Polio Eradication Initiative

(data as of 31 December 2018)

Situation update

Transmission of wild poliovirus in 2018 is restricted to the Southern and Eastern regions in Afghanistan. 21 polio cases were reported in 2018 from six of Afghanistan’s 34 provinces. Of these cases, 15 are from the Southern region, including nine from Kandahar province with spillover transmission from Helmand and Uruzgan. The Southern region is facing major issues related to inaccessibility. More than 840,000 children have missed vaccination opportunities since May 2018, which makes responding to detected polio transmission difficult. Inaccessibility coupled with vaccination refusal in some communities, particularly in and around Kandahar, makes polio eradication challenging. The six cases in the Eastern region are part of northern corridor transmission zone, which extends from Nangarhar, Kunar and Nuristan in Afghanistan to KP/FATA in Pakistan.

The programme continues to implement the National Emergency Action Plan (NEAP) for Polio Eradication, and has developed a framework of change to address the remaining challenges in the Southern and Eastern regions and achieve interruption of transmission. The country has maintained strong poliovirus surveillance and, in most districts, children’s immunity to the virus has significantly increased.

The Technical Advisory Group (TAG) reviewed progress towards polio eradication in May 2018 and noted three critical roadblocks to stopping transmission of the virus: children missed due to inaccessibility, refusals, and gaps in campaign quality in areas with security challenges. The TAG noted that if accessibility can be improved in a sustained way, the programme is on the right track to stopping transmission.

Achievements

Three National Immunization Days (NID) and seven Sub-National Immunization Days (SNID) were conducted in 2018, targeting around 10 and 6 million children respectively. For every new case, the programme conducted three case response campaigns in areas surrounding where the case was detected.
As of end October 2018, a total of 11,480,437 children under five years of age were vaccinated by Polio Transit Teams (PTT), with a monthly average of 1,148,044 children. During the same period, 862,415 children were vaccinated by Cross-Border Teams, most of which were at the Friendship Gate and Torkham borders between the Southern and Eastern regions of Afghanistan with Pakistan. In addition, UNHCR repatriation centres vaccinated 17,982 children and IOM vaccinated 191,427 children.
In accessible areas, campaign qualities have improved. The percentage of lots that passed by Lot Quality Assessments improved from 87.5% in the October 2017 NID to 96% in the August 2018 NID.
In response to increases in polio cases and positive environmental samples in 2018, the Emergency Operations Centre (EOC) developed a supplement to the NEAP called the Framework for Change. The Framework is a midterm correction to the plans outlined in the 2018 NEAP and will drive the creation of the 2019 NEAP.
For inaccessible areas in the Southern region, a contingency plan is being implemented which includes doing site-to-site vaccination, IPV-OPV vaccination, placing permanent transit teams at all exit points and including OPV in the pre-planned measles campaign.
For addressing refusals in the Southern and Eastern regions, a refusal oversight committee and refusal resolution committee have been formed to implement cluster-specific approaches to address refusals, along with other measure such as engaging local influencers, religious scholars, medical professionals and the Islamic Advisory Group (IAG).
Cross-border coordination with Pakistan on the Northern and Southern corridors continues to be strengthened.

Programme risks and challenges

The continued ban on house-to-house campaigns in large parts of the Southern region.
In the Eastern region, small pockets of inaccessible children and high population mobility between Afghanistan and Pakistan.
Pockets of refusal, particularly in and around Kandahar as well as in the Eastern region.
Sub-optimal campaign quality in some key areas under control of AGE, due to management issues.
Low EPI coverage in areas that are at high risk of polio transmission.

Way forward

The way forward to eradicate polio in Afghanistan includes:

Maintaining programme neutrality, and gaining and maintaining access for vaccination.
Implementing thematic changes set out in the Framework for Change. Addressing refusals, improving campaign quality and focusing on missed children.