Afghanistan and Pakistan have reported a very small number of polio infections in their region this year, fueling expectations the neighboring countries could be just months away from interrupting the endemic transmission of the crippling virus.
Pakistani authorities have reported a three-year-old child with paralytic polio, the only case in the country in the first seven months of 2023 compared to 20 cases last year.
Afghan health officials have confirmed five cases of polio paralysis in children, which is an increase from two reported infections in 2022.
“Pakistan and Afghanistan have never been this close to reaching the goal of eradicating wild poliovirus (WPV1) concurrently,” said Dr. Hamid Jafari, the World Health Organization’s director of polio eradication for the eastern Mediterranean region.
“And both countries need to reach this goal together - with the full support of the political, administrative, and security apparatus — if we are to finally eradicate wild poliovirus from the world,” Jafari told VOA in written comments.
Out of the 34 Afghan provinces, poliovirus transmission is limited to two eastern provinces, Nangarhar and Kunar, bordering Pakistan. According to official data, all five WPV1 cases detected this year are in Nangarhar.
“Immunity gaps, resulting from significant disruption of immunization campaigns during 2021 and 2022, have left children in the region at risk of polio and other vaccine-preventable diseases,” Jafari said.
Before the Taliban’s return to power in August 2021, Islamist militants routinely attacked health volunteers who fanned out across the country to administer vaccines. In October 2021, the Taliban backed a WHO vaccination campaign in Afghanistan, enabling the polio program to resume nationwide immunizations later that year.
It has since reached millions of children in the south and other regions of the country who had not received immunizations for at least four years, Jafari noted. He added that the Afghan vaccination program has also increased the number of site testing for poliovirus in wastewater, allowing timely detection and response, Jafari said.
“The quality of vaccination campaigns has improved remarkably since late 2022 in the east region of Afghanistan, and if such quality campaigns are sustained, endemic transmission in the region will be interrupted in the coming months,” said the senior WHO official.
“Cross-border coordination with Pakistan will continue to be essential throughout 2023 given the circulation of WPV1 on both sides of the border and the large population movement between the two countries,” Jafari stated.
He said that the “last mile” had always proven to be the most challenging phase of any national effort to interrupt polio transmission.
Since January 2021, all reported cases in Pakistan, a country of about 230 million people, have been from seven polio-endemic districts in the southern area of Khyber Pakhtunkhwa province out of 171 districts nationwide.
Despite detections of poliovirus in wastewater samples in other Pakistani districts, circulation has yet to be established outside the seven endemic districts.
“This is the result of very effective outbreak responses in each affected district outside the seven endemic districts,” Jafari said. He added that the polio program in Pakistan was "capitalizing on the momentum of recent success and continues to strive for zero polio.”
On Tuesday, Pakistan will launch its latest vaccination campaign to eliminate the highly contagious virus in a country where the disease paralyzed approximately 20,000 children in the early 1990s.
A polio program spokesperson told VOA the campaign aims to immunize nearly 8 million children under five across 61 districts in two phases. He said the government had deployed around 65,000 “front-line workers” to administer polio drops to the targeted population.
Pakistan has repeatedly come close to eradicating polio, but long-running propaganda in conservative rural areas that the vaccines cause sterility in children, coupled with deadly militant attacks on vaccinators, have set back the mission. Anti-state militants allege polio vaccinators gather intelligence on their hideouts.
The global polio eradication program identifies Pakistan, Afghanistan, parts of Somalia, and Yemen as areas where outbreaks are difficult to control.