Afghanistan, one of the three remaining bastions of deadly and debilitating Polio virus, kick-started another round of countrywide immunisation drive this October. Over nine million Afghan children under the age of five were to be immunised within this three-day campaign period between October 17-19, and another extra day for those who missed the dose was scheduled on October 21. The Afghan Ministry of Public Health, UNICEF and the World Health Organisation (WHO), have launched this programme to fight the disease under the Polio Eradication Initiative (PEI). The latest rounds of campaign was also supported by the Afghan Cricket Board (ACB). These many children were vaccinated during National Immunisation Days (NIDs) and Sub-NIDs in April-May 2016. The anti-polio or other countrywide vaccination campaigns have always been hit by the reckless fluctuating security situations on the ground as well as due to inhospitable terrain, logistical challenges and other accessibility factors. An estimated 320,000 children were not reached during the last immunisation drive in May this year due to lack of access or continued violence, mainly in the eastern and northeastern regions.
Besides Afghanistan, the other countries of concern are Pakistan and Nigeria, where efforts are underway to eradicate naturally occurring polio cases. In September 2016, following a brief quiescence, polio reappeared in Nigeria’s Borno province. Pakistan, which is also a polio-endemic country, struggles to fight the virus as new cases are reported, primarily in The Federally Administered Tribal Areas ( FATA )and Khyber Pakhtunkhwa regions. According to WHO estimates, in 2015, a total of 74 cases of polio were reported in Afghanistan and Pakistan, the two neighbouring polio-endemic countries. The most common factor in these polio-endemic regions remain the prevalence of violent insurgency where fatal attacks on the health workers and vaccinators are rampant for a host of conservative reasons laced with religious prejudices, apprehension of espionage and conspiracy theories. The other common cause is limited or nonexistent government’s influence and access over the afflicted regions due to insurgents’ writ over large swathes of territory.
Polio (Poliomyelitis), a deadly infectious disease with paralysing effect on children below five years, has been resurfacing in countries like Afghanistan where the civil administration and health apparatus are more or less sluggish due to myriad factors including prolonged armed violence and unyielding resistance from the Islamic zealots against any immunisation or vaccination programme.
Militants such as Taliban in Afghanistan and the neighbouring Pakistan routinely kill anti-polio health workers (including volunteers and social mobilisers) and security forces associated with the immunisation drive. While these attacks are frequent in Pakistan, Afghanistan, too, witnesses sporadic attacks on anti-polio campaign volunteers and vaccination support teams. Intermittent militant strikes targeting anti-polio programmes, and intimidations, abduction of health workers and officials are common in Afghanistan. In late December last year, armed militants killed a polio worker in Afghanistan’s Kandahar city and injured her grand-daughter. Similar violence against anti-polio health workers occurred in Ghaziabad district of Kunar province this February when at least three health workers were abducted and later killed by suspected militants.
In 2016, there have been eight polio cases reported from Kunar, Kandahar, Helmand, and Paktika. Previously, polio vaccination campaigns were halted or kept on hold for more than a year because of security issues in few districts (e.g. Achin, Kot and Haska Mina) in Nangarhar province which was a stronghold of the Islamic State of Khurasan (ISK) militant group. The ISK has been blocking polio vaccination campaigns, like Taliban, citing conspiracy theories, primarily accusing the Afghan government and the International bodies of espionage and intelligence gathering. These militant formations, too, engaged in a misinformation campaigns about the anti-polio drives citing health effects and Islamic laws. Now that these groups have faced military reversals due to concerted offensive in last many months, the vaccination drive would reach remote corners of these places.
Islamist-led propaganda campaigns against government-backed health projects, especially polio vaccination programmes, began in the region/AfPak) sometime in 2006. In the neighboring Pakistan the campaign was spearheaded by Maulana Fazlullah, the present Taliban leader there and then a radical muslim cleric leading another banned organisation, the Tehrik Nifaz-e-Shariat-e-Muhammadi (TNSM- Movement for the Enforcement of Islamic Law). Fazlullah and his followers carried out a propaganda campaign against the polio vaccination programme in Khyber Pakhtunkhwa (then North-West Frontier Province- NWFP) through his illegal FM radio sermons and Friday prayers at the local mosques. He termed the whole vaccination programme as a Western conspiracy to render Muslims infertile and impotent. According to Fazllulah who owes his allegiance to the Afghanistan Taliban, anti-polio campaign is a part of conspiracy of Jews and Christians to make Muslims infertile and impotent and stunt the growth of Muslim community. He, along with his followers, were the first Islamists to tag anti-polio campaigns as part of Western espionage against the Muslim community (much before the Central Intelligence Agency (CIA)-sponsored hepatitis vaccination programme, that was believed to have helped in tracking down and killing Osama bin Laden at his hideout in Abbottabad, Pakistan, in May 2011). The CIA’s actions made the Taliban leaderships in Pakistan as well as in Afghanistan all the more suspicious about the vaccination programmes that resulted in a renewed armed backlash against polio immunisation workers in the region thereafter.
Unlike Pakistani Taliban, Afghanistan Taliban had cooperated indirectly with the government backed immunisation programmes from time to time. Even the so-called Islamic Emirate of Afghanistan (Taliban government) issued statement in May 2013, in support of ‘all those programmes which work for the health care of the helpless people of Afghanistan’. The Taliban statement with its usual conditionality and caveats against foreign health or aid workers, clearly stated that “all the associated Mujahidin of the Islamic Emirate of Afghanistan are directed, not to create any kind of trouble for them, rather they should be provided with all necessary support.” Unfortunately, the Afghan Taliban announced a ban on polio vaccinations in restive Helmand province in July 2014. As a result, the anti-polio drive faced a roadblock in the country for some time until December 2015, when Taliban leaderships in Afghanistan extended support again for the anti-polio drive. The Taliban’s change of heart occurred reportedly due to negotiations initiated by public health officials and the International Committee of the Red Cross.
Facing these many arduous tasks, Afghanistan’s ongoing vaccination campaign would be focussing the apparently high risk eastern Afghan districts. With relative calm in the region and reduced militant hostility against the vaccination programmes, the situation would definitely help the country and international health agencies to take the next logical steps for eradicating this primordial disease from the last and remaining frontiers.