On a good day, getting polio vaccination to children in Afghanistan is challenging, and that’s not to do with its difficult terrain. Healthworkers are shot and killed by extremists.

In June this year, five health workers carrying out a polio vaccination campaign in Afghanistan’s Nangarhar Province were killed and four others injured, in a series of attacks. Earlier this month, gunmen shot and killed a police officer assigned to protect a polio vaccination team in northwestern Pakistan, according to reports from the region. The reports also pointed out it was the third attack in two days on Pakistani policemen assigned to protect polio workers.

Experts worry

Afghanistan and Pakistan are the last two regions with the wild polio virus in the world. The recent Taliban take-over in Afghanistan has experts worried for children in the region, and about cases that could be “ïmported” into neighbouring India. In 2014, India was certified polio-free.

Concerned about the humanitarian crisis emerging in the midst of a pandemic, paediatrician Vipin M Vashishtha said, “It has been difficult for vaccinators to carry out immunisation campaigns among the children in times of conflict; then came the pandemic and now the latest political turn of events. “India has a past history of importation of cases and needs to be watchful,” said Dr Vashishtha, former national convener with the Indian Academy of Paediatrics — committee on immunisation.

On Sunday, Health Minister Mansukh Mandaviya tweeted, “We have decided to vaccinate Afghanistan returnees with free Polio Vaccine — OPV & fIPV, as a preventive measure against Wild Polio Virus,” — a necessary medical intervention, as flights brought back people to India.

UNICEF “hopeful”

Last week, after the Taliban had taken over Kabul, UNICEF Afghanistan representative Hervé Ludovic De Lys was, however, hopeful that the country would take a “giant stride” on polio.

“Afghanistan is one of the two polio-endemic countries in the world. One of our biggest challenges in recent years has been access to communities, including homes and mosques, to vaccinate children. Now, we are hopeful that access will become easier,” the representative said.

“Despite all the unanswered questions that lie ahead, one thing is certain: UNICEF is here to stay and deliver for every child and every woman in Afghanistan. UNICEF has been here for 65 years and we’re not leaving,” the official said, adding that they had paused operations in some provincial areas until order was restored; in the interest of their safety and on a suggestion by the Taliban.

In July, UNICEF and the World Health Organization had sounded the alarm, as Covid-19 caused a “backsliding” on childhood vaccinations. About 23 million children missed-out on basic vaccines through routine immunisation services in 2020 – 3.7 million more than in 2019, they said. The data shows that middle-income countries now accounted for an increasing share of unprotected children – that is, children missing out on at least some vaccine doses.