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Guest Editorial


Building trust and wiping out polio, door by door, drop by drop

The volunteers who walk in pairs as they go door-to-door with polio vaccine in remote parts of Afghanistan usually have two things in their minds: one, to protect children under 5 years old against a deadly and crippling disease; and two, to protect themselves from possible security incidents. A couple of months ago, a young polio field worker was caught in the crossfire and lost his life while doing just this type of door-to-door vaccinations. Another polio volunteer, a 19- year old, was killed in a separate incident while returning from a security-compromised area after completing his daily tasks.

These youngsters have lost their lives playing their part in a neutral and impartial campaign aimed at saving the lives of hundreds of thousands of children. The Polio Eradication Initiative in Afghanistan has made it clear from the outset that it is neutral and impartial. It doesn’t support any political interests, nor side with any party to the conflict. The programme’s sole interest is children, no matter where they are or who they are.

The programme’s guiding principle is to engage communities, accomplish essential activities and achieve milestones. The results are fruitful. By the end of May this year, the number of polio cases countrywide has been only two, down from 80 in 2011.

Part of this success is based on the fact that the polio programme has introduced innovative approaches that pair the vaccination efforts with other health benefits. For example, de-worming tablets have been provided along with vaccination. In places where communities are far from health facilities and lack transport, community health centres have been set up to meet numerous community needs, including the oral polio vaccine (OPV).

The result has been the building of trust, buy-in and acceptance of OPV among the most marginalized and vulnerable communities. The widespread networking of surveillance systems for the detection and analysis of polio cases has also been integrated with surveillance for other communicable diseases. Thus, the ability to make inaccessible areas accessible has built a polio legacy, which is mainstreaming essential functions of eradication into other ongoing public health programmes.

Afghanistan’s eastern region still remains a challenge. For some time this area has not been a transmission zone. But cases of wild polio have again started appearing in some inaccessible areas where only small numbers of children remain unvaccinated. No matter how small the number of unvaccinated children is, it is big enough for the virus to infect them. In such cases, community elders and religious leaders are key ‘influencers’ who help health workers gain access to hard-to-reach settlements and children. These influencers are the game changers in the fight against polio.

All we need is the gatekeepers — those with connections and roots in the communities — to engage these people of influence. No doubt the Afghanistan Red Crescent has a key role to play. With its widespread network in 33 provinces, the Red Crescent is carrying out activities through 47 fixed centres and 17 mobile health teams, especially addressing the needs of vulnerable people in emergencyaffected areas.

With their presence at grass roots and their neutrality vis-à-vis any political interest, the Afghanistan Red Crescent’s 20,000 volunteers can play a very concrete role: vaccinating children; monitoring campaign performance; and creating demand by parents in the most insecure and inaccessible areas. Their reputation for conducting community-based activities is a promising basis for engaging the National Society even more actively. They hold the key as gatekeepers to advance what has been achieved so far and finish the business of getting rid of this crippling and fatal disease once and for all.

Our experience in Afghanistan shows that even in an extremely difficult environment — with mountainous terrain, inadequate infrastructure, remote communities, poverty and areas of insecurity — concerted, long-term effort can lead to the near elimination of a once widespread killer. We still have a way to go, but I firmly believe that innovative strategies aimed at building grass-roots trust and long-term community health will allow us to declare polio a thing of the past — not just in Afghanistan but throughout the entire globe.

By Dr Suraya Dalil
Minister of Public Health
Islamic Republic of Afghanistan

Dr Suraya Dali
Photo: ©REUTERS/Denis Balibouse
















The Afghanistan
Red Crescent’s
20,000 volunteers
hold the key as
gatekeepers to
finish the business
of getting rid of this
crippling and fatal
disease once
and for all.


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