Afghanistan’s long battle to eradicate the crippling polio virus has been thwarted by conflict, migration, and myths over the vaccine.
But the war-torn nation of around 30 million people has faced a new hurdle: the coronavirus pandemic.
Polio vaccination drives in Afghanistan, which has the world’s deadliest ongoing conflict, were halted in March to limit the risk of transmitting COVID-19 to children, parents, and health workers.
Although vaccination campaigns resumed this month, health authorities are grappling with a surge of new cases of polio, a childhood virus that leads to deformed limbs, paralysis, and even death.
Afghanistan and neighboring Pakistan are the only countries in the world where new polio cases are found after the World Health Organization (WHO) on August 25 declared that Africa is free of the disease.
The coronavirus pandemic prevented some 50 million children in the two countries from being immunized against polio, according to the United Nations Children's Fund (UNICEF).
'Ongoing Conflict, Political Instability'
The Afghan Health Ministry on August 24 reported three new polio cases, bringing the total this year to 40, with some recorded in areas of the country previously free of the virus.
Twenty-eight of those cases have been recorded in southern Afghanistan, a stronghold of the Taliban insurgency and the scene of some of the fiercest fighting in the country.
The total number of cases reported in 2019 was 29.
Meanwhile, 63 cases have been recorded in Pakistan, a South Asian nation of around 220 million where efforts to eradicate the virus have been thwarted for years by militant attacks, radical Islamic clerics, and anti-vaccination propaganda.
Pakistan recorded 147 polio cases in 2019, a sharp rise from a record low figure of 22 cases in 2017.
The majority of cases in Pakistan are found in the northwestern province of Khyber Pakhtunkhwa, a poor, violence-stricken, and religiously conservative region that was once a stronghold of militant groups like Al-Qaeda and the Pakistani Taliban.
Many residents of the province, which lies along the porous border with Afghanistan, have been suspicious of the polio vaccine, with conservative Islamic clerics and militants claiming it is a Western conspiracy to harm or sterilize children.
“Ongoing conflict and political instability make it difficult to access hard-to-reach areas, and migration along the porous and rugged border between Afghanistan and Pakistan further complicates vaccination efforts, making children on both sides vulnerable to contracting the debilitating disease,” according to UNICEF, which along with the WHO and Rotary International, has spearheaded global efforts to eradicate the disease since 1988.
“Efforts are still needed to dispel myths around the vaccine and to convince families who are afraid of immunization,” according to UNICEF.
Public-health studies in Pakistan have shown that maternal illiteracy and low parental knowledge about vaccines -- together with poverty and rural residency -- are the factors that usually influence whether parents vaccinate their children against the polio virus.
Anti-vaccination propaganda has also been fueled by a distrust of Western governments who fund vaccine programs, including after the CIA reportedly staged a fake hepatitis-vaccination campaign in 2011 to confirm the location of Al-Qaeda leader Osama bin Laden -- living in the Pakistani garrison town of Abbottabad -- where he was killed by U.S. SEALs.
Since then, some clerics have even issued fatwas saying that children who become paralyzed or die from polio are "martyrs" because they refused to be tricked by a "Western conspiracy."
Pakistani militants have also propagandized that Western-made vaccines contain pig fat or alcohol, which are both forbidden in Islam. Neither substance is used to make vaccines.
Insurgents have even kidnapped, beaten, and assassinated dozens of vaccinators or their armed police escorts in recent years in a bid to stop local anti-polio campaigns.
'Back On Track'
In Afghanistan, polio vaccination drives restarted in three provinces in July. A second campaign covering nearly half of the country was announced earlier this month.
In Pakistan, a first round of vaccinations took place in July, covering almost 800,000 children. A nationwide vaccination campaign targeting 40 million children is expected to start in the coming weeks.
“These life-saving vaccinations are critical if children are to avoid yet another health emergency,” said Jean Gough, UNICEF director in South Asia, in a statement on August 11. “As the world has come to see only too well, viruses know no borders and no child is safe from polio until every child is safe.”
“Although we have experienced new challenges and a setback in the fight against polio because of COVID-19, the eradication of this contagious disease will get back on track and is firmly within our reach,” Gough added.
The new vaccination drives come after Afghanistan and Pakistan were affected from the coronavirus pandemic.
Afghanistan has recorded more than 38,000 cases and 1,400 deaths, according to government tallies.
Afghanistan, which has poor health infrastructure and has been wracked by decades of war, has a very limited testing capacity.
Pakistan has registered nearly 300,000 coronavirus cases and over 6,200 deaths as of August 27, according to official numbers.
The real number of infections in both countries is believed to be much higher, as little testing has been completed.
Earlier this month, the Afghan Health Ministry estimated that nearly one-third of the population -- or 10 million people -- has been infected with the coronavirus.
Kabul and Islamabad have reported that the rate of new infections has dropped as both countries have started to ease lockdown measures aimed at curbing the spread of the virus.