As the final frontier of the poliovirus in 2015 draws closer, the Technical Advisory Group for Afghanistan met to assess and strengthen progress.
In 2015, Afghanistan and Pakistan are the only countries in the world where children have been paralyzed by wild poliovirus, with four cases of wild poliovirus type 1 (WPV1) reported in Afghanistan in 2015 since the beginning of the year. The Technical Advisory Group (TAG) met in June to assess the programme’s efforts to end the persistent low-level transmission of polio in Afghanistan, and identified that further strengthening the government leadership, reaching missed children, coordinating with Pakistan to vaccinate children that frequently crosses borders for various reasons improving surveillance, and improving the quality of vaccination campaigns are crucial for finally closing the door on polio.
With the ‘high season’ for polio transmission now underway, well-coordinated and well-executed plans will determine whether the programme will be successful in 2015. The TAG noted the strengthened commitment of the new government of Afghanistan to stop transmission of polio in 2015, following a long period of political transition that had affected programme oversight, as a positive determinant of this success. The Government is finalizing an emergency action plan to intensify the eradication activities. September will see the start of a major push against the virus, and the actions taken in the coming months must be utilised to fully prepare for this.
Focus on the missed child
While inaccessibility and insecurity continue to make reaching all children with vaccines a challenge, the TAG warned that the programme was still not strong enough to reach children even where it should. Despite constant efforts to obtain and sustain access to children, May 2015 saw 500,000 children under the age of five remain unvaccinated. Around 75 % of these live in areas that vaccinators should be able to reach, yet 120,000 children are being missed as they live in areas with varying degrees of inaccessibility. Where accessible children are being missed, the major causes are unavailable children, insufficiently detailed micro-plans or inadequate supportive supervision and monitoring systems. Community health workers play an increasingly important role in social mobilization activities, going door-to-door to interact with caregivers on repeat visits if there is an initial refusal. Where children are being missed due to weak micro-plans, innovative tools such as the Geographic Information System (GIS) are helping to map areas such as Nahrisaraj in Helmand province. Four villages were identified that had not previously been included. This provides an example of the level of microscopic detail that will be required of the programme going forward to reach its ultimate goal of polio eradication.
One with Pakistan
The TAG emphasised that Pakistan and Afghanistan being treated as a single epidemiological block has become more urgent than ever. They recognised that the programme has managed to keep most of Afghanistan polio-free, with recent cases restricted to the Southern Region and Farah, which has been a major achievement in light of the high level of transmission in Pakistan in 2014. Cross-border coordination was deemed to be more important now than ever, and it was emphasised that tracking moving populations and ensuring that information is gathered on their final destinations was essential for strong planning.
Campaign quality
"The 2015 campaigns must be the best prepared and highest quality in Afghanistan's history."
The TAG found that campaign quality to increase immunity against polio had not improved sufficiently in the South and the East, leaving these areas at risk. Speeding up the rate at which campaigns improve is essential if 2015 is to be the last year with polio threatening the children of Afghanistan. To ensure more children than ever before are reached with the polio vaccine, the 2015 campaigns must be the best-prepared and highest-quality in Afghanistan’s history.
If all elements of the polio programme are accountable for reaching and immunizing every last child in polio vaccination campaigns, Afghanistan can reach the finish line for polio eradication in 2015. Crucially, this means strong government ownership, partner support and the financial and political support of the global community to well-equipped Afghan teams to vaccinate every child, everywhere, every time. With all of these aspects in place, 2015 could see dramatic progress against polio in Afghanistan.