Afghanistan almost defeated polio.Now the future is uncertain

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For more than Over the past week, global attention to Afghanistan has focused on the Taliban’s surprisingly rapid return to power and the international airlift that evacuated diplomats, Western workers, and refugees. But there is another reason why a small group of disease experts are attracted by political change: They worry that it may undermine the long-term campaign to eradicate polio, depending on the country-after years of disappointment, it now seems to be close to success. .

Since 1988, a tenacious and costly international movement has chased polio from most parts of the world. Afghanistan is one of only two countries where the spread of wild poliovirus has never been interrupted; Pakistan, which has a long border with Pakistan, is the other. As religious and political factionalism interrupted the provision of vaccines to children, the number of cases has increased unabated. Last year, the new coronavirus pandemic forced the two countries to surge again to 140 cases. A three-month pause In the vaccination campaign.

But the numbers now are unbelievably good: this year there is only one case of polio in every country-all in January-and much fewer viruses have been found in sewage than in the past few years, which is a key Monitoring technology. This was a fragile moment facing a full-scale change of government, and the health officials who promoted the movement held their breath collectively.

“We are now in an incredible epidemiological window in Afghanistan and Pakistan,” said Hamid, director and physician of the World Health Organization’s polio eradication program in the Eastern Mediterranean Region (from North Africa through the Middle East to Pakistan). · Jafari (Hamid Jafari) said. “We see that the level of wild poliovirus transmission in these two countries is very, very low-as low as never before. It creates a huge opportunity for the program to seize this low viral burden and stop it.”

What needs to be clear is that the polio movement in Afghanistan has not stopped, and there is no sign that the Afghan Taliban leaders will ask it to stop.Last week, the official name of the campaign, “Global Polio Eradication Initiative”, proposed a statement It “is currently assessing direct interference with polio eradication and the provision of other basic health services to ensure the continuity of surveillance and immunization activities, while giving priority to the safety and security of staff and frontline health workers.”

Like case statistics, the Afghan Taliban’s attitude towards eradication activities has been mixed. When it first took power in the 1990s, the Taliban allowed the movement (a coalition of the World Health Organization, the Centers for Disease Control and Prevention, the Gates Foundation, and Rotary International) to begin in Afghanistan. But in 2018, it was forced to suspend in areas under its control, banning vaccinators from door to door in the community, and then banning mass vaccination in public buildings such as mosques.

These bans, and the suspension of similar political parties in Pakistan fighting for power, are responsible for the surge in polio cases: from 33 cases in the two countries in 2018 to 117 in 2019. A long-lasting interruption can be a serious blow because it takes multiple rounds of oral vaccine drops to immunize children. (Even in the United States and Western Europe, where the injection formula is used, it takes three rounds to consolidate immunity and a fourth school-age booster to lock it in.)

“We estimate that between 2018 and 2020, approximately 3 million children will indeed not be able to access services,” said John Vertefeuille, a doctor and head of the CDC’s polio eradication department. This will make these children-some partially vaccinated and some born after the start of the ban-susceptible to the virus and the paralysis it causes, and will be affected when the child is infected and spreads it to others Expand the number of viruses present in the environment.

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