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Afghanistan/Pakistan: Polio programme persists despite worsening security

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Security threat forces temporary evacuations from Afghanistan and Pakistan but 'critical' polio immunization activities to continue

ALTHOUGH international polio eradication staff in Afghanistan and parts of Pakistan have been relocated as the security threat continues to rise, more than 70 national staff in Afghanistan and 120 national staff in affected parts of Pakistan continue to prepare for National Immunization Days to be held later this month.

Following an armed attack on a private guest house frequently used by United Nations staff in Kabul, Afghanistan, on 28 October in which five UN staff and two Afghan security guards were killed, and a suicide bomb attack on the World Food Programme offices in Islamabad on 5 October, in which a further five UN staff were killed, the UN has scaled back operations in the region as it re-evaluates how best to protect its staff.

The polio programme has nine international staff based in Afghanistan and 20 in Pakistan. While all international Afghanistan staff have temporarily evacuated the country, a UN security review has rated polio eradication a "critical" programme, meaning all international staff will return to the country by 13 November, prior to the next National Immunization Days from 15-17 November. In Pakistan, due to persistent terrorist attacks in Peshawar, the three international staff members based there have been temporarily relocated to Islamabad.

International staff movement has already been severely restricted in parts of both countries (the Southern, South-Eastern and Eastern Regions of Afghanistan, and most of North-West Frontier Province (NWFP), Federally Administered Tribal Areas (FATA) and the Quetta area of Balochistan in Pakistan) for the past two years, requiring the polio eradication program in these areas to rely on its dedicated national staff to implement and monitor supplementary immunization and polio surveillance activities at province and district level.

The decreased mobility of international staff in these critical areas is likely to have some impact on the quality and coverage of SIAs. However, the planned National Immunization Days (NIDs) using trivalent oral polio vaccine will be held as planned in Afghanistan from 15-17 November and Pakistan from 16-18 November. In Afghanistan, senior staff from the Ministry of Public Health have agreed to assist in monitoring the campaign activities in the field.

Meanwhile, transit immunization teams are working around-the-clock to immunize children fleeing conflict-affected South Waziristan, with immunization posts set up at the three main exit routes from the area. Mobile teams are also immunizing children at the medical camps for IDPs in the Tank and D.I.Khan regions, at the camp established in Mir Ali for Internally Displaced Persons (IDPs), and at a temporary roadside refreshment camp established at Gambila Lakki Marwat. Officially, 49,000 families from South Waziristan are registered as IDPs, with almost all living with host families and relatives.

Despite the intensification of the conflict, access for vaccinators to conduct supplementary immunization activities in critical areas of Afghanistan and Pakistan has actually improved in recent months. In October, NIDs in Afghanistan immunized more than seven million children aged five and under, with only 8% of the targeted population in the Southern Region unable to be accessed by immunizers. This amounted to 147,325 "missed" children, predominantly in the Kandahar and Helmand provinces.

In Pakistan's Swat Valley, which until August had been controlled by anti-government groups for more than a year, making it completely inaccessible to immunization teams, SIAs were first held again in September, with 40% of children accessible to immunizers. By early October, this number had swelled to 87% and by 30 October, 98% of children under five were immunized. However, it is critical that this accessibility continues: due to chronic under-immunization, 19 polio cases have been reported from Swat this year. Polio outbreaks continue in other conflict-affected parts of FATA: this week, neighboring Bajaur tribal agency reported the 14th case of polio this year an eight-year-old girl who was paralysed after not receiving a single dose of OPV.

As of 11 November, Afghanistan has recorded 24 wild poliovirus cases in 2009: 15 type 1 and nine type 3s. However, a case caused by wild poliovirus type 1 has not been reported since 25 July. In mid-December, it is likely that Afghanistan will become the first country in the world to use the new bivalent oral polio vaccine - a crucial new tool in the polio eradication effort as it is able to tackle both type 1 and type 3 polio serotypes concurrently.

Pakistan has recorded 76 cases in 2009 to date: 52 type 1, 23 type 3, and one type 1/3 mixture.