Members of the Taliban in eastern Afghanistan in March 2020. Some are hopeful that the extremist group will allow polio campaigns to continue if it consolidates power.
JIM HUYLEBROEK/THE NEW YORK TIMES
The U.S. troop withdrawal from Afghanistan—along with the surge of the Taliban there—is imperiling the 3-decade global quest to eradicate polio. The Taliban has blocked house-to- house polio vaccination in areas under its reign for the past 3 years, putting up to 3 million children out of reach of the campaign and leaving Afghanistan one of only two countries, along with Pakistan, where the wild polio virus survives. Since the United States began to pull out troops, the Taliban has made rapid military gains and now controls much of the country. Some fear it may wrest complete control from the Afghan government—which supports the eradication campaign—after U.S. forces are gone in September.
That’s a frightening prospect to many polio watchers. But some inside and outside the Global Polio Eradication Initiative (GPEI) say a clear resolution to the conflict, regardless of who prevails, may actually aid eradication efforts. They hope the campaign will be able to work with the Taliban to keep vaccinations going. Until the conflict subsides, though, chaos is likely to interfere with vaccination drives.
The U.S. withdrawal comes at a time when the program is making strides against the wild virus after several years of setbacks. Cases in Afghanistan almost tripled to 56 between 2018 and 2020, and the country also saw explosive outbreaks of polio virus derived from the live vaccine, which paralyzed more than 300 children in 2020. Roughly 85% of all cases occur in areas inaccessible because of Taliban control, says Aidan O’Leary, who in January took over as head of GPEI, headquartered at the World Health Organization in Geneva. The COVID-19 pandemic initially made things worse.
But so far this year, there has only been one case caused by the wild virus. That may be partly due to reduced population movement during the pandemic and more hand washing, says GPEI’s Hamid Jafari, who directs eradication efforts in the region. Even so, “The trend is very real.”
Afghanistan’s fate is closely tied to that of Pakistan, with which it shares a porous, 2670-kilometer border. That country has also reported just one wild virus case in this year, after a similar upsurge from 12 in 2018 to 84 last year. (The spike there was largely because of vaccine refusals driven by rumors and a virulent disinformation campaign, along with a sometimes-inefficient eradication program.)
Some optimism about Afghanistan stems from the belief that the Taliban is not opposed to polio vaccination per se—in fact, it has collaborated with the program in the past. “It was purely for security reasons in specific areas where it imposed the ban,” Jafari says. The insurgents accused polio vaccinators of passing along information to help the United States target airstrikes that killed Taliban leadership. “Whether right or wrong, if that is the perception, that is reality,” O’Leary says. “You have to admit, the airstrikes have been brutal” for the Taliban and civilians, adds Stephen Morrison, senior vice president and director of the global health policy center at the Center for Strategic and International Studies in Washington, D.C.
The hope is that if the Taliban continues to consolidate power, its suspicions may ease and GPEI may be able to operate unimpeded. Following years of negotiations, the Taliban recently gave GPEI the green light to conduct vaccination in mosques in the provinces where it has imposed the house-to-house ban. The program is awaiting “a more formal statement” to proceed this month, O’Leary says—if the security situation allows. The Taliban will select people it trusts to be trained as vaccinators by GPEI, Jafari says. Mosque campaigns are usually not as effective as going house to house, O’Leary says, reaching perhaps 40% to 50% of the target population, “but we can hope to build on that.”
Given this opening, Jafari thinks it unlikely the Taliban will issue new bans on polio vaccination. “We are on a very different trajectory in negotiations with them,” he says. Others decline to speculate. “The Taliban’s endgame remains to be determined. There are more dire and more benevolent views,” O’Leary says. And Morrison cautions that “U.S. aerial campaigns won’t necessarily end with the withdrawal.”
Although fighting between the Taliban and the government is a major obstacle, “the program is not at a standstill,” Jafari says. But it has had to cease activities where there is active fighting, says Godwin Mindra, UNICEF’s polio team lead in Kabul. And districts that are accessible today might not be tomorrow, Mindra adds. A nationwide polio vaccination campaign is scheduled for September—if it can be conducted safely—with smaller campaigns scheduled for November and December. “We will look very carefully at how the situation is evolving,” O’Leary says.
The worst-case scenario is a descent into full civil war, with escalating violence, large numbers of refugees, and a broader public health crisis. Even then, GPEI leaders point out that the program has lots of experience operating during conflict, in Syria and many other countries.
GPEI’s new strategic plan for 2022–26 aims to interrupt all polio transmission in Afghanistan and Pakistan by the end of 2023. “If we can continue to vaccinate through this year, we can make good progress” toward that goal, Jafari says. But success also depends on stopping the virus in Pakistan, as the virus has often jumped back into Afghanistan just as the country was making gains. Although the polio program is “very resilient, very innovative,” Morrison thinks the 2023 time frame may be “a bit delusional.” For now, O’Leary says, “We are hostage to events on the security side.”
Source: Science Mag