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Notes from the field - Afghanistan December 2013


Notes from the field - Afghanistan December 2013

Entry 2 for this trip from Chris Morry

As I left for Afghanistan, Robert Steinglass sent me a commentary he recently wrote on routine immunization (RI) titled "Routine Immunization: An essential but wobbly platform". In it, he argues for a re-balancing of immunization direction and investment and offers a critique of long standing approaches and thinking within programmes like the Global Polio Eradication Initiative (GPEI). His arguments echo the discussions that are now (and many would say very belatedly) going on within the GPEI itself. Click here for a summary of his commentary and a link to the original.

As polio eradication gets closer, reaching the virus in its remaining reservoirs has become increasingly complex and expensive. At the same time, the increasing energy and resources required to eradicate polio in those areas where it remains endemic have been diluted by the need to respond to outbreaks in other areas where very poor RI, conflict, or both leave children unimmunized.

If we look at two regions in Afghanistan, the impact of poor RI coverage on the polio programme becomes clear. Southern Afghanistan is presently a success story where after years of transmission there has not seen a single wild polio case for over twelve months. But any sense of success has to be tempered by the knowledge that RI is almost non-existent in provinces like Kandahar, and the risk of re-importation, therefore, is extremely high. The short term response is continuous door-to-door rounds until the risk of importation is gone, but this is not, of course, a viable long-term strategy.

In Eastern Afghanistan, RI is much better, and this has served as a defence against the outbreaks just across the border in Pakistan. It has not been sufficient, and the region has had 11 cases in 2013, largely importations from Pakistan, in areas made inaccessible to the programme due to insecurity. Adding to the security/access issue is a worrying decline in RI rates. The response for East Afghanistan is: to conduct more or less continuous door-to-door campaigns where it can; to look for innovative ways to reach children in inaccessible areas; to focus on turning the downward RI trend around; and to hope that Pakistan is successful in its efforts this year.

In both the East and South, RI coverage levels are playing a role. Had they been less neglected, had more resources been applied and more emphasis placed on routinely immunizing children, the 'end game' would be easier. This is not to say that the polio programme is to blame for the poor state of RI in parts of Afghanistan or many other countries nor that it is by itself able to offer a solution. It is to say that for far too long RI has been neglected and under-funded, and the impact of this on programmes such as the GPEI is significant. Polio eradication is still possible under these conditions, but, without the long term ability to maintain basic levels of immunity that a functioning RI system provides, it is less certain.

Chris Morry
Programme Director
The Communication Initiative
mobile (when travelling only) +250 884 7045
phone +250 323 7045

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