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Polio Eradication Initiative

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PEINational Immunization Day, Afghanistan, Kids showing their fingers marked with indelible ink after they were vaccinated against polio.Afghanistan is one of three remaining polio-endemic countries. Circulation of poliovirus, though localized, continues. Although most cases (85%) are reported from the recognized transmission zone of the southern region and its neighbouring Farah province of the western region, the remaining cases (13 cases) were reported from nine provinces of different regions of the country. Most of these had not reported a case for more than 5 years. As on 8 July 2012, a total of 11 confirmed polio cases had been reported.

Continued circulation and the explosive outbreak in 2011 are symptomatic of a serious decline in the quality of campaigns and routine immunization coverage, particularly in the southern Region. This situation can result in serious public health consequences.

The continuation of circulation carries high risk of geographic expansion to neighbouring provinces/areas; the detection of polio virus in the newly-infected provinces may lead to re-establishment of circulation causing infection and paralysis among a number of children. There is also risk of potential spread to neighbouring countries, particularly towards Central Asia.

Poliovirus eradication: a programmatic emergency for global public health

The 130th session of the WHO's Executive Board in January 2012 adopted resolution EB130.R10, declaring the completion of poliovirus eradication a "programmatic emergency for global public health". The Sixty-fifth session of the World Health Assembly, held in May 2012, also endorsed the resolution of the Executive Board. The resolution urges countries with poliovirus transmission to consider such transmission as national public health emergencies.

Almost 55 000 service providers, including coordinators, supervisors, monitors, community mobilizers and volunteers are involved in each national immunization day (NID). Almost 8 million children under-5 years are targeted to vaccinate against polio through a house-to-house approach in each round of NID, while 3 million children are vaccinated in subnational NIDs (subNIDs). This network is also used to administer vitamin A and de-worming tablets to almost 6.8 and 4.7 million children, respectively.

WHO also provides assistance to maintain a sensitive surveillance system to detect cases of acute flaccid paralysis through a countrywide network of international and national polio officers. There are 483 focal points and over 10 000 community-based reporting volunteers all over the country.

Polio eradication efforts

Afghanistan readjusted the country-specific milestones to gear up efforts with a more aggressive approach to interrupt the transmission. A country team, in consultation with partners, prepared a national emergency action plan to stop poliovirus transmission with a more focus and measureable approach. The plan focuses on management and accountability, improving access and quality in security-affected areas in teh southern region, structural reforms in service delivery, increasing awareness and demand in the community. The plan also aims at engaging the Office of H.E the President and governors to oversee the efforts.

Immediate large-scale case response vaccination rounds are implemented in all the newly-infected provinces and districts bordering the outbreak zone of Pakistan with intensified monitoring. New tactics such as the introduction of permanent polio teams in high-risk districts, high-risk cluster approach with communication, indirect monitoring mechanisms and using “windows of opportunity” in conflict-affected areas are being adapted.

IN 2011 four rounds of NIDs, four subNIDs, four case responses and supplementary immunization activity days in selected districts were conducted.

Related links

Eastern Mediterranean Polio Fax Issues

WHO/UNICEF estimates of immunization coverage in Afghanistan

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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Australian AID logoThe Polio Eradication Initiative is the largest global polio partnership in the world and Australian Government Cooperation is a key partner in polio eradication in Afghanistan. It has offered its unwavering support to polio eradication efforts over the years. AusAID’s contribution to the polio eradication programme in Uruzgan has ensured that polio campaigns take place every year and an improved and community-oriented approach has been adopted to accelerate polio eradication.