WHO News

For Afghan polio eradication the show goes on

Just a few days before the US and the UK launched on 7 October the first attacks against targets inside Afghanistan, teams of health workers and volunteers went ahead with a planned drive to immunize all of the estimated 36 million children under five in Afghanistan and Pakistan against poliomyelitis.

Between 23 and 27 September, about five million children in Afghanistan and 30 million in Pakistan were given polio vaccine, despite massive population movements caused by the political situation. The campaign was organized by the Taliban health ministry with assistance from WHO and UNICEF, and with the cooperation of the opposition Northern Alliance. The two countries together form a single reservoir for wild poliovirus, which circulates across the border between them. They are two of the remaining ten countries in the world that are priority targets of the global initiative to eradicate polio by 2005.

"The timing of these polio immunizations was critical, as both countries are on the verge of eradicating this dreaded disease," said Dr Hussein Gezairy, director of WHO's Eastern Mediterranean regional office. It was also critical to conduct at least the first round of immunizations before the onset of winter. A second round is planned for 6–8 November.

Dr Naveed Sadozai, WHO's polio team leader for Afghanistan, told the Bulletin that teams of health workers on the Afghanistan–Pakistan border had been strengthened to cope with the huge numbers of people trying to leave Afghanistan. Speaking from Islamabad in Pakistan, he said: "We have had our cross-border teams in place for seven days this time, instead of the usual three, and they have been immunizing every incoming and outgoing child."

National Immunization Days, as the mass polio vaccination campaigns are called, organized by the global polio eradication initiative, have since 1988 led to a dramatic reduction in the numbers of polio cases in these countries. To date in 2001, only 8 cases have been detected in Afghanistan, all in and around Kandahar province, vs 120 cases recorded last year from throughout the country. Pakistan has reported 42 cases to date in 2001 — a two-thirds reduction from last year, with the greatest number in the North-West Frontier province bordering Afghanistan.

Full immunization coverage data are not yet in, but Sadozai said he did not expect coverage to have been as good as it would have been had the situation been normal. "Afghanistan has made tremendous strides to eradicate polio so we were clear that we were not going to give up."

Even at normal times, the Afghan population is very mobile, Sadozai said. Between 5% and 10% of its people are nomadic and it is usual for whole families to move to a different part of the country to celebrate a wedding or visit a relative. To cope with these habits, health workers not only visit homes but also form "floating teams" to "catch" children in markets, at entrances and exits to and from cities, and at places such as bus stations.

Initial figures from the September immunization drive are encouraging, Sadozai said. In Kabul, 80% of the expected number of children had been immunized, but in surrounding rural districts more than the expected number of children were reached, reflecting the population movements out of the capital. "When we receive the results from the provinces bordering Pakistan we will have a better picture," Sadozai added.

All UN international staff had been evacuated from the country before the vaccination campaign, so the polio team was made up solely of national staff, with international staff trying to orchestrate the effort from Pakistan. Polio initiative coordinator Dr Bruce Aylward said national staff had not been evacuated because they have their lives — homes, families, friends — in the country. WHO will continue to support them and has taken measures, he said, to try and ensure their safety.

One reassuring factor was the successful outcome of negotiations between the UN agencies, the Taliban and the Northern Alliance. Sadozai said so-called "days of tranquillity" negotiated in the past for polio vaccination campaigns had been "more or less respected by every faction", enabling health workers to gain access to all children in the area.

Sharon Kingman, London, UK