Entry 3 from Chris Morry
It is good to hear from some you - I want to particularly address Wendy’s question: "What do you think accounts for the decrease in cases in Afghanistan?"
The question you ask is a good one. We have yet to get a chance to look closely at all that’s happened but it is true that there has been no case of wild polio in southern Afghanistan this year.
I think there is a need to see this as an opportunity, while being cautious. We are coming to the low season and not having had a case in almost a year is a good place to be right now. The programme itself remains optimistic but also healthily sceptical. Reviews are about to start to make sure the surveillance system hasn’t missed cases, and environmental sampling is to be expanded to see if the virus is circulating in the sewage. However, there is every reason to believe that the main reason children have been spared polio for so long in this region is the improved quality of the immunisation campaigns coupled with fewer inaccessible areas and a lot of hard work through repeated rounds.
This provides an opportunity to continue to build immunity in the region through the low season. Of course, there remain serious gaps in programme coverage in the south; the danger of cases coming from Pakistan is high; the south east is threatened by the bans on vaccination in North and South Waziristan in Pakistan; and 8 cases are now confirmed in the east, also along the Pakistan border. There is much to remain concerned about!
However, with strong cross border and transit point coverage in strategic areas, continued focus on improving the operational quality of campaigns (especially in the south, east and south east), continued innovation in negotiating access in areas where security is an issue, and a greater focus on interpersonal communication and advocacy amongst community leaders, Afghanistan could interrupt transmission in 2014. Afghanistan is a potential bright spark in an otherwise difficult year of outbreaks and slow progress in the other endemic countries, but eradication is not a foregone conclusion.
That’s my sense of things as of today, but I have many more discussions here. There has been a great deal of healthy dialogue reminding us not to get too overconfident. Perhaps the most positive sign for me at this point is that people working on polio in-country are not celebrating. They understand that they have taken some steps forward but are intensely concerned about the gaps and challenges, and all the talk here is about what can be done better.
We’re off to view the programme more closely tomorrow. I’ll be back in touch as soon as I am able.
The Communication Initiative