Dr Najibullah Mojadidi, Presidential Focal Point for Polio Eradication. Photo: Tuuli HongistoKabul, 4 June 2018 – The Technical Advisory Group for polio eradication (TAG) met 30–31 May to assess progress made towards eradicating polio in Afghanistan so far and to make recommendations for the way forward.
In his opening remarks, Dr Najibullah Mojadidi, Presidential Focal Point for Polio Eradication said, that “polio eradication is a national priority”.
He called on the armed groups to “respect the neutrality of the programme.”
Dr Richard Peeperkorn, WHO Representative in Afghanistan, commended the achievements made. "We are now at a critical juncture. Refusal and access issues continue to be a challenge. We need to tackle these issues in a different way”.
United Nations Humanitarian Coordinator Toby Lanzer said that “We count on the goodwill of all parties to the conflict.“ Despite difficulties, he encouraged the participants. “We must not be discouraged. It is a marathon, not a sprint. Keep moving towards the finishing line – together with Pakistan.”
Adele Khodr, UNICEF Representative in Afghanistan, stated that “It is a difficult time for the programme, and the world’s eyes are on us. However, we must not be discouraged. We must join forces and act as one.”
Progress and challenges
During the meeting, the TAG received presentations from regional and national polio teams covering key activities from vaccination and surveillance to communications.
Of special concern was the district of Shahwalikot in Kandahar province, which the Humanitarian Coordinator Lanzer called “the capital of polio”: the area which has had most cases in the world in the last 2 years.
Missed children due to refusals, gaps in campaign quality and inaccessibility were raised as road blocks to stopping the virus transmission.
In their conclusions, the expert group noted that transmission of wild poliovirus had not been interrupted, which had resulted in 8 polio cases and 18 positive environmental samples in Afghanistan in 2018.
The group stated that in their opinion access problems are the biggest challenge facing the Afghanistan programme. Specifically, TAG expressed concern over recent bans on house-to-house vaccination activities in the southern region, leading to a huge upsurge in the number of inaccessible children during the May campaign, after a long period of improvement. The group warned that the restrictions could jeopardize global eradication efforts. In addition to the problems in the south, TAG was also concerned about expanding inaccessibility in the eastern region.
Dr Richard Peeperkorn, WHO Representative in Afghanistan (r) with United Nations Humanitarian Coordinator Toby Lanzer. Photo: Tuuli HongistoThe group reiterated that the strategies being implemented by the Afghanistan programme are appropriate. If accessibility would improve and can be sustained, the programme is on the right track to achieve the goal of stopping transmission. The group agreed that the reasons for continuing transmission are well understood by the programme and that clear plans are in place to address gaps.
Despite challenges, the group noted that the programme had made progress, particularly in improving the quality of campaigns in key areas, and in analysing reasons for missed children at cluster level. In 2018 there is overall a reduction in missed children during polio campaigns.
The TAG was further encouraged by the results of the seroprevalence study conducted in 2017. More than 96% of surveyed children had immunity against poliovirus type 1.
In addition, the TAG noted that extensive activities were being undertaken to enhance vaccine acceptance and the data shows that communications and social mobilization activities are having a positive impact.
Way forward
To stop the transmission of wild poliovirus in Afghanistan, the TAG recommended that the programme must fully implement The Northern and Southern Corridor action plans together with and the Pakistan programme. The TAG urged the country programme and all stakeholders to urgently intensify advocacy to gain quality access in Khakrez and Shahwalikot.
Further, the programme should review and strengthen the interventions aimed at providing opportunities for immunization for areas with continued chronic inaccessibility.
TAG stated that special focus should be put on regular assessment of planning and functioning of permanent transit teams and cross-border teams to ensure that no opportunity is missed for vaccinating children on the move.
In total, the TAG made 18 recommendations.
Adele Khodr, UNICEF Representative in Afghanistan. Photo: Tuuli HongistoIn addition to the members of the TAG, the meeting was attended by Minister of Public Health Dr Ferozuddin Feroz, Senior Advisor to Minister of Public Health Dr Hedayatullah Stanekzai, UNICEF Regional Director for South Asia, Jean Gough, representatives from regional offices and headquarters of WHO and UNICEF, members of the Afghanistan Polio Eradication Initiative team from national and regional levels as well as representatives from donor agencies and the Pakistan National Emergency Operations Centre.
Afghanistan is one 3 polio-endemic countries globally, together with Pakistan and Nigera. In 2017, the country had 14 cases of polio and to date in 2018, a total of 8 cases have been reported.
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About the Technical Advisory Group
The Technical Advisory Group (TAG) is comprised of a group of global public health experts who provide guidance to the Ministry of Public Health and partners across the necessary components of the polio programme.
The group was established to review progress towards polio eradication in specific countries, assess implementation, discuss planned activities and issue recommendations to address constraints.
TAG meetings are attended by country-specific TAG members, national representatives and international and regional partner organizations. The TAG meets twice a year in Pakistan and Afghanistan. Following the Afghanistan meeting, the expert group continued to Pakistan to review the progress and challenges of the programme.
The next TAG meeting in Afghanistan will be held in late 2018.
