Editor in Chief: Moh. Reza Huwaida Wednesday, March 22nd, 2023

Obstacles to anti-Polio Campaign in two Polio-Endemic States

The global anti-polio campaign has made great breakthrough and the number of afflicted countries, including 125, from the start of the campaign in 1988 reduced to two or three, which is a tremendous achievement. But terrorism and religious fundamentalism hamper the campaign in Afghanistan and Pakistan, the only two countries polio is endemic, and no case reported from Africa since last year.
The cases of polio in Afghanistan reportedly 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. In 2016, 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 eastern Afghanistan, which borders Pakistan.
In 2017, the total number of officially reported wild poliovirus type 1 (WPV1) cases in the country was 14.
But in 2020, total polio positive cases reached 56, according to Ministry of Public Health (MoPH), as the COVID-19 spread delayed polio vaccination campaign for six months and 3.4 million children were deprived of the vaccine across the country. 
The spread of coronavirus pandemic and mounting insurgency have disrupted the anti-polio campaign. It is believed that two main obstacles hamper the 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 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, staff 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. In recent years, a number of polio workers, including women, have been targeted by armed gunmen in insecure provinces. Last week, six members of health staff were killed in Nangarhar province. It came as two police officers, who were safeguarding health workers, were gunned down in Khayber Pakhthun Khah province of Pakistan six days before the Nangarhar incident. The Taliban denied responsibility for the death of polio workers in Nangarhar. There are three reasons behind the militants’ opposition to the administration of oral polio vaccine (OPV) to kids. First, the fake vaccination scheme, which was used as a cover to track the whereabouts of Osama bin Laden in 2011, triggered a sense of mistrust and hatred among the terrorist networks. Second, they deem the anti-polio campaigns a ploy by the US policy-makers rendering recipients impotent or infertile so as to reduce the Muslim population and the Taliban call it even against Islam. Third reason is vis-à-vis female workers. The militants’ attacks against female health workers might be mainly the result of their misogynistic view and their mindset denying women’s social role and discriminating them on the ground of their sex.  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. 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.” I believe that the Afghan government will not be able to eradicate diseases, especially the polio, without international aids. No wonder, World Health Organization (WHO) and UNICEF play key role in the campaign against polio. Four 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 government 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 self-explanatory that terrorism is the main obstacle to the campaign in Pakistan and Afghanistan, which remain in the list of polio epidemics out of 125 countries despite the global campaigns against polio within more than two decades.