Editor in Chief: Moh. Reza Huwaida Friday, November 24th, 2017

Obstacles before Polio Campaign

Afghanistan is one of the three countries, alongside Pakistan and Nigeria, in the world where polio remains endemic. The number of reported cases has been reduced significantly in recent years in the wake of strong campaign against poliovirus. Polio Eradication Initiative (PEI) seeks to immunize every single child in the country to minimize its risk. The decline in polio fills the air with a sense of hope and optimism, but there are obstacles which impede the campaign.
Reports show that the cases of polio in Afghanistan dropped from 80 in 2011 to 37 in 2012. The downward trend continued with 8 cases confirmed, in eastern part of the country, during January – September 2013, compared with 26 within the same period in 2012. Last year, 13 polio cases were registered, down from 20 the year before and 28 in 2014. In 2015, in which polio reduced to a great extent, 40 per cent of cases were reported from Nangarhar province.
In the current year, three cases have been reported to date from Helmand, Kandahar and Kunduz provinces. The country-wide immunization campaigns began on January 30, targeting 5.6 million children. It is hoped that 2017 will be the end of poliovirus in Afghanistan with the lowest number expected in this year. World Health Organization (WHO), along with UNICEF and the Ministry of Public Health of Afghanistan, operate actively to eradicate the crippling disease of polio, “Thousands of frontline workers visit every house in the country during campaigns. That’s not an easy task. Due to the hard work of these dedicated frontline workers, we are closer to polio eradication than ever,” polio director for UNICEF in Afghanistan Melissa Corkum quoted as saying.  
The fruition of global campaigns against polio is highly promising. The international efforts decreased the number of endemic countries from 123 in 1988 to two in 2015, when Nigeria was delisted from polio-endemic countries. However, this country returned to the list when three cases of polio were found out in August 2016 in state of Borno – where the Islamic extremist group Boko Haram is active. Hence, the global campaigns within two decades and so decreased 123 polio-endemic countries to three, which is a tremendous progress.  
The downward trend also continues in Afghanistan as fewer cases are reported annually. “We have seen significant progress in our polio eradication efforts over the past year. Most of Afghanistan is now polio-free, the circulation of the poliovirus is restricted to small areas in the eastern, southern and southeastern parts of the country and we have seen huge improvements in vaccination campaign quality,” said director of the polio program at WHO Dr. Hemant Shukla adding that “Our focus is now on reaching every single child during every vaccination campaign to stop the transmission of polio.”
Despite the notable progress, there are also challenges in this regard. It is believed that two main obstacles hamper the anti-polio campaign in the country. First, a sense of mistrust filled the air in tribal belts – where the militants hold strong sway – as a result of the militants’ negative propaganda. Parents lost their trust in health workers and showed little tendency in having their children vaccinated.
Second, the escalated insurgency in restive provinces jeopardize the life of health workers. Warring factions, mainly the self-styled Islamic State of Iraq and the Levant (ISIL) and the Taliban, spill the blood of combatants and non-combatants indiscriminately. They have constantly violated humanitarian law through slaying women, children and health workers. In other words, although medical facilities, staffs and patients during war time are given immunity by the Laws of Armed Conflict – also known as International Humanitarian Law – the militants target them on purpose. Within past years, a number of polio workers, including women, have been targeted by armed gunmen in insecure provinces.
Health workers are threatened not only by terrorist groups but also by counter insurgency war. For instance, dozens of health workers and patients were killed in October 2015 as a result of the US military air attack on the Kunduz Trauma Center. Similarly, eight polio workers were killed while performing their duty in 2014. War is a serious threat to health workers and impedes their operations in this regard.
Thanks to clerics for mitigating this problem through issuing decree in support of anti-polio campaign and endorsing polio vaccines. Last year, a National Islamic Advisory Group for Polio Eradication was founded to bridge the gap between parents and health workers which was created by the militant fighters. Consequently, almost 90 per cent of Afghans accepted how critical immunization was for their children and the improvement paved the ground for the implementation of 2016 polio-free in 99 per cent of Afghanistan’s districts. The WHO hoped that eradication in the country was a “realistic goal”.   
Constitutionally, the state is committed to “provide free preventative healthcare and treatment of diseases as well as medical facilities to all citizens in accordance with the provisions of the law.” It is believed that Afghan government will not be able to eradicate diseases, especially the polio, without international aids. No wonder, WHO and UNICEF play key role in the campaign against polio. Three decades of war has inflicted great harm on Afghanistan’ political structure and economic infrastructures. That is to say, terrorism is still a challenging issue for the National Unity Government (NUG) and it has caused severe blow to the country’s economic bases. Therefore, the country will not be able to continue this campaign without international supports.
It is the government’s responsibility to protect the life and liberty of all, especially health workers, so that the anti-polio campaign can bear the desired result. If militancy continues unabated and health workers lose their lives, Afghans will not have a polio-free country in near future.
Since polio is endemic in two neighboring countries Afghanistan and Pakistan, both the states have formed a cross border team so as to prevent from children’s life-long paralysis and end this virus for good. The two polio endemic countries are on the horizon and poised to continue the campaign. However, insurgency remains a challenging issue hindering the campaign every once in a while and the vaccinators killed in Pakistan are believed to outnumber those targeted in Afghanistan.
Now the question is that why Nigeria, Pakistan and Afghanistan remain in the list of polio epidemics out of 123 countries despite the global campaigns against polio within more than two decades? It is most likely that terrorism is the only impediment to the anti-polio campaign. To put it succinctly, Boko Haram in Nigeria and the Taliban in Pakistan and Afghanistan spread misconception and target health workers.

Clerics and health workers fulfilled their duties in the best possible way. The clergy persuaded parents to have their children vaccinated so as to safeguard them against disabilities and erased misconceptions spread by the Taliban. Health workers made great sacrifices to immunize children in any parts of the country. The only obstacle in this respect seems to be the escalated militancy. To have a polio-free Afghanistan, the state will have to provide a safe ground for health workers and make sure that every single child is vaccinated.