level service delivery.
Starting in September 2012, WHO will launch a permanent polio team strategy through which local people will be trained to vaccinate children in their assigned areas on a regular basis.
Both district Polio Eradication Initiative management teams and permanent polio teams will work to accelerate and reinforce vaccination outreach capacity to further protect children from this paralysing disease.
There are a few remaining obstacles to reach the eradication target in Uruzgan province but community engagement and building grass-roots’ support for poliomyelitis eradication is key.
Uruzgan province is one of three high-risk provinces for polio in the southern region: four districts of Uruzgan reported five cases of paralysis due to poliovirus in 2011.
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Key health-related statistics

Population (000s) 28 500
Health expenditure (% of general government expenditure) 7.1
Adult (15+) literacy rate (%) 31
Life expectancy at birth (2010) 61.0

Source: Country statistical profiles (2015)

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