Fighting a stubborn poliovirus

Despite efforts to eliminate polio in Afghanistan since 1980, the disease is still prevalent: At least 10 children have caught the virus in the past six months, according to health officials.

Immunization coverage has increased in the past seven years from 32 percent in 2001 to over 80 percent in 2007, according to UN World Health Organization (WHO) statistics, and no polio case was reported in northern and central parts of the country in 2008, prompting the Health Ministry and WHO to say the poliovirus had been restricted to only a few conflict-affected provinces in the south and southeast.

However, there has been a recent confirmed case in the northern province of Kapisa, and nine other cases have been reported in the southern provinces of Kandahar and Helmand, and in Nooristan (in the east).

In 2008 WHO reported 31 polio cases in Afghanistan.

The immunization of over seven million under-five children requires about US$18 million a year, most of which comes from international donors.

Access problematical

Access to children in insecure areas has long been a major obstacle for polio immunization drives. Health workers have often been attacked, harassed and kidnapped by insurgents or criminals, according to media reports.

Only 13 percent of children in the southern provinces routinely received oral poliovirus vaccine compared to 47 percent in the southeast, 66 percent in the east and 69 percent in central areas, according to a WHO weekly epidemiological record in March 2009.

About 200,000 children miss out on polio drops every time the vaccinators conduct a nationwide immunization drive, it said.

“Three things impede polio immunization in Helmand Province: First the insecurity, second a lack of public awareness, and very low payments to vaccinators,” said Jan Agha, a local health worker.

“The Taliban often oppose vaccinations. They threaten and beat vaccinators and break their vaccination kits… so people don’t want to risk their lives for 150 Afghanis [US$3] a day,” said a vaccinator in Kandahar Province who declined to be named.

Also, the return of Afghan refugees from Pakistan and unregulated cross border movements between the two countries have contributed to the movement of the poliovirus, health officials say.

Ambitious goal

Poliovirus is endemic in four countries in the world: Afghanistan, Pakistan, India and Nigeria.

But the Afghan government has an ambitious goal: “We aim to eradicate polio by the end of 2010,” Aqa Gul Dost, head of the Health Ministry’s immunization department, told IRIN.

“Technically it’s very possible to finish the job in this period if vaccinators have access to every child for 5-6 rounds of immunization,” said Tahir Pervaiz Mir, WHO’s polio medical officer in Kabul.

“We call on all warring parties to allow access to children and also call on parents to immunize their children,” said Dost.