Entry 2 from Chris Morry
Not much to say about Afghanistan as I am still in India. We have had some logistical difficulties getting visas for some of the international panellists because of Eid al-Adha. So we have moved the dates a little to make sure we are all able to participate.
Logistically, it is worth noting that these reviews have to be organised with flexibility and some thought towards Plans B and C, as they occur in difficult and unpredictable regions.
The last three endemic countries, Afghanistan, Pakistan, and Nigeria, remain endemic for a range of inter-related, complex reasons - conflict; extremely high rates of poverty; poor nutrition; lack of infrastructure, especially in areas effecting health and access, such as sanitation, drinking water, and roads; gender inequality; lack of education; the denial of immunisation access to populations for political reasons; and the list goes on. All of this creates the opportunity for the virus to flourish in pockets and then occasionally to leap out, as new pockets of under-immunised and vulnerable children emerge.
We have seen this recently in Somalia, Kenya, and Ethiopia; we have watched Israel worry about the virus appearing in its sewage even if there have been no cases as of yet; and, just today, we heard the news that polio may be appearing in the midst of the chaos of Syria’s civil war.
Amongst all this, Afghanistan has only had 7 wild-polio-virus-derived cases - this compared to 26 cases for the same period last year and none of these cases is in the south where the majority of cases usually occur. This may be interpreted as good news, though the increase in polio cases in the east along the Pakistan border speaks to the ever present danger of the virus travelling from one vulnerable area to another - Pakistan and Afghanistan being a single transmission zone sharing the same genetic type of polio virus.
As they say, “what goes around comes around”, and, while things may be looking better in some of the hardest areas of Afghanistan, population movements between the two countries continue. In addition, lack of services, poverty, malnutrition, insecurity, and gender inequality all continue to contribute to low levels of maternal and child health, which leave large segments of the population vulnerable to the polio virus.
Polio eradication in Afghanistan will depend partly on what happens in Pakistan, and, in both countries, it will depend on the ability of the programme to reach as close to every child as possible through high-quality and well-supervised campaigns, including strong communication strategies, planning, and messages that not only provide information but also build demand among parents and caregivers for polio and, indeed, all routine childhood vaccines and other health services for their children.
I am looking forward to getting a closer look in the next week or so.
The Communicaiton Initiative