Polio amid a humanitarian crisis in Afghanistan: challenges and recommendations.

According to WHO, Afghanistan is one of only two countries in the world in which poliovirus type 1 is still circulating. Over the years, Afghanistan has made tremendous efforts to completely eradicate polio from the population; however, a fragile health-care system and pre-existing socioeconomic and political challenges have delayed this success.

To eradicate polio completely, every child (aged <5 years) in every household must be vaccinated, but millions of children in Afghanistan are still unable to get the polio vaccine for several reasons. The ban on door-to-door polio vaccination by the Taliban in 2018 led to approximately 3·4 million children not being vaccinated. Around 74% of the country's population lives in rural areas where basic health-care facilities and vaccination services are not available.

The COVID-19 pandemic and political instability are contributing to the challenges. During the first 6 months of 2020, the polio vaccination programme was completely shut down due to COVID-19 and approximately 23 million children missed out on their routine vaccinations—an increase of 3·7 million from 2019.

Among these unprecedented circumstances, recent efforts in engaging negotiations with the Taliban establishment have seen relative progress. As of Nov 8, 2021, the Taliban decided to resume polio vaccination efforts, including door-to-door polio vaccinations across the country. This will allow WHO, the UN Children's Fund, and other key non-governmental organisations to access more than 3 million children in parts of the country that had previously been determined to be inaccessible.

To eradicate polio in Afghanistan, security for health-care workers and mobilisation of awareness campaigns should be prioritised. Security is particularly essential considering reports of violence against health-care workers in 2021. This can be done by working with the Taliban to deploy their own security forces at vaccination centres, while working in tandem with local leaders to prevent violent acts against health-care workers. There is an opportunity arising with the reopening of school systems in the country to educate the masses, with the help of teachers, about the signs and symptoms of polio and the need to be vaccinated. These messages could even trickle down to the students’ homes and families, thus leading to more vaccinations.

Afghanistan, with its already fragile health-care system, can use the premise and already somewhat present infrastructure of COVID-19 vaccination efforts to simultaneously vaccinate children for polio, which should reduce some of the burden on the health-care system and increase the number of polio vaccinations substantially.

We declare no competing interests.