Progress in a challenging environment
Overall, the expert group appreciated that there was strong political commitment at the highest levels of government to eradicate polio in Afghanistan and appreciated that 22 out of the 31 previous TAG recommendations had been fully implemented.
The advisory group commended the progress made in polio eradication in Afghanistan and complemented the improved quality of campaign activities, including a rise in the vaccine acceptance, noting that most cases in Afghanistan were isolated in few high risk and very high risk districts, mostly in the Southern and Eastern regions, where access was limited.
The TAG noted that Afghanistan had stopped all outbreaks in 2015 and 2016 successfully and that a robust response to the transmission, which occurred in Kunduz in February 2017 − an area which was inaccessible for more than 18 months − had also succeeded in stopping the transmission.
TAG appreciated that there was improved quality of the campaign activities in Very High Risk Districts (VHRDs). However, the group also noted that there still remain clusters of unreached children due to inaccessibility in some districts of Helmand & Kandahar and refusals in South, East and Southeast regions.
The group was concerned that in 2017, transmission in South had been re-established and that there was evidence of internal circulation. Furthermore, transmission in Nangarhar, showing orphan linkages across the northern corridor, showed that programs of both Afghanistan and Pakistan had still not been able to identify and address the population group which had been harboring transmission for more than three years.
Further, the TAG noted that at the start of a low transmission season, a common epidemiological block was in the best situation to stop the transmission on the basis of evidence of increased population immunity in high risk areas and improved program performance.
WHO Rrepresentative Dr. Rik Peeperkorn speaking at the TAG opening sessionDespite the challenges − a high number of polio cases and positive environmental samples this year − the advisory group believed that with further implementation of the National Emergency Action Plan (NEAP), polio transmission could be interrupted.
Further, the group believed that the NEAP 2018 was appropriate to current challenges and had strategies in place to keep the program on a right track.
The way forward
Based on the presentations made by regional representatives and the review of the National Emergency Action Plan (NEAP) for 2018, TAG recommended that the program should continue focusing its efforts in very high risk districts.
The group believed that the implementation of the 15 district plan should be strengthened in coordination with Pakistan as a part of Southern Corridor Action Plan. TAG also urged Afghanistan to conduct an exercise in coordination with Pakistan to identify potential population groups harboring and spreading transmission in the northern corridor and develop a Northern Corridor Action Plan.
Further the TAG recommended that the polio eradication program should continue to identify pockets of chronically missed children. The TAG endorsed a cluster approach for addressing refusals in South and Southeast districts and recommended that the program look both at geographical and social clustering of refusals.
The TAG further recommended that the program should also ensure regular dialogue with key authorities to reduce any potentials for disruption of access. Further, they recommended that in areas with access challenges, the program should maintain a flexible approach to ensure reaching the maximum proportion of children. TAG also recommended conducting IPV-OPV campaigns in chronically inaccessible areas as and when access was gained and noted that the program should exploit any potential for access.
TAG encouraged continuing close coordination with UNHCR, IOM and OCHA in implementing the High Risk Mobile Populations Strategy and encouraged strengthening the in-campaign transit strategy to reach children on the move.
In total, TAG made 21 recommendations and encouraged them to be incorporated to the NEAP before its finalization.
Polio eradication has been a remarkable success story internationally and in Afghanistan. Poliomyelitis can only be found in three countries anymore, and cases in Afghanistan have gone down from 20 in 2015 to 11 so far in 2017.
The next TAG meeting will be held in the summer of 2018.
About the Technical Advisory Group
The Technical Advisory Group (TAG) was established to review progress towards polio eradication in specific countries, assess implementation of previous TAG recommendations, discuss planned activities and issue recommendations to address constraints facing national programmes in achieving their targets. TAG meetings are attended by country-specific TAG members, national representatives and partner organizations, both international and regional. The TAG meets twice a year in Pakistan and Afghanistan to review progress and provide expert advice on the final road to polio eradication.
