US departure from Afghanistan jeopardizes global quest for polio eradication | Science

The withdrawal of US troops from Afghanistan, along with the rise of the Taliban there, threatens the three-decade global quest to eradicate polio. The Taliban have blocked door-to-door polio vaccination in areas under their rule for the past 3 years, putting up to 3 million children out of reach of the countryside and making Afghanistan one of the only two countries, with Pakistan, where the polio virus survives. Since the United States began withdrawing its troops, the Taliban have made rapid military gains and now control much of the country. Some fear this will wrest full control of the Afghan government – which supports the eradication campaign – after US forces leave in September.

It is a frightening prospect for many polio watchers. But some inside and outside of the Global Polio Eradication Initiative (GPI) argue that a clear resolution to the conflict, no matter who prevails, can actually help eradication efforts. They hope the campaign can work with the Taliban to maintain vaccinations. Until the conflict subsides, however, chaos is likely to interfere with vaccination campaigns.

The US withdrawal comes at a time when the program is advancing against the wild virus after several years of setbacks. Cases in Afghanistan nearly tripled to 56 between 2018 and 2020, and the country has also seen explosive outbreaks of live vaccine-derived poliovirus, which crippled more than 300 children in 2020. About 85% of all cases occur in areas inaccessible because of the Taliban. control, explains Aidan O’Leary, who took over as head of the GPEI in January, headquartered at the World Health Organization in Geneva. The COVID-19 pandemic initially made matters worse.

But so far this year, there has only been one case caused by the wild virus. This may be in part due to reduced population movements during the pandemic and more frequent handwashing, says Hamid Jafari of the GPEI, who is leading eradication efforts in the region. Even so, “The trend is very real.”

The fate of Afghanistan is closely linked to that of Pakistan, with which it shares a porous 2,670 kilometer border. This country has also reported only one case of the wild virus this year, after a similar increase from 12 in 2018 to 84 last year. (The spike there was largely due to vaccine refusals driven by rumors and a virulent disinformation campaign, as well as a sometimes ineffective eradication program.)

Some optimism about Afghanistan stems from the belief that the Taliban are not opposed to polio vaccination per se – in fact, they have collaborated with the program in the past. “It was purely for security reasons in specific areas where he imposed the ban,” Jafari said. Insurgents accused polio vaccinators of passing on information to help the United States target airstrikes that killed Taliban leaders. “Whether it’s true or false, if it’s perception, it’s reality,” says O’Leary. “You have to admit the airstrikes were brutal” for the Taliban and civilians, adds Stephen Morrison, senior vice president and director of the center for global health policy at the Center for Strategic and International Studies in Washington, DC

The hope is that if the Taliban continue to consolidate their power, their suspicions may subside and the GPEI may be able to function unhindered. After years of negotiations, the Taliban recently gave the green light to the GPEI to carry out vaccination in mosques in provinces where they imposed a door-to-door ban. The program expects “a more formal declaration” to continue this month, says O’Leary, if the security situation permits. The Taliban will select people they trust to be trained as vaccinators by the GPEI, Jafari said. Campaigns against mosques are usually not as effective as going door-to-door, says O’Leary, reaching perhaps 40 to 50 percent of the target population, “but we can hope to capitalize on that.”

Given this openness, Jafari believes the Taliban is unlikely to issue further polio vaccination bans. “We are on a very different trajectory in negotiations with them,” he said. Others refuse to speculate. “The end of the game for the Taliban remains to be determined. There are more dire and more benevolent opinions, ”says O’Leary. And Morrison warns that “US air campaigns will not necessarily end with withdrawal.”

Although the fighting between the Taliban and the government is a major obstacle, “the program is not at a standstill,” Jafari said. But he had to cease his activities where there is active fighting, explains Godwin Mindra, head of the UNICEF polio team in Kabul. And neighborhoods that are accessible today may not be accessible tomorrow, adds Mindra. A national polio vaccination campaign is slated for September, if it can be done safely, with smaller campaigns slated for November and December. “We will be looking very carefully at how this evolves,” says O’Leary.

The worst-case scenario is a descent into all-out civil war, with escalating violence, large numbers of refugees and a wider public health crisis. Even then, GPEI leaders point out that the program has a lot of experience operating during conflict, in Syria and in many other countries.

The GPEI’s new strategic plan for 2022-2026 aims to stop all transmission of polio in Afghanistan and Pakistan by the end of 2023. “If we can continue to immunize this year, we can make good progress” towards this. goal, says Jafari. But success also depends on stopping the virus in Pakistan, as the virus has often returned to Afghanistan just as the country was making progress. Although the polio program is “very resilient, very innovative,” Morrison believes the 2023 timeline can be “a bit of a delusion.” For now, O’Leary says, “We are being held hostage to events on the security side. “