The Box-Lobby Challenge

National Emergency Operation Center (NEOC) is the center for polio eradication program in Afghanistan.

Afghanistan remains one of the two polio endemic countries in the world. Since establishment of National and regional emergency operation centers (EOCs) in 2015, the program has scaled up its efforts to stop wild poliovirus circulation. National emergency action plan 2021 is being implemented aiming to stop ongoing polio transmission and will serve as a key guiding document for whole polio eradication program.

Afghanistan’s Polio eradication program since 2018 has been challenged with consistent inaccessibility in major areas of Southern region and the access situation has worsened since 2019 extending to all the children in the country hindered by reasons beyond the program’s control. The ban on house-to-house vaccination imposed since May 2018 became more stringent in April 2019 with its imposition everywhere. This led to the suspension of campaigns from April to July 2019. Polio transmission is chiefly in areas that are mostly access compromised either for national, provincial teams to have regular oversight from program implementation, ban on house-to-house implementation of SIAs or inability of vaccination teams to reach children in security-compromised areas.

The number of polio cases and infected districts has been on the increase from 2017 to 2020. The number of infected districts based on polio cases reporting increased from 4 in 2016 to 9 in 2017, 14 in 2018, 20 in 2019, and 38 in 2020. Similarly, the number of cases also increased from 13 in 2016 to 14 in 2017, 21 in 2018, 29 in 2019 and 56 in 2020. Regarding environmental samples, after a steady rise in the positive samples from 2016 to 2018 (41 in 2016, 42 in 2017 and 83 in 2018), the number of positive environmental isolates has shown a further decrease: 56 in 2019 and 35 in 2020.

In 2020, the majority of polio cases (42/56; 75%) were reported from inaccessible areas. Forty five percent of the cases from inaccessible areas had been reported from areas in the Southern region where house to house vaccination was banned since May 2018.  As a result of the cVDPV2 outbreak, which was a total of 308 cases were reported in 2020.

In 2020 due to COVID-19 pandemic: all polio supplementary immunization activities (SIA) were halted following Polio Oversight Board (POB) decision in late February 2020. The steep increase in the number of WPV1 cases and the outbreak of cVDPV2 cases was due to the dual impact of (i) COVID-19 which led to halting of polio supplementary immunization activities (SIA) and complementary vaccination activities (CVA) for a period of five months (Mar-Jun) and (ii) ban on house-to-house vaccination campaign. As a result of the COVID-19 pandemic, the Routine Immunization (RI) outreach services were also affected (>20%).

In 2021 (as on 31^st July 2021), only one polio case has been reported from Andar district of Ghazni province in Southeast region and one positive environmental isolate detected in Lashkargah district of Helmand province. Both these wild polioviruses are genetically linked with environmental wild poliovirus isolate across the border in Quetta district of Baluchistan province of Pakistan.

Despite COVID-19 challenges, campaigns restarted in July 2020 to respond to WPV1 and cVDPV2 outbreaks and owing to good quality polio SIA campaigns in all accessible areas of the country the WPV1 transmission is restricted to lowest levels and all importations to polio free areas have been stopped.

In 2021 (as on 31^st July), the PEI program has reported 42 cVDPV2 cases from inaccessible areas. Following case response campaign with type 2 containing vaccine, the cVDPV2 outbreak has been rapidly controlled and stopped in all accessible areas.