Strategy to eradicate polio in Afghanistan
Context
Persistent wild poliovirus transmission is restricted to a dozen or so security-compromised districts in the provinces of Helmand, Kandahar and Uruzgan in Southern Region.
In 2009, a range of new approaches to improve access to children in southern Afghanistan were piloted. Nongovernmental agencies were contracted and local leaders and negotiators were involved to ensure that parties in conflict were approached, a safe passage for vaccinators was assured, and children were reached. These activities helped to reduce the proportion of inaccessible children in Southern Region to less than 5% by July 2009. However, in the 13 persistent transmission districts of the Southern Region, the proportion of '0-dose' children was 20% at end-2009, compared with 5% in other districts of the Region, highlighting the need for district-specific plans to address the particular access challenges in these areas.
In January 2010, the first District Planning Workshop was conducted with district teams from the persistent transmission districts.
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 requires the following activities.
a. Scaling-up the new tactics piloted in 2009 such as:
- enhanced collaboration with NGOs
- revision of all microplans (including communities covered, team workloads, transport, etc.)
- prioritization of key village 'clusters' in each district
- local advocacy plans to enhance access
- key communications and social mobilization activities
- systematic use of the SIAD strategy to exploit fully any windows of opportunity that were created by improvements in access.
b. Upgrading and updating the skills of provincial- and district-level staff in micro-planning, and establishing infrastructure sufficient support to implement the district-specific planning process.
c. Improving coordination with neighbouring Pakistan – in particular for tracking and mapping population movements, and supplementing vaccination posts at key gathering sites and border crossings.
d. Implementing national and subnational polio immunization days to maintain the high levels of population immunity needed to reduce the risk of outbreaks following importations. Bivalent oral polio vaccine is anticipated to be used extensively in these supplementary immunization activities.
Eradication targets
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End–2010: <10% missed children during at least two supplementary immunization activities in the 13 conflict-affected districts with persistent transmission in the Southern Region.
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End–2011: <10% missed children during at least 80% of supplementary immunization activities in the 13 conflict-affected districts with persistent transmission in the Southern Region.
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End–2012: >90% of children with >3 doses of oral polio vaccine in all provinces.