Afghanistan

Status: endemic

Financial resource requirements (2013-2015) for Afghanistan.

Most of Afghanistan is polio-free. Persistent wild poliovirus transmission is largely restricted to 13 districts in the provinces of Helmand, Kandahar and Uruzgan in the south of the country, where accessing children is difficult due to insecurity and conflict. In addition, Afghanistan and neighboring Pakistan repeatedly re-infect one other, with Afghanistan appearing to receive a higher share of the poliovirus importations. 

Polio this week in Afghanistan:

Technical Advisory Group

Meeting Reports

Related links

Strategy to eradicate polio in Afghanistan

Context

The Southern Region of Afghanistan and Farah province in the Western Region remain polio-endemic: in 2011, 85% of polio cases occurred in these areas. The other cases were reported in nine previously polio-free provinces, the result of importations from this endemic zone and from neighbouring Pakistan.

In the endemic zone, the immunization status of children was worse in 2011 than in 2008, uncovering a steady decline in the quality of Supplementary Immunization Activities. The 28 worst-performing districts have been identified in Hilmand, Kandahar and Uruzgan provinces in Southern Region and Farah province in Western Region.

In addition to problems accessing children in insecure areas, serious flaws in the management and accountability of the polio eradication programme persisted in 2011. Poor access and management were compounded by a failure to sufficiently communicate to parents and communities the importance of polio eradication.

Communication in Action: overview of community engagement

Strategic approach in Asia

In Asia, persistent poliovirus transmission is highly localized in a few districts. The approach in Asia therefore focuses on district- and sub-district-specific plans to achieve exceptionally high coverage with very frequent supplementary immunization activities to boost population immunity to >95% – the threshold required to stop transmission in Asia.

Engaging local political and administrative leaders to ensure the quality of supplementary immunization activities is also important.

Strategic approach in Afghanistan

Interrupting the remaining poliovirus transmission in Afghanistan has been declared an emergency by the World Health Assembly. In response, the National Polio Emergency Action Plan has been developed which recommends the following emergency approach.

1. Resources focus on 28 worst-performing districts of endemic zone
2. Engagement with local-level access negotiators and humanitarian organizations active in conflict areas
3. New ‘permanent polio teams’: vaccination teams in place in worst-performing, security-compromised districts, able to circulate on a rolling basis to deliver additional OPV doses in between large-scale SIAs
4. Scaling up Short Interval Additional Dose approach to more rapidly boost population immunity among populations living in hard-to-reach areas
5. Strengthened capacity in worst-performing districts, through additional technical support and full-time district polio managers
6. Strengthened accountability, through assessment and monitoring through provincial polio teams
7. Refined post-SIA monitoring to obtain clearer picture of programmatic performance and enable corrective measures
8. Sensitised micro-planning, and increased recruitment of local personnel for vaccination teams and supervision
9. Assessment of community perceptions and targeted and scaled-up social mobilization efforts

Eradication targets

• Coverage of >90% in high risk districts (HRDs) in at least 4 of the SIAs in a year

• <5% inaccessible children in each high risk district
• Awareness levels increased from 50% to 90% at the national level
• Zero Dose AFP cases reduced by 50%4 
• Among all the unvaccinated children, <10% missed due to “no team visit”
• Reduction in total missed children and refusals by at least 50% in the country with special focus on 28 High Risk Districts.