23088618800ISSNE: 3006-094XP: 3105-0786مجلة علوم طبّی غالبMJhttps://mj.ghalib.edu.af/index.php/mj12503156286500دورة دوم، شمارة دوم، خزان و زمستان 1404، صص 113-122-1905-24003000پوهنتون غالبپولیو در افغانستان: چالشهای کنونی و مسیرهای ریشهکنسازی277114010922000525970596520005100955806450039423859588500امیرحسین غفاری1، محمد فیصل وردک 1،2، عبدالسمیع عظیمی 11. دیپارتمنت پاراکلینیک، پوهنحی/ دانشکدۀ طب معالجهوی، پوهنتون/ دانشگاه غالبِ هرات، هرات، افغانستان.2. مرکز تحقیقات و مجلات علمی، پوهنتون غالب، هرات، افغانستان.چکیده اطلاعات مقالهپیشزمینه: ابتکار جهانی ریشهکنی فلج اطفال، آغاز شده در سال ۱۹۸۸، بروز جهانی فلج اطفال را بیش از ۹۹.۹٪ کاهش داده و نوعهای ۲ و ۳ ویروس وحشی فلج اطفال را ریشهکن کرده است. افغانستان و پاکستان آخرین ذخایر ویروس وحشی فلج اطفال نوع ۱ باقی ماندهاند، با انتقال ادامهدار به دلیل ناامنی، محدودیتهای واکسیناسیون خانهبهخانه، تردید در مورد واکسن و ضعف زیرساختهای بهداشتی.روشها: ما در پایگاههای داده اسکاپوس، پابمد و گوگل اسکالر جستجو کردیم و از کلیدواژههایی مانند «ریشهکنی فلج اطفال در افغانستان»، «ویروس وحشی فلج اطفال نوع ۱»، «تردید در مورد واکسن» و «واکسیناسیون خانهبهخانه» استفاده نمودیم. منابع بررسی شده شامل مقالات مرور شده و گزارشهای خاکستری، از جمله گزارشهای سازمان جهانی صحت و یونیسف بود.یافتهها: جستجو، ۳۴ منبع مرتبط شامل مقالات علمی، گزارشها و ادبیات خاکستری را شناسایی کرد. یافتهها نشان میدهد انتقال ویروس وحشی فلج اطفال نوع ۱ به دلیل ناامنی، محدودیتهای واکسیناسیون و حرکتهای جمعیتی ادامه دارد. پایش محیطی و ژنتیکی، هماهنگی فرامرزی و درسهایی از هند و نیجریه اهمیت ترکیب واکسیناسیون با خدمات بهداشتی گستردهتر، استفاده از ابزارهای دیجیتال مانند سیستمهای اطلاعات جغرافیایی و هوش مصنوعی و تقویت اعتماد جامعه از طریق رهبران محلی را نشان میدهند.نتیجهگیری: ریشهکنی فلج اطفال در افغانستان نیازمند راهبرد چندجانبه است که واکسیناسیون را با خدمات بهداشتی گستردهتر پیوند دهد، از پایش دیجیتال و مشارکت جامعه بهره گیرد، حمایت سیاسی پایدار داشته باشد و هماهنگی قوی با پاکستان برقرار شود.نوع مقاله: مروریتاریخ دریافت: 05/06/1404تاریخ پذیرش: 25/06/1404تاریخ نشر: 31/06/1404شناختنامة نویسندة مسؤول:امیرحسین غفاریدیپارتمنت پاراکلینیک، پوهنحی/ دانشکدۀ طب معالجهوی، پوهنتون/ دانشگاه غالبِ هرات، هرات، افغانستان.50801397000amirhossain.ghaffari@ghalib.edu.afکُد اختصاصیِ مقاله/ DOI: HYPERLINK "https://doi.org/10.58342/ghalibMj.V.2.I.2.11" https://doi.org/10.58342/ghalibMj.V.2.I.2.11 واژهگانِ کلیدی: ریشهکنی پولیو، ویروس پولیوی وحشی نوع اول (WPV1)، استراتیژیهای واکسینشن، افغانستان، صحت جهانیارجاع به این مقاله: غفاری ا ح، وردک م ف، عظیمی ع. پولیو در افغانستان: چالشهای کنونی و مسیرهای ریشهکنسازی. [اینترنت]. 22 سپتامبر ۲۰۲5. [تاریخ برداشت]؛ 2(2): 113- 122: https://doi.org/10.58342/ghalibMj.V.2.I.2.115600700-1397000این مقاله تحت مجوز بینالمللی Creative Commons Attribution 4.0 International License ثبت میباشد.381007937500GHALIB UNIVERSITY GHALIB MEDICAL JOURNAL MJhttps://mj.ghalib.edu.af/index.php/mj12407901905000Vol. 2, Issue. 2, Autumn and Winter 2025, pp 113-12276200010096500ISSNE: 3006-094XP: 3105-0786Polio in Afghanistan: Current Challenges and Pathways to Eradication11969752476500138811010795004531360209550032105602857500 Amir Hossain Ghaffari1*, Mohammad Faisal Wardak1,2, Abdul Sami Azimi11. Paraclinical Department, Faculty of Medicine, Ghalib University, Herat, Afghanistan.2. Research Center and Scientific Journals, Ghalib University-Herat, Herat, Afghanistan.Article Information AbstractType: Review Received: 27/08/2025Accepted: 16/09/2025Published: 22/09/2025*Present address and corresponding author:Amir Hossain GhaffariParaclinical Department, Faculty of Medicine, Ghalib University, Herat, Afghanistan4445731500 amirhossain.ghaffari@ghalib.edu.af DOI: https://doi.org/10.58342/ghalibMj.V.2.I.2.11 Background: The Global Polio Eradication Initiative (GPEI), launched in 1988, has reduced global polio incidence by over 99.9% and eradicated wild poliovirus types 2 and 3. Afghanistan and Pakistan remain the last reservoirs of wild poliovirus type 1 (WPV1), with transmission hindered by insecurity, restrictions on house-to-house vaccination, vaccine hesitancy, and fragile health infrastructure.Methods: We searched Scopus, PubMed, and Google Scholar using keywords such as “Afghanistan polio eradication,” “WPV1,” “vaccine hesitancy,” and “house-to-house vaccination.” Both peer-reviewed and grey literature, including WHO and UNICEF reports, were included.Results: The search identified 34 relevant sources. Findings highlight persistent WPV1 transmission due to insecurity, vaccination restrictions, and population movements. Environmental and genetic surveillance, cross-border coordination, and lessons from India and Nigeria emphasize integrating vaccination with broader health services, using digital tools like Geographic Information Systems (GIS) and Artificial Intelligence (AI), and strengthening community trust through local leaders.Conclusion: Eradication in Afghanistan requires multi-faceted strategies linking vaccination to broader health services, digital surveillance, community engagement, and sustained political commitment, alongside strong coordination with Pakistan.Key words: Polio eradication, Wild poliovirus type 1 (WPV1), Vaccination strategies, Afghanistan, Global health.To cite this article: Ghaffari A H, Wardak M F, Azimi A S. Polio in Afghanistan: Current Challenges and Pathways to Eradication. Ghalib Medical Journal. [Internet]. September 22, 2025. [taking date]; 2(2): 113-122: https://doi.org/10.58342/ghalibMj.V.2.I.2.11This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 International License 13335444500IntroductionThe Global Polio Eradication Initiative (GPEI), launched in 1988, has driven a remarkable reduction of over 99.9% in global polio cases and led to the eradication of two of the three wild poliovirus types (WPV2 and WPV3). However, the final push toward a polio-free world is stalled by the persistent circulation of WPV1 in a single, interconnected epidemiological bloc: Afghanistan and Pakistan ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PlYCsuPp","properties":{"formattedCitation":"[1,2]","plainCitation":"[1,2]","noteIndex":0},"citationItems":[{"id":381,"uris":["http://zotero.org/users/16428907/items/8GRIMZN9"],"itemData":{"id":381,"type":"post-weblog","abstract":"The final phase of the polio eradication effort has proven to be the toughest. The number of children paralyzed by polio has been reduced by 99% over the last","language":"en-GB","title":"Update from the Global Polio Eradication Initiative on programmatic challenges and accountability - GPEI","URL":"https://polioeradication.org/news/update-from-the-global-polio-eradication-initiative-on-programmatic-challenges-and-accountability/","accessed":{"date-parts":[["2025",8,21]]}}},{"id":383,"uris":["http://zotero.org/users/16428907/items/X483EY79"],"itemData":{"id":383,"type":"webpage","language":"en","title":"Poliomyelitis","URL":"https://www.who.int/news-room/questions-and-answers/item/poliomyelitis","accessed":{"date-parts":[["2025",8,21]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [1,2]. The historical context of polio in Afghanistan is one of profound vulnerability, marked by prolonged conflict, political instability, and humanitarian crises that have consistently undermined public health efforts. Historically, the nation has struggled to achieve high vaccination coverage due to a combination of internal conflicts and fragmented governance. Eradicating the virus from this region is both a public health goal and a matter of global health security. Circulating WPV1 threatens polio-free countries with importation and outbreaks, risking reversal of decades of progress ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2HtB7Qv1","properties":{"formattedCitation":"[3]","plainCitation":"[3]","noteIndex":0},"citationItems":[{"id":385,"uris":["http://zotero.org/users/16428907/items/Z3IF7SRS"],"itemData":{"id":385,"type":"article-journal","container-title":"The Lancet Global Health","DOI":"10.1016/S2214-109X(21)00205-9","ISSN":"2214-109X","issue":"8","journalAbbreviation":"The Lancet Global Health","language":"English","note":"publisher: Elsevier\nPMID: 34118192","page":"e1172-e1175","source":"www.thelancet.com","title":"Polio eradication at the crossroads","volume":"9","author":[{"family":"Chumakov","given":"Konstantin"},{"family":"Ehrenfeld","given":"Ellie"},{"family":"Agol","given":"Vadim I."},{"family":"Wimmer","given":"Eckard"}],"issued":{"date-parts":[["2021",8,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [3]. The GPEI’s mission has shifted from vaccination campaigns to a multi-layered effort requiring diplomacy, community trust, and technological innovation to eliminate the last reservoirs of the virus ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"xn9f3zI3","properties":{"formattedCitation":"[1]","plainCitation":"[1]","noteIndex":0},"citationItems":[{"id":381,"uris":["http://zotero.org/users/16428907/items/8GRIMZN9"],"itemData":{"id":381,"type":"post-weblog","abstract":"The final phase of the polio eradication effort has proven to be the toughest. The number of children paralyzed by polio has been reduced by 99% over the last","language":"en-GB","title":"Update from the Global Polio Eradication Initiative on programmatic challenges and accountability - GPEI","URL":"https://polioeradication.org/news/update-from-the-global-polio-eradication-initiative-on-programmatic-challenges-and-accountability/","accessed":{"date-parts":[["2025",8,21]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [1]. GPEI has had a long and complex history in Afghanistan ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Hw6NpLGa","properties":{"formattedCitation":"[4]","plainCitation":"[4]","noteIndex":0},"citationItems":[{"id":390,"uris":["http://zotero.org/users/16428907/items/X3E3WNIS"],"itemData":{"id":390,"type":"post-weblog","abstract":"Afghanistan’s long struggle to eradicate polio is showing strong signs that the country is closer than it has ever been to finally stopping the disease, once","language":"en-GB","title":"Staying the course on the long road - GPEI","URL":"https://polioeradication.org/news/staying-the-course-on-the-long-road/","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [4]. In the early 1990s, despite civil war, the polio program achieved success by negotiating local cease-fires and creating safe corridors that allowed vaccination teams to reach children on both sides of the conflict ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Vrce3tSQ","properties":{"formattedCitation":"[5,6]","plainCitation":"[5,6]","noteIndex":0},"citationItems":[{"id":394,"uris":["http://zotero.org/users/16428907/items/I8WGWNJU"],"itemData":{"id":394,"type":"webpage","title":"Approaching Days of Tranquility: Afghanistan Polio Eradication Initiative | The Communication Initiative","URL":"https://global.comminit.com/content/approaching-days-tranquility-afghanistan-polio-eradication-initiative","accessed":{"date-parts":[["2025",8,28]]}}},{"id":393,"uris":["http://zotero.org/users/16428907/items/MGRHMBPF"],"itemData":{"id":393,"type":"article-journal","language":"en","source":"Zotero","title":"Polio: The beginning of the end"}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [5,6]. This period demonstrated that even in the most challenging security environments, sustained political will and persistent diplomacy could yield real gains ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"14V16KcZ","properties":{"formattedCitation":"[7]","plainCitation":"[7]","noteIndex":0},"citationItems":[{"id":396,"uris":["http://zotero.org/users/16428907/items/CH5PQHBX"],"itemData":{"id":396,"type":"webpage","title":"Progress Toward Poliomyelitis Eradication --- Afghanistan, 1999--2000","URL":"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5008a3.htm","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [7]. As a result, polio cases dropped significantly; by the mid-2000s Afghanistan was nearing polio-free status, with annual case numbers falling into the single digits ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"44Ur0m3Q","properties":{"formattedCitation":"[8]","plainCitation":"[8]","noteIndex":0},"citationItems":[{"id":398,"uris":["http://zotero.org/users/16428907/items/EMCDM78V"],"itemData":{"id":398,"type":"webpage","title":"Progress Toward Poliomyelitis Eradication --- Pakistan and Afghanistan, January 2000--April 2002","URL":"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5124a1.htm","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [8]. However, this progress was not sustained. The mid-2010s saw a sharp resurgence in polio cases, driven by escalating conflict, the rise of new insurgent groups, and renewed restrictions on house-to-house vaccination campaigns ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"83cYcYqj","properties":{"formattedCitation":"[9,10]","plainCitation":"[9,10]","noteIndex":0},"citationItems":[{"id":402,"uris":["http://zotero.org/users/16428907/items/MEWJXQHW"],"itemData":{"id":402,"type":"article-newspaper","abstract":"Development marks attitude change of militants, who previously allowed medics into region but now suspect them of spying","container-title":"The Guardian","ISSN":"0261-3077","language":"en-GB","section":"World news","source":"The Guardian","title":"Afghan Taliban bans polio vaccination teams from southern Helmand","URL":"https://www.theguardian.com/world/2014/jul/08/afghan-taliban-bans-polio-vaccination-teams-southern-helmand-province","author":[{"family":"Graham-Harrison","given":"Emma"}],"accessed":{"date-parts":[["2025",8,28]]},"issued":{"date-parts":[["2014",7,8]]}}},{"id":400,"uris":["http://zotero.org/users/16428907/items/QL44IJXJ"],"itemData":{"id":400,"type":"article-journal","abstract":"Indigenous transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Pakistan, India, and Nigeria. Among those countries, Afghanistan and Pakistan represent a common epidemiologic reservoir. This report updates previous reports (1,4) and describes polio eradication activities and progress in Afghanistan and Pakistan during January 2010--September 2011, as of October 31, 2011, and planned activities during 2011--2012 to address challenges to polio eradication. In Afghanistan, WPV transmission during 2010--2011 predominantly occurred in the conflict-affected South Region and the adjacent Farah Province of the West Region. During 2010, 25 WPV cases were confirmed in Afghanistan, compared with 38 in 2009; 42 WPV cases were confirmed during January--September 2011, compared with 19 for the same period in 2010. In Pakistan, WPV transmission during 2010--2011occurred both in conflict-affected, inaccessible areas along the common border with Afghanistan and in accessible areas; 144 WPV cases were confirmed in 2010, compared with 89 in 2009, and 120 WPV cases were confirmed during January--September 2011, compared with 93 during the same period in 2010. In Pakistan, the president launched a National Emergency Action Plan for polio eradication in January 2011, emphasizing the key role and responsibility of political and health-care leaders at the district and subdistrict (union council) levels. Enhanced commitment, management, and oversight by provincial and district authorities will be needed to achieve further progress toward interruption of WPV transmission in Pakistan. Continued efforts also will be needed to enhance the safety of vaccination teams within insecure areas of both countries.","container-title":"MMWR. Morbidity and mortality weekly report","ISSN":"1545-861X","issue":"44","journalAbbreviation":"MMWR Morb Mortal Wkly Rep","language":"eng","note":"PMID: 22071591","page":"1523-1527","source":"PubMed","title":"Progress toward poliomyelitis eradication--Afghanistan and Pakistan, January 2010-September 2011","volume":"60","author":[{"literal":"Centers for Disease Control and Prevention (CDC)"}],"issued":{"date-parts":[["2011",11,11]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [9,10]. A turning point was the exposure of a CIA-run (Central Intelligence Agency) fake vaccination program in neighboring Pakistan, which sowed deep mistrust in vaccination campaigns. Militants came to view vaccination teams as instruments of intelligence gathering, leading to widespread bans on immunization and heightened resistance, particularly in southern Afghanistan, the stronghold of insurgent groups ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"weaDEA43","properties":{"formattedCitation":"[9]","plainCitation":"[9]","noteIndex":0},"citationItems":[{"id":402,"uris":["http://zotero.org/users/16428907/items/MEWJXQHW"],"itemData":{"id":402,"type":"article-newspaper","abstract":"Development marks attitude change of militants, who previously allowed medics into region but now suspect them of spying","container-title":"The Guardian","ISSN":"0261-3077","language":"en-GB","section":"World news","source":"The Guardian","title":"Afghan Taliban bans polio vaccination teams from southern Helmand","URL":"https://www.theguardian.com/world/2014/jul/08/afghan-taliban-bans-polio-vaccination-teams-southern-helmand-province","author":[{"family":"Graham-Harrison","given":"Emma"}],"accessed":{"date-parts":[["2025",8,28]]},"issued":{"date-parts":[["2014",7,8]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [9]. After the Taliban takeover, restrictions were imposed on house to house vaccination campaigns, particularly in the southern and southeastern regions, as well as on broader supplementary immunization activities (SIAs) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"FxpvO5mA","properties":{"formattedCitation":"[11]","plainCitation":"[11]","noteIndex":0},"citationItems":[{"id":522,"uris":["http://zotero.org/users/16428907/items/LGFKFAAK"],"itemData":{"id":522,"type":"article-journal","container-title":"Morbidity and Mortality Weekly Report","DOI":"10.15585/mmwr.mm7149a1","issue":"49","language":"en","note":"PMID: 36480464","page":"1541","source":"pmc.ncbi.nlm.nih.gov","title":"Progress Toward Poliomyelitis Eradication ― Afghanistan, January 2021–September 2022","volume":"71","author":[{"family":"Mohamed","given":"Abdinoor"},{"family":"Akbar","given":"Irfan Elahi"},{"family":"Chaudhury","given":"Sumangala"},{"family":"Wadood","given":"Mufti Zubair"},{"family":"Ather","given":"Fazal"},{"family":"Jorba","given":"Jaume"},{"family":"Martinez","given":"Maureen"}],"issued":{"date-parts":[["2022",12,9]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [11]. Beginning in 2022, however, Afghanistan gradually reintroduced nationwide house to house campaigns, a globally recognized standard that proved far more effective than fixed posts. In early 2024, the program expanded efforts by supporting hard to reach children and strengthening community engagement. With nationwide access restored, 99 percent of children were vaccinated during the June and July SIAs, and coverage improved across all regions. Yet in August authorities unexpectedly reversed this decision, and September SIA was postponed to revise fixed site strategies. Monitoring data showed that non house to house modalities consistently achieved low coverage, especially in the South, the epicenter of ongoing transmission. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XZb1mzOB","properties":{"formattedCitation":"[12]","plainCitation":"[12]","noteIndex":0},"citationItems":[{"id":519,"uris":["http://zotero.org/users/16428907/items/SEBDHLTR"],"itemData":{"id":519,"type":"article-journal","container-title":"Morbidity and Mortality Weekly Report","DOI":"10.15585/mmwr.mm7349a4","ISSN":"0149-2195","issue":"49","journalAbbreviation":"MMWR Morb Mortal Wkly Rep","note":"PMID: 39666643\nPMCID: PMC11637418","page":"1129-1134","source":"PubMed Central","title":"Progress Toward Poliomyelitis Eradication — Afghanistan, January 2023–September 2024","volume":"73","author":[{"family":"Hardy","given":"Colleen Mone"},{"family":"Rathee","given":"Mandeep"},{"family":"Chaudhury","given":"Sumangala"},{"family":"Wadood","given":"Mufti Zubair"},{"family":"Ather","given":"Fazal"},{"family":"Henderson","given":"Elizabeth"},{"family":"Martinez","given":"Maureen"}],"issued":{"date-parts":[["2024",12,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [12]. The historical pattern of rapid advances followed by sharp setbacks demonstrates that progress in polio control is fragile and can be easily reversed without sustained political commitment and strong community trust ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1IBtXnBw","properties":{"formattedCitation":"[9]","plainCitation":"[9]","noteIndex":0},"citationItems":[{"id":402,"uris":["http://zotero.org/users/16428907/items/MEWJXQHW"],"itemData":{"id":402,"type":"article-newspaper","abstract":"Development marks attitude change of militants, who previously allowed medics into region but now suspect them of spying","container-title":"The Guardian","ISSN":"0261-3077","language":"en-GB","section":"World news","source":"The Guardian","title":"Afghan Taliban bans polio vaccination teams from southern Helmand","URL":"https://www.theguardian.com/world/2014/jul/08/afghan-taliban-bans-polio-vaccination-teams-southern-helmand-province","author":[{"family":"Graham-Harrison","given":"Emma"}],"accessed":{"date-parts":[["2025",8,28]]},"issued":{"date-parts":[["2014",7,8]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [9]. This review aims to critically examine the current challenges to polio eradication in Afghanistan and to outline potential pathways for achieving a polio-free future.Epidemiology of Polio in AfghanistanIn 2023, Afghanistan reported six wild poliovirus type 1 (WPV1) cases ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"tlIS0e7m","properties":{"formattedCitation":"[13,14]","plainCitation":"[13,14]","noteIndex":0},"citationItems":[{"id":404,"uris":["http://zotero.org/users/16428907/items/CBC2SUCG"],"itemData":{"id":404,"type":"webpage","abstract":"The thirty-eighth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 20 March 2024 with committee members and advisers meeting via video conference with affected countries, supported by the WHO Secretariat.","language":"en","title":"Statement following the Thirty-eighth Meeting of the IHR Emergency Committee for Polio","URL":"https://www.who.int/news/item/08-04-2024-statement-following-the-thirty-eighth-meeting-of-the-ihr-emergency-committee-for-polio","accessed":{"date-parts":[["2025",8,28]]}}},{"id":527,"uris":["http://zotero.org/users/16428907/items/ZQ8TBVW5"],"itemData":{"id":527,"type":"article-journal","abstract":"After the August 2021 political change in Afghanistan, millions of inaccessible target children in polio campaigns became accessible. The change improved oral polio vaccine coverage and polio surveillance performance. Nonhousehold implementation of polio campaigns remains a significant challenge., \nGraphical Abstract","container-title":"The Journal of Infectious Diseases","DOI":"10.1093/infdis/jiae129","ISSN":"0022-1899","issue":"2","journalAbbreviation":"J Infect Dis","note":"PMID: 38597896\nPMCID: PMC11841624","page":"e438-e445","source":"PubMed Central","title":"Progress in Access and Oral Polio Vaccine Coverage Among Children Aged <5 Years in Polio Campaigns After the Political Change in Afghanistan","volume":"231","author":[{"family":"Sabawoon","given":"Wrishmeen"},{"family":"Seino","given":"Shion"},{"family":"Pason","given":"Bakht Mohmmad"},{"family":"Momin","given":"Nek Wali Shah"},{"family":"Kanamori","given":"Sayako"},{"family":"Bender","given":"Connor"},{"family":"Takemura","given":"Kazuhisa"}],"issued":{"date-parts":[["2024",4,10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [13,14]. This rose dramatically in 2024 (25 cases), and by early 2025 an additional 1 case had been reported. Environmental surveillance in 2024 detected WPV1 in ten Afghan provinces (e.g., Kandahar, Helmand, Uruzgan, Nangarhar, Laghman, Kunar, Kabul, Ghazni, Herat, Paktia), indicating widespread silent circulation as shown in Table 1 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ZXpHydnB","properties":{"formattedCitation":"[15]","plainCitation":"[15]","noteIndex":0},"citationItems":[{"id":407,"uris":["http://zotero.org/users/16428907/items/W9ZWHMG7"],"itemData":{"id":407,"type":"document","publisher":"Global Polio Erdaication Initiative","title":"General factsheet","URL":"https://polioeradication.org/wp-content/uploads/2025/04/GPEI-general-factsheet-20250401.pdf","issued":{"date-parts":[["2025",4,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [15]. The WHO Emergency Committee noted that the virus had spread to new provinces in 2024 and emphasized that transmission remained most intense in the southern cross-border corridor linking the Quetta Block (Pakistan) and southern Afghanistan. It also warned that the persistence of WPV1 transmission despite ongoing campaigns highlights gaps in immunization quality, and that transmission during the low season could worsen without consistently high-quality campaigns ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"UOwO8iqu","properties":{"formattedCitation":"[16]","plainCitation":"[16]","noteIndex":0},"citationItems":[{"id":409,"uris":["http://zotero.org/users/16428907/items/J6K4EY3F"],"itemData":{"id":409,"type":"webpage","abstract":"The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV) in the context of the global target of interruption and certification of WPV1 eradication by 2027 and interruption and certification of cVDPV2 elimination by 2029. Technical updates were received about the situation in the following countries: Afghanistan, Algeria, Chad, Democratic Republic of the Congo (DR Congo), Djibouti, Ethiopia, Germany, Pakistan, Poland and the United Kingdom of Great Britain and Northern Ireland.","language":"en","title":"Statement of the forty-first meeting of the Polio IHR Emergency Committee","URL":"https://www.who.int/news/item/10-04-2025-statement-of-the-forty-first-meeting-of-the-polio-ihr-emergency-committee","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [16]. The GPEI’s strategy continues to target interrupting WPV1 transmission by the end of 2025 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Z5VL7D6u","properties":{"formattedCitation":"[17]","plainCitation":"[17]","noteIndex":0},"citationItems":[{"id":411,"uris":["http://zotero.org/users/16428907/items/UZKQLRL4"],"itemData":{"id":411,"type":"webpage","container-title":"World Health Organization - Regional Office for the Eastern Mediterranean","language":"en-gb","title":"Afghanistan","URL":"http://www.emro.who.int/polio-eradication/priority-countries/afghanistan.html","author":[{"family":"Administrator","given":""}],"accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [17].Genetic sequencing of poliovirus isolates has become a key tool for tracing outbreaks, helping to confirm virus sources, establish links between cases, and track transmission pathways. For example, one study that characterized WPV1 strains from 2010–2012 found a close genetic link between isolates of Cluster C1 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ZvjHzNL8","properties":{"formattedCitation":"[18]","plainCitation":"[18]","noteIndex":0},"citationItems":[{"id":413,"uris":["http://zotero.org/users/16428907/items/RM8EXTJK"],"itemData":{"id":413,"type":"article-journal","abstract":"Pakistan and Afghanistan share a long uncontrolled border with extensive population movement on both sides. Wild poliovirus transmission has never been interrupted in this block due to war against terrorism, poor public health infrastructure, misconceptions about polio vaccines and inadequate immunization activities. All these issues complicate the eradication operations and reinforce the complexity of wiping out poliomyelitis from this region. This study illustrates the origins and routes of cross-border wild poliovirus type 1 (WPV1) transmission during 2010–2012 between Pakistan and Afghanistan. Sequence analyses were conducted based on complete VP1 capsid protein sequences for WPV1 study strains to determine the origin of poliovirus genetic lineages and their evolutionary relationships. Phylogenetic tree was constructed from VP1 gene sequences applying Maximum Likelihood method using Kimura 2- parameter model in MEGA program v 5.0. A total of 72 (14.3%) out of 502 wild-type 1 polioviruses were found circulating in border areas of both countries during 2010–2012. Molecular phylogenetic analysis classified these strains in to two sub-genotypes with four clusters and 18 lineages. Genetic data confirmed that the most of WPV1 lineages (12; 66.6%) were transmitted from Pakistan to Afghanistan. However, the genetic diversity was significantly reduced during 2012 as most of the lineages were completely eliminated. In conclusion, Pakistan-Afghanistan block has emerged as a single poliovirus reservoir sharing the multiple poliovirus lineages due to uncontrolled movement of people across the borders between two countries. If it is neglected, it can jeopardize the extensive global efforts done so-far to eradicate the poliovirus infection. Our data will be helpful to devise the preventive strategies for effective control of wild poliovirus transmission in this region.","container-title":"PLoS ONE","DOI":"10.1371/journal.pone.0107697","ISSN":"1932-6203","issue":"9","journalAbbreviation":"PLoS One","note":"PMID: 25229826\nPMCID: PMC4168008","page":"e107697","source":"PubMed Central","title":"Molecular Characterization and Phylogenetic Relationship of Wild Type 1 Poliovirus Strains Circulating across Pakistan and Afghanistan Bordering Areas during 2010–2012","volume":"9","author":[{"family":"Shaukat","given":"Shahzad"},{"family":"Angez","given":"Mehar"},{"family":"Alam","given":"Muhammad Masroor"},{"family":"Sharif","given":"Salmaan"},{"family":"Khurshid","given":"Adnan"},{"family":"Malik","given":"Farzana"},{"family":"Rehman","given":"Lubna"},{"family":"Zaidi","given":"Syed Sohail Zahoor"}],"issued":{"date-parts":[["2014",9,17]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [18]. Likewise, WHO reports from 2023–2024 show that most WPV1 cases in Pakistan and Afghanistan belong to interlinked genetic clusters (e.g., YB3A and YB3C), reflecting frequent virus flow across the porous border. These genetic data confirm that polio routinely crosses the Afghan Pakistani border, underscoring the need for synchronized, high-quality vaccination campaigns on both sides ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"g4h4WPuR","properties":{"formattedCitation":"[13,18]","plainCitation":"[13,18]","noteIndex":0},"citationItems":[{"id":413,"uris":["http://zotero.org/users/16428907/items/RM8EXTJK"],"itemData":{"id":413,"type":"article-journal","abstract":"Pakistan and Afghanistan share a long uncontrolled border with extensive population movement on both sides. Wild poliovirus transmission has never been interrupted in this block due to war against terrorism, poor public health infrastructure, misconceptions about polio vaccines and inadequate immunization activities. All these issues complicate the eradication operations and reinforce the complexity of wiping out poliomyelitis from this region. This study illustrates the origins and routes of cross-border wild poliovirus type 1 (WPV1) transmission during 2010–2012 between Pakistan and Afghanistan. Sequence analyses were conducted based on complete VP1 capsid protein sequences for WPV1 study strains to determine the origin of poliovirus genetic lineages and their evolutionary relationships. Phylogenetic tree was constructed from VP1 gene sequences applying Maximum Likelihood method using Kimura 2- parameter model in MEGA program v 5.0. A total of 72 (14.3%) out of 502 wild-type 1 polioviruses were found circulating in border areas of both countries during 2010–2012. Molecular phylogenetic analysis classified these strains in to two sub-genotypes with four clusters and 18 lineages. Genetic data confirmed that the most of WPV1 lineages (12; 66.6%) were transmitted from Pakistan to Afghanistan. However, the genetic diversity was significantly reduced during 2012 as most of the lineages were completely eliminated. In conclusion, Pakistan-Afghanistan block has emerged as a single poliovirus reservoir sharing the multiple poliovirus lineages due to uncontrolled movement of people across the borders between two countries. If it is neglected, it can jeopardize the extensive global efforts done so-far to eradicate the poliovirus infection. Our data will be helpful to devise the preventive strategies for effective control of wild poliovirus transmission in this region.","container-title":"PLoS ONE","DOI":"10.1371/journal.pone.0107697","ISSN":"1932-6203","issue":"9","journalAbbreviation":"PLoS One","note":"PMID: 25229826\nPMCID: PMC4168008","page":"e107697","source":"PubMed Central","title":"Molecular Characterization and Phylogenetic Relationship of Wild Type 1 Poliovirus Strains Circulating across Pakistan and Afghanistan Bordering Areas during 2010–2012","volume":"9","author":[{"family":"Shaukat","given":"Shahzad"},{"family":"Angez","given":"Mehar"},{"family":"Alam","given":"Muhammad Masroor"},{"family":"Sharif","given":"Salmaan"},{"family":"Khurshid","given":"Adnan"},{"family":"Malik","given":"Farzana"},{"family":"Rehman","given":"Lubna"},{"family":"Zaidi","given":"Syed Sohail Zahoor"}],"issued":{"date-parts":[["2014",9,17]]}}},{"id":404,"uris":["http://zotero.org/users/16428907/items/CBC2SUCG"],"itemData":{"id":404,"type":"webpage","abstract":"The thirty-eighth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 20 March 2024 with committee members and advisers meeting via video conference with affected countries, supported by the WHO Secretariat.","language":"en","title":"Statement following the Thirty-eighth Meeting of the IHR Emergency Committee for Polio","URL":"https://www.who.int/news/item/08-04-2024-statement-following-the-thirty-eighth-meeting-of-the-ihr-emergency-committee-for-polio","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [13,18]. Many infections remain silent (non-paralytic), so weak surveillance can mask ongoing circulation. Pakistan’s data illustrate this: sewage samples showed a spike in WPV1 despite few detected cases, due to gaps in local AFP (acute flaccid paralysis) reporting ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"KAMFDPOT","properties":{"formattedCitation":"[19]","plainCitation":"[19]","noteIndex":0},"citationItems":[{"id":416,"uris":["http://zotero.org/users/16428907/items/2QJPL7BQ"],"itemData":{"id":416,"type":"article-journal","abstract":"Since its launch in 1988, the Global Polio Eradication Initiative has made substantial progress toward the eradication of wild poliovirus (WPV), including eradicating two of the three serotypes, and reducing the countries with ongoing endemic transmission of WPV type 1 (WPV1) to just Afghanistan and Pakistan. Both countries are considered a single epidemiologic block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 over the subsequent 12 months, specifically in the historical reservoirs of the cities of Karachi, Peshawar, and Quetta. As of June 30, 2024, eight WPV1 cases had been reported in Pakistan in 2024, compared with six reported during all of 2023. These cases, along with more than 300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels, would be vital for the polio program. Efforts to systematically track and vaccinate children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy.","container-title":"MMWR. Morbidity and mortality weekly report","DOI":"10.15585/mmwr.mm7336a2","ISSN":"1545-861X","issue":"36","journalAbbreviation":"MMWR Morb Mortal Wkly Rep","language":"eng","note":"PMID: 39264848\nPMCID: PMC11392225","page":"788-792","source":"PubMed","title":"Progress Toward Poliomyelitis Eradication - Pakistan, January 2023-June 2024","volume":"73","author":[{"family":"Mbaeyi","given":"Chukwuma"},{"family":"Ul Haq","given":"Anwaar"},{"family":"Safdar","given":"Rana Muhammad"},{"family":"Khan","given":"Zainul"},{"family":"Corkum","given":"Melissa"},{"family":"Henderson","given":"Elizabeth"},{"family":"Wadood","given":"Zubair M."},{"family":"Alam","given":"Muhammad Masroor"},{"family":"Franka","given":"Richard"}],"issued":{"date-parts":[["2024",9,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [19]. In short, subnational AFP surveillance has been uneven, allowing hidden transmission. A robust surveillance system including environmental sampling and genetic analysis is therefore critical to detect and respond to these hidden chains ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"MyoZw7r7","properties":{"formattedCitation":"[18,19]","plainCitation":"[18,19]","noteIndex":0},"citationItems":[{"id":413,"uris":["http://zotero.org/users/16428907/items/RM8EXTJK"],"itemData":{"id":413,"type":"article-journal","abstract":"Pakistan and Afghanistan share a long uncontrolled border with extensive population movement on both sides. Wild poliovirus transmission has never been interrupted in this block due to war against terrorism, poor public health infrastructure, misconceptions about polio vaccines and inadequate immunization activities. All these issues complicate the eradication operations and reinforce the complexity of wiping out poliomyelitis from this region. This study illustrates the origins and routes of cross-border wild poliovirus type 1 (WPV1) transmission during 2010–2012 between Pakistan and Afghanistan. Sequence analyses were conducted based on complete VP1 capsid protein sequences for WPV1 study strains to determine the origin of poliovirus genetic lineages and their evolutionary relationships. Phylogenetic tree was constructed from VP1 gene sequences applying Maximum Likelihood method using Kimura 2- parameter model in MEGA program v 5.0. A total of 72 (14.3%) out of 502 wild-type 1 polioviruses were found circulating in border areas of both countries during 2010–2012. Molecular phylogenetic analysis classified these strains in to two sub-genotypes with four clusters and 18 lineages. Genetic data confirmed that the most of WPV1 lineages (12; 66.6%) were transmitted from Pakistan to Afghanistan. However, the genetic diversity was significantly reduced during 2012 as most of the lineages were completely eliminated. In conclusion, Pakistan-Afghanistan block has emerged as a single poliovirus reservoir sharing the multiple poliovirus lineages due to uncontrolled movement of people across the borders between two countries. If it is neglected, it can jeopardize the extensive global efforts done so-far to eradicate the poliovirus infection. Our data will be helpful to devise the preventive strategies for effective control of wild poliovirus transmission in this region.","container-title":"PLoS ONE","DOI":"10.1371/journal.pone.0107697","ISSN":"1932-6203","issue":"9","journalAbbreviation":"PLoS One","note":"PMID: 25229826\nPMCID: PMC4168008","page":"e107697","source":"PubMed Central","title":"Molecular Characterization and Phylogenetic Relationship of Wild Type 1 Poliovirus Strains Circulating across Pakistan and Afghanistan Bordering Areas during 2010–2012","volume":"9","author":[{"family":"Shaukat","given":"Shahzad"},{"family":"Angez","given":"Mehar"},{"family":"Alam","given":"Muhammad Masroor"},{"family":"Sharif","given":"Salmaan"},{"family":"Khurshid","given":"Adnan"},{"family":"Malik","given":"Farzana"},{"family":"Rehman","given":"Lubna"},{"family":"Zaidi","given":"Syed Sohail Zahoor"}],"issued":{"date-parts":[["2014",9,17]]}}},{"id":416,"uris":["http://zotero.org/users/16428907/items/2QJPL7BQ"],"itemData":{"id":416,"type":"article-journal","abstract":"Since its launch in 1988, the Global Polio Eradication Initiative has made substantial progress toward the eradication of wild poliovirus (WPV), including eradicating two of the three serotypes, and reducing the countries with ongoing endemic transmission of WPV type 1 (WPV1) to just Afghanistan and Pakistan. Both countries are considered a single epidemiologic block. Despite the occurrence of only a single confirmed WPV1 case during the first half of 2023, Pakistan experienced widespread circulation of WPV1 over the subsequent 12 months, specifically in the historical reservoirs of the cities of Karachi, Peshawar, and Quetta. As of June 30, 2024, eight WPV1 cases had been reported in Pakistan in 2024, compared with six reported during all of 2023. These cases, along with more than 300 WPV1-positive environmental surveillance (sewage) samples reported during 2023-2024, indicate that Pakistan is not on track to interrupt WPV1 transmission. The country's complex sociopolitical and security environment continues to pose formidable challenges to poliovirus elimination. To interrupt WPV1 transmission, sustained political commitment to polio eradication, including increased accountability at all levels, would be vital for the polio program. Efforts to systematically track and vaccinate children who are continually missed during polio vaccination activities should be enhanced by better addressing operational issues and the underlying reasons for community resistance to vaccination and vaccine hesitancy.","container-title":"MMWR. Morbidity and mortality weekly report","DOI":"10.15585/mmwr.mm7336a2","ISSN":"1545-861X","issue":"36","journalAbbreviation":"MMWR Morb Mortal Wkly Rep","language":"eng","note":"PMID: 39264848\nPMCID: PMC11392225","page":"788-792","source":"PubMed","title":"Progress Toward Poliomyelitis Eradication - Pakistan, January 2023-June 2024","volume":"73","author":[{"family":"Mbaeyi","given":"Chukwuma"},{"family":"Ul Haq","given":"Anwaar"},{"family":"Safdar","given":"Rana Muhammad"},{"family":"Khan","given":"Zainul"},{"family":"Corkum","given":"Melissa"},{"family":"Henderson","given":"Elizabeth"},{"family":"Wadood","given":"Zubair M."},{"family":"Alam","given":"Muhammad Masroor"},{"family":"Franka","given":"Richard"}],"issued":{"date-parts":[["2024",9,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [18,19].Table 1. WPV 1 Cases and Environmental Detections in Afghanistan and Pakistan (2024-2025) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"YTz9H9v7","properties":{"formattedCitation":"[20,21]","plainCitation":"[20,21]","noteIndex":0},"citationItems":[{"id":420,"uris":["http://zotero.org/users/16428907/items/XPJMR8SY"],"itemData":{"id":420,"type":"post-weblog","language":"en-GB","title":"Vaccination campaigns - GPEI","URL":"https://polioeradication.org/news-categories/vaccination-campaigns/","accessed":{"date-parts":[["2025",8,28]]}}},{"id":419,"uris":["http://zotero.org/users/16428907/items/IK47Y2QP"],"itemData":{"id":419,"type":"article-journal","abstract":"After the Global Polio Eradication Initiative was established, the global incidence of polio decreased by 99 percent. However, from a global perspective, the number of polio cases in Afghanistan is still increasing, therefore more attention should be brought to the issue of polio eradication in Afghanistan. This article is set out to revisit and analyze the interventions and challenges of polio eradication in Afghanistan. Data in the article are obtained from various academic journals and official public health websites. After reviewing the research results of public health experts throughout the years, it is evident that despite using multiple intervention measures in the eradication process, more effort is needed to address the challenges that are specific to different areas of Afghanistan. In the recent future, more cases of polio are expected due to the COVID-19 pandemic. Therefore, public health workers must increase the intensity of polio surveillance in Afghanistan and ensure that there are sufficient vaccines in stock when house-to-house vaccination begins again.","container-title":"E3S Web of Conferences","DOI":"10.1051/e3sconf/202127103029","ISSN":"2267-1242","journalAbbreviation":"E3S Web Conf.","language":"en","license":"https://creativecommons.org/licenses/by/4.0/","page":"03029","source":"DOI.org (Crossref)","title":"Polio in Afghanistan: a systemic review on eradication interventions and challenges","title-short":"Polio in Afghanistan","volume":"271","author":[{"family":"Lin","given":"Yitong"}],"editor":[{"family":"Zhu","given":"T."},{"family":"Anpo","given":"M."},{"family":"Sharifi","given":"A."}],"issued":{"date-parts":[["2021"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [20,21]YearCountryTotal WPV1 CasesTotal WPV1 Environmental SamplesKey Affected Regions/Provinces2024Afghanistan25 113 South Region 2024Pakistan74 628 Khyber Pakhtunkhwa, Sindh, Balochistan, Karachi, South KP, Central Pakistan 2025 (as of June 4)Afghanistan1 30 South Region, Badghis province 2025 (as of June 4)Pakistan8 245 Quetta Block, Karachi, South KP, Central Pakistan Note: The southern cross-border epidemiological corridor, encompassing Afghanistan's South Region and Pakistan's Quetta Block, experiences the most intense WPV1 transmission ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XbNzwXu0","properties":{"formattedCitation":"[20]","plainCitation":"[20]","noteIndex":0},"citationItems":[{"id":420,"uris":["http://zotero.org/users/16428907/items/XPJMR8SY"],"itemData":{"id":420,"type":"post-weblog","language":"en-GB","title":"Vaccination campaigns - GPEI","URL":"https://polioeradication.org/news-categories/vaccination-campaigns/","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [20]. Key Challenges to Polio Eradication: A Critical DiscussionSecurity and AccessOngoing conflict and distrust have severely curtailed vaccination access. Since May 2018, the Islamic Emirate of Afghanistan has intermittently prohibited house-to-house vaccination campaigns, with repeated on-and-off restrictions. These interruptions have resulted in approximately 3.4 million children being missed in each national immunization round. Currently, the ban remains in effect ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"xn9lc9n4","properties":{"formattedCitation":"[22]","plainCitation":"[22]","noteIndex":0},"citationItems":[{"id":422,"uris":["http://zotero.org/users/16428907/items/5GH99MMB"],"itemData":{"id":422,"type":"webpage","abstract":"Reaching every child in Afghanistan with polio vaccines","language":"en","title":"Polio eradication | UNICEF Afghanistan","URL":"https://www.unicef.org/afghanistan/polio-eradication","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [22]. This mirrors Nigeria’s experience, where political bans created huge immunity gaps. Afghanistan’s switch to site-to-site delivery has partly adapted, but WHO warns that site-to-site campaigns often fail to reach all children particularly younger children and girls ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ryxhvT9A","properties":{"formattedCitation":"[23]","plainCitation":"[23]","noteIndex":0},"citationItems":[{"id":424,"uris":["http://zotero.org/users/16428907/items/FR7LL9HS"],"itemData":{"id":424,"type":"webpage","abstract":"The Forty-second meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 18 June 2025 with committee members and advisers meeting via video conference with affected countries, supported by the WHO Secretariat. The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV) in the context of the global target of interruption and certification of WPV1 eradication by 2027 and interruption and certification of cVDPV2 elimination by 2029.","language":"en","title":"Statement of the Forty-second meeting of the Polio IHR Emergency Committee","URL":"https://www.who.int/news/item/28-07-2025-statement-of-the-forty-second-meeting-of-the-polio-ihr-emergency-committee","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [23]. In practice, this means many toddlers and girls slip through the cracks, keeping the virus alive.Violence against vaccinators compounds these problems. Over the past decade dozens of polio workers (most of them being female vaccinators) have been assassinated, creating a climate of terror. A UNICEF polio official noted that after three vaccinators were killed, officials considered security escorts for women workers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"3SZoz0QE","properties":{"formattedCitation":"[24]","plainCitation":"[24]","noteIndex":0},"citationItems":[{"id":426,"uris":["http://zotero.org/users/16428907/items/UXHTTXJ4"],"itemData":{"id":426,"type":"webpage","abstract":"The women are the latest victims in a campaign against health care workers as violence has increased while peace talks between the government and Taliban continue.","container-title":"dw.com","language":"en","title":"Three female polio workers shot dead in Afghanistan – DW – 03/30/2021","URL":"https://www.dw.com/en/afghanistan-3-female-polio-workers-shot-dead/a-57047830","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [24]. Such attacks, whether carried out by militant groups or unidentified gunmen, discourage new recruits and leave rural areas unvaccinated.Vaccine Hesitancy and Community ResistanceDistrust of polio campaigns in Afghanistan is deeply rooted in history. Many communities recall past abuse. For example, in 2011 the CIA used a fake vaccination campaign to collect DNA during the search for Bin Laden, which severely damaged confidence in immunization programs. Since then, rumors have spread that vaccines are a foreign plot or cause infertility. One field report noted families refusing polio drops, believing vaccination would 'compromise their children’s fertility. For locals, these fears are not irrational but reflect long-standing suspicion of outside actors. Misinformation and cultural beliefs continue to fuel hesitancy, with caregivers in conflict zones often reporting distrust of health workers and negative attitudes toward vaccination ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"rMSHdDTK","properties":{"formattedCitation":"[25]","plainCitation":"[25]","noteIndex":0},"citationItems":[{"id":428,"uris":["http://zotero.org/users/16428907/items/N6Z3ZI8K"],"itemData":{"id":428,"type":"webpage","abstract":"For the past decade, Sughra Ayaz has traveled door to door in southeastern Pakistan, pleading with parents to allow children to be vaccinated against polio as part of a global campaign to wipe out the paralytic disease. She hears their demands and fears. Some are practical – families need basics like food and water more than vaccines. Others are simply unfounded – the oral doses are meant to sterilize their kids.","container-title":"CNN","language":"en","title":"The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback","URL":"https://www.cnn.com/2025/08/05/health/polio-eradication-missteps","accessed":{"date-parts":[["2025",8,28]]},"issued":{"date-parts":[["2025",8,5]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [25]. Specific myths continue to circulate, such as claims that the vaccine causes infertility or that it is un-Islamic, especially in the South. Experts emphasize that top-down messages alone are not enough. Eradication requires community-led strategies, with trusted local leaders and religious figures addressing rumors directly ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"NPgXdZKg","properties":{"formattedCitation":"[22,25]","plainCitation":"[22,25]","noteIndex":0},"citationItems":[{"id":422,"uris":["http://zotero.org/users/16428907/items/5GH99MMB"],"itemData":{"id":422,"type":"webpage","abstract":"Reaching every child in Afghanistan with polio vaccines","language":"en","title":"Polio eradication | UNICEF Afghanistan","URL":"https://www.unicef.org/afghanistan/polio-eradication","accessed":{"date-parts":[["2025",8,28]]}}},{"id":428,"uris":["http://zotero.org/users/16428907/items/N6Z3ZI8K"],"itemData":{"id":428,"type":"webpage","abstract":"For the past decade, Sughra Ayaz has traveled door to door in southeastern Pakistan, pleading with parents to allow children to be vaccinated against polio as part of a global campaign to wipe out the paralytic disease. She hears their demands and fears. Some are practical – families need basics like food and water more than vaccines. Others are simply unfounded – the oral doses are meant to sterilize their kids.","container-title":"CNN","language":"en","title":"The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback","URL":"https://www.cnn.com/2025/08/05/health/polio-eradication-missteps","accessed":{"date-parts":[["2025",8,28]]},"issued":{"date-parts":[["2025",8,5]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [22,25].Logistical and Infrastructure BarriersAfghanistan’s health system is extremely fragile. Many high-risk districts have no permanent clinics, so polio vaccination remains campaign-based rather than integrated into routine care. One consequence is an unreliable cold chain. Keeping OPV (Oral Polio Virus) doses cold in remote villages with no electricity is a major hurdle. To meet this need, GPEI has deployed solar-powered refrigerators, cold boxes and temperature monitors technologies proven to keep vaccines viable. These solar refrigerators can run for days without grid power, extending the program’s reach in some of the most difficult yet critical areas ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"GOUZk5Jh","properties":{"formattedCitation":"[26]","plainCitation":"[26]","noteIndex":0},"citationItems":[{"id":431,"uris":["http://zotero.org/users/16428907/items/BBDK9LHX"],"itemData":{"id":431,"type":"document","publisher":"Global Polio Erdaication Initiative","title":"BUILDING A CLIMATE-RESILIENT, POLIO-FREE WORLD","URL":"https://polioeradication.org/wp-content/uploads/2024/07/GPEI-Climate-Resilient-Health-20240712.pdf","issued":{"date-parts":[["2024",7,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [26]. Still, summers in Afghanistan are scorching, and bad roads mean frequent breaks in the chain. WHO inspectors found in 2017 that many vaccinators did not know about vaccine management, often failing to keep doses properly cold ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XktHvVEt","properties":{"formattedCitation":"[25]","plainCitation":"[25]","noteIndex":0},"citationItems":[{"id":428,"uris":["http://zotero.org/users/16428907/items/N6Z3ZI8K"],"itemData":{"id":428,"type":"webpage","abstract":"For the past decade, Sughra Ayaz has traveled door to door in southeastern Pakistan, pleading with parents to allow children to be vaccinated against polio as part of a global campaign to wipe out the paralytic disease. She hears their demands and fears. Some are practical – families need basics like food and water more than vaccines. Others are simply unfounded – the oral doses are meant to sterilize their kids.","container-title":"CNN","language":"en","title":"The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback","URL":"https://www.cnn.com/2025/08/05/health/polio-eradication-missteps","accessed":{"date-parts":[["2025",8,28]]},"issued":{"date-parts":[["2025",8,5]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [25]. As a result, vaccine wastage remains high and thousands of doses spoil before use.Without strong infrastructure, vaccination campaigns cannot simply become routine. The lack of fixed facilities prevents integration of polio shots into standard child health visits. This is a long-term gap and experts agree that only by building clinics and routine immunization can Afghanistan close the immunity gap sustainably ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"FtblT2LJ","properties":{"formattedCitation":"[25,26]","plainCitation":"[25,26]","noteIndex":0},"citationItems":[{"id":428,"uris":["http://zotero.org/users/16428907/items/N6Z3ZI8K"],"itemData":{"id":428,"type":"webpage","abstract":"For the past decade, Sughra Ayaz has traveled door to door in southeastern Pakistan, pleading with parents to allow children to be vaccinated against polio as part of a global campaign to wipe out the paralytic disease. She hears their demands and fears. Some are practical – families need basics like food and water more than vaccines. Others are simply unfounded – the oral doses are meant to sterilize their kids.","container-title":"CNN","language":"en","title":"The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback","URL":"https://www.cnn.com/2025/08/05/health/polio-eradication-missteps","accessed":{"date-parts":[["2025",8,28]]},"issued":{"date-parts":[["2025",8,5]]}}},{"id":431,"uris":["http://zotero.org/users/16428907/items/BBDK9LHX"],"itemData":{"id":431,"type":"document","publisher":"Global Polio Erdaication Initiative","title":"BUILDING A CLIMATE-RESILIENT, POLIO-FREE WORLD","URL":"https://polioeradication.org/wp-content/uploads/2024/07/GPEI-Climate-Resilient-Health-20240712.pdf","issued":{"date-parts":[["2024",7,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [25,26]. Until then, every campaign must bring its own cold chain equipment into rugged terrain, which is costly and logistically complex.Political Will and Cross-Border CoordinationRegional politics heavily influence eradication. Pakistan and Afghanistan have tense relations, but polio transcends borders. WHO notes that both countries continue to implement an intensive and mostly synchronized campaign schedule focused on shared reservoir areas ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"192cuqsl","properties":{"formattedCitation":"[23]","plainCitation":"[23]","noteIndex":0},"citationItems":[{"id":424,"uris":["http://zotero.org/users/16428907/items/FR7LL9HS"],"itemData":{"id":424,"type":"webpage","abstract":"The Forty-second meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 18 June 2025 with committee members and advisers meeting via video conference with affected countries, supported by the WHO Secretariat. The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV) in the context of the global target of interruption and certification of WPV1 eradication by 2027 and interruption and certification of cVDPV2 elimination by 2029.","language":"en","title":"Statement of the Forty-second meeting of the Polio IHR Emergency Committee","URL":"https://www.who.int/news/item/28-07-2025-statement-of-the-forty-second-meeting-of-the-polio-ihr-emergency-committee","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [23]. This alignment of vaccinating mobile and refugee populations on both sides is essential. However, diplomatic spats and distrust can still undermine cooperation. For example, failure to share surveillance data promptly or clashes at the border could allow the virus to slip through in either country. Mass population movements amplify risk ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1E0siZY4","properties":{"formattedCitation":"[23]","plainCitation":"[23]","noteIndex":0},"citationItems":[{"id":424,"uris":["http://zotero.org/users/16428907/items/FR7LL9HS"],"itemData":{"id":424,"type":"webpage","abstract":"The Forty-second meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 18 June 2025 with committee members and advisers meeting via video conference with affected countries, supported by the WHO Secretariat. The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV) in the context of the global target of interruption and certification of WPV1 eradication by 2027 and interruption and certification of cVDPV2 elimination by 2029.","language":"en","title":"Statement of the Forty-second meeting of the Polio IHR Emergency Committee","URL":"https://www.who.int/news/item/28-07-2025-statement-of-the-forty-second-meeting-of-the-polio-ihr-emergency-committee","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [23]. In 2023–24, Pakistan returned hundreds of thousands of Afghans through both forced and voluntary movements. According to IOM and UNHCR, over 600,000 returnees have been officially recorded, with estimates suggesting that up to 1.7 million people have been affected. These returns, combined with seasonal movements within and between the two countries, have further compounded the challenges faced. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"8KU2aRxa","properties":{"formattedCitation":"[13]","plainCitation":"[13]","noteIndex":0},"citationItems":[{"id":404,"uris":["http://zotero.org/users/16428907/items/CBC2SUCG"],"itemData":{"id":404,"type":"webpage","abstract":"The thirty-eighth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 20 March 2024 with committee members and advisers meeting via video conference with affected countries, supported by the WHO Secretariat.","language":"en","title":"Statement following the Thirty-eighth Meeting of the IHR Emergency Committee for Polio","URL":"https://www.who.int/news/item/08-04-2024-statement-following-the-thirty-eighth-meeting-of-the-ihr-emergency-committee-for-polio","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [13]. Many of these returnees left the poliovirus reservoirs of Pakistan (e.g., Karachi and Quetta) and re-entered Afghan provinces. This continued return of undocumented migrants has compounded the challenges of eradication ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ROPkbmfK","properties":{"formattedCitation":"[23]","plainCitation":"[23]","noteIndex":0},"citationItems":[{"id":424,"uris":["http://zotero.org/users/16428907/items/FR7LL9HS"],"itemData":{"id":424,"type":"webpage","abstract":"The Forty-second meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 18 June 2025 with committee members and advisers meeting via video conference with affected countries, supported by the WHO Secretariat. The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV) in the context of the global target of interruption and certification of WPV1 eradication by 2027 and interruption and certification of cVDPV2 elimination by 2029.","language":"en","title":"Statement of the Forty-second meeting of the Polio IHR Emergency Committee","URL":"https://www.who.int/news/item/28-07-2025-statement-of-the-forty-second-meeting-of-the-polio-ihr-emergency-committee","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [23]. It heightens the chance that undetected WPV1 cases seed new outbreaks in previously polio-free districts. Both countries are responding by vaccinating at transit points and updating local micro-plans, but lasting success requires high-level commitment to keep campaigns truly synchronized ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"QtfGfzmy","properties":{"formattedCitation":"[13,23]","plainCitation":"[13,23]","noteIndex":0},"citationItems":[{"id":404,"uris":["http://zotero.org/users/16428907/items/CBC2SUCG"],"itemData":{"id":404,"type":"webpage","abstract":"The thirty-eighth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 20 March 2024 with committee members and advisers meeting via video conference with affected countries, supported by the WHO Secretariat.","language":"en","title":"Statement following the Thirty-eighth Meeting of the IHR Emergency Committee for Polio","URL":"https://www.who.int/news/item/08-04-2024-statement-following-the-thirty-eighth-meeting-of-the-ihr-emergency-committee-for-polio","accessed":{"date-parts":[["2025",8,28]]}}},{"id":424,"uris":["http://zotero.org/users/16428907/items/FR7LL9HS"],"itemData":{"id":424,"type":"webpage","abstract":"The Forty-second meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 18 June 2025 with committee members and advisers meeting via video conference with affected countries, supported by the WHO Secretariat. The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV) in the context of the global target of interruption and certification of WPV1 eradication by 2027 and interruption and certification of cVDPV2 elimination by 2029.","language":"en","title":"Statement of the Forty-second meeting of the Polio IHR Emergency Committee","URL":"https://www.who.int/news/item/28-07-2025-statement-of-the-forty-second-meeting-of-the-polio-ihr-emergency-committee","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [13,23].Strategies and Pathways to Eradication: Innovative ProposalsTo address the deeply rooted challenges of eradication, Afghanistan requires not only persistence but also a more innovative and policy-focused approach. Lessons from the success stories of other countries, particularly India and Nigeria, provide crucial insights into strategies that can be adapted for the Afghan context.India’s achievement, despite a massive and diverse population and immense logistical barriers, was built on unwavering political will, extensive community mobilization, and rigorous surveillance ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"M0AHCaiO","properties":{"formattedCitation":"[27,28]","plainCitation":"[27,28]","noteIndex":0},"citationItems":[{"id":435,"uris":["http://zotero.org/users/16428907/items/DQ2ZAPR8"],"itemData":{"id":435,"type":"webpage","title":"Eradicating poliomyelitis: India's journey from hyperendemic to polio-free status - PMC","URL":"https://pmc.ncbi.nlm.nih.gov/articles/PMC3734678/","accessed":{"date-parts":[["2025",8,28]]}}},{"id":514,"uris":["http://zotero.org/users/16428907/items/2PVVJTDF"],"itemData":{"id":514,"type":"article-journal","abstract":"After more than 30 years of efforts to eliminate polio, India was certified polio free by WHO in 2014. The final years prior to polio elimination were characterised by concentrated efforts to vaccinate hard-to-reach groups in the state of Uttar Pradesh, including migrant workers, religious minority Muslims and impoverished communities with poor pre-existing social support systems. This article aims to describe the management strategies employed by India to improve the deployment and acceptance of vaccines among hard-to-reach groups in Uttar Pradesh in the final years prior to polio elimination.Three main management principles contributed to polio elimination among the hardest to reach in Uttar Pradesh: bundling of health services, local stakeholder engagement and accountability mechanisms for public health initiatives. In an effort to market the polio campaign as an authentic health-oriented programme, vaccine acceptance was improved by packaging other basic healthcare services such as routine check-ups and essential medications. India also prioritised local stakeholder engagement by using influential community leaders to reach vaccine hesitant groups. Lastly, the accountability mechanisms developed between non-profit organisations and decision-makers in the field ensured accurate reporting and identified deficiencies in healthcare worker training. The lessons learnt from India's polio vaccination programme have important implications for the implementation of future mass vaccination initiatives, particularly when trying to reach vulnerable communities.","container-title":"BMJ global health","DOI":"10.1136/bmjgh-2021-005125","ISSN":"2059-7908","issue":"4","journalAbbreviation":"BMJ Glob Health","language":"eng","note":"PMID: 33906848\nPMCID: PMC8088252","page":"e005125","source":"PubMed","title":"Overcoming vaccine deployment challenges among the hardest to reach: lessons from polio elimination in India","title-short":"Overcoming vaccine deployment challenges among the hardest to reach","volume":"6","author":[{"family":"Bellatin","given":"Alejandra"},{"family":"Hyder","given":"Azana"},{"family":"Rao","given":"Sampreeth"},{"family":"Zhang","given":"Peter Chengming"},{"family":"McGahan","given":"Anita M."}],"issued":{"date-parts":[["2021",4]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [27,28]. The Pulse Polio Initiative relied on National Immunization Days (NIDs) and a house-to-house strategy to ensure every child was reached. A vast network of community health workers and volunteers including women and young students was mobilized to go door-to-door, dispel myths, and build trust. Surveillance was equally robust, with monitoring of AFP and environmental testing of sewage ensuring that no virus circulation went undetected. Emergency Operations Centers (EOCs) further strengthened the effort by serving as central hubs for real-time data analysis and problem-solving, a model that has since been adopted by other countries ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"9PssoJ3V","properties":{"formattedCitation":"[29]","plainCitation":"[29]","noteIndex":0},"citationItems":[{"id":437,"uris":["http://zotero.org/users/16428907/items/2AGHQNEW"],"itemData":{"id":437,"type":"webpage","title":"Eradicating polio in Nigeria | McKinsey","URL":"https://www.mckinsey.com/industries/healthcare/our-insights/eradicating-polio-in-nigeria#/","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [29]Nigeria’s path to eradication was marked by insecurity and widespread vaccine boycotts, yet its eventual success came through a multi-pronged and highly adaptive approach. Central to this was the use of high-tech EOCs for real-time data analysis and decision-making ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vVGU6E2z","properties":{"formattedCitation":"[30]","plainCitation":"[30]","noteIndex":0},"citationItems":[{"id":439,"uris":["http://zotero.org/users/16428907/items/NUGAG6ZT"],"itemData":{"id":439,"type":"webpage","title":"(PDF) Nigeria’s Polio Elimination Playbook: Lessons To Strengthening Health Systems For Other Eradicable Diseases","URL":"https://www.researchgate.net/publication/364593984_Nigeria's_Polio_Elimination_Playbook_Lessons_To_Strengthening_Health_Systems_For_Other_Eradicable_Diseases","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [30]. Equally important was the strategic engagement of influential religious and traditional leaders, who played a decisive role in rebuilding community trust and countering misinformation. In areas of high insecurity, health camps and alternative vaccine delivery methods including the use of Inactivated Polio Vaccine (IPV) were deployed to provide at least partial protection. Nigeria also strengthened its appeal to communities by integrating polio vaccination with other essential services, such as vitamin A supplementation and basic health screenings, making the program not only more effective but also more beneficial in the eyes of families ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"tlKGEQI6","properties":{"formattedCitation":"[31]","plainCitation":"[31]","noteIndex":0},"citationItems":[{"id":583,"uris":["http://zotero.org/users/16428907/items/Q4HPIP29"],"itemData":{"id":583,"type":"webpage","abstract":"News and Press Release in English on Nigeria; published on 14 Jun 2010 by TNH","language":"en","title":"NIGERIA: Vitamin A handouts boost polio vaccine acceptance - Nigeria | ReliefWeb","title-short":"NIGERIA","URL":"https://reliefweb.int/report/nigeria/nigeria-vitamin-handouts-boost-polio-vaccine-acceptance","accessed":{"date-parts":[["2025",9,14]]},"issued":{"date-parts":[["2010",6,14]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [31] ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"bfoVRNa8","properties":{"formattedCitation":"[32]","plainCitation":"[32]","noteIndex":0},"citationItems":[{"id":441,"uris":["http://zotero.org/users/16428907/items/39LC9D3G"],"itemData":{"id":441,"type":"post-weblog","abstract":"It has been 18 months since Nigeria, once considered one of the biggest challenges to global polio eradication, saw a child paralysed by wild poliovirus. Yet","language":"en-GB","title":"Learning From Experience - GPEI","URL":"https://polioeradication.org/news/learning-from-experience/","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [32].Applying the lessons of India and Nigeria to Afghanistan requires innovative strategies that adapt to the country’s unique challenges while strengthening long-term health systems. One critical step is the integration of polio vaccination into broader public health services. The current push to link vaccination with routine immunization and essential health interventions such as vitamin A supplementation represents a crucial move toward building a resilient and sustainable system that can outlast the GPEI’s campaign-based model ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"NjjBuJVZ","properties":{"formattedCitation":"[33]","plainCitation":"[33]","noteIndex":0},"citationItems":[{"id":443,"uris":["http://zotero.org/users/16428907/items/NSRBX7NA"],"itemData":{"id":443,"type":"post-weblog","abstract":"The GPEI Strategy 2022-2026 lays out the roadmap to achieving a lasting world free of all forms of poliovirus. The Strategy has two clear goals:","language":"en-GB","title":"Our Strategy - GPEI","URL":"https://polioeradication.org/who-we-are/our-strategy/","accessed":{"date-parts":[["2025",8,28]]},"issued":{"date-parts":[["2021",4,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [33]. By offering tangible benefits beyond polio, this approach also enhances community trust and addresses some of the root causes of resistance.Leveraging innovative technologies can also reshape surveillance and microplanning. Artificial intelligence (AI) and Geographic Information Systems (GIS) have the potential to revolutionize how vaccination gaps are identified and addressed. AI algorithms can rapidly analyze data from diverse sources including news reports, social media, and environmental sampling to detect emerging hotspots and predict outbreaks faster than traditional surveillance ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"cEMDbl3Q","properties":{"formattedCitation":"[34]","plainCitation":"[34]","noteIndex":0},"citationItems":[{"id":445,"uris":["http://zotero.org/users/16428907/items/EVUH92FM"],"itemData":{"id":445,"type":"article-journal","abstract":"Artificial intelligence (AI) techniques have been widely applied to infectious disease outbreak detection and early warning, trend prediction, and public health response modeling and assessment. Such public health surveillance and response tasks of major importance pose unique technical challenges such as data sparsity, lack of positive training samples, difficulty in developing baselines and quantifying the control measures, and interwoven dependencies between spatiotemporal elements and finer-grained risk analyses through contact and social networks. Traditional public health surveillance relies heavily on statistical techniques. Recent years have seen tremendous growth of AI-enabled methods, including but not limited to deep learning–based models, complementing statistical approaches. This chapter aims to provide a systematic review of these recent advances applying AI techniques to address public health surveillance and response challenges.","container-title":"Artificial Intelligence in Medicine","DOI":"10.1016/B978-0-12-821259-2.00022-3","journalAbbreviation":"Artificial Intelligence in Medicine","note":"PMID: null\nPMCID: PMC7484813","page":"437-453","source":"PubMed Central","title":"Artificial intelligence–enabled public health surveillance—from local detection to global epidemic monitoring and control","author":[{"family":"Zeng","given":"Daniel"},{"family":"Cao","given":"Zhidong"},{"family":"Neill","given":"Daniel B."}],"issued":{"date-parts":[["2021"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [34]. Tools such as RapidPro enable real-time data collection via mobile devices, allowing campaign strategies to be adjusted dynamically. GIS-based microplanning further strengthens accountability, as vaccination teams can be tracked with detailed, real-time maps showing covered and missed households. This structured use of GIS, pioneered by the GPEI in Africa, ensures that previously unreached communities are not overlooked ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"jDoM764p","properties":{"formattedCitation":"[35]","plainCitation":"[35]","noteIndex":0},"citationItems":[{"id":448,"uris":["http://zotero.org/users/16428907/items/VFWR8YBD"],"itemData":{"id":448,"type":"post-weblog","abstract":"The top five tech solutions that helped eradicate wild poliovirus in the African region Ten years ago, health workers and volunteer vaccinators had to rely on hand-drawn maps and memory in order to reach every child. Today Africa’s polio eradication programme has been transformed by technology and innovation. New systems have also brought an unprecedented … The top five tech solutions that helped eradicate wild poliovirus in the African Region Read More »","container-title":"Africa Kicks Out Wild Polio","language":"en-US","title":"The top five tech solutions that helped eradicate wild poliovirus in the African Region","URL":"https://www.africakicksoutwildpolio.com/the-top-five-tech-solutions-that-helped-eradicate-wild-poliovirus-in-the-african-region/","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [35].Sustained progress also depends on international diplomacy. Cross-border collaboration requires more than synchronized vaccination campaigns; it relies on political will and shared responsibility between Afghanistan and Pakistan. The mobility of nomadic groups and refugees makes joint surveillance, shared data, and coordinated response plans indispensable. In this context, “polio diplomacy” is not only a technical necessity but also an opportunity to build broader cooperation between the two nations. Given recent diplomatic tensions and the mass return of refugees from Pakistan, achieving this form of collaboration is more urgent than ever ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ssi9FEOt","properties":{"formattedCitation":"[36]","plainCitation":"[36]","noteIndex":0},"citationItems":[{"id":449,"uris":["http://zotero.org/users/16428907/items/NZ4YB2GP"],"itemData":{"id":449,"type":"webpage","title":"Polio Diplomacy Between Pakistan and Afghanistan – The Diplomat","URL":"https://thediplomat.com/2025/01/polio-diplomacy-between-pakistan-and-afghanistan/","accessed":{"date-parts":[["2025",8,28]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [36].Global Health and Policy ImplicationsThe persistence of WPV1 in Afghanistan and Pakistan carries critical global health implications. These two countries remain the only reservoirs of endemic wild poliovirus, and failure to stop transmission there could trigger a global resurgence of the disease ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"m45U9hUL","properties":{"formattedCitation":"[2]","plainCitation":"[2]","noteIndex":0},"citationItems":[{"id":383,"uris":["http://zotero.org/users/16428907/items/X483EY79"],"itemData":{"id":383,"type":"webpage","language":"en","title":"Poliomyelitis","URL":"https://www.who.int/news-room/questions-and-answers/item/poliomyelitis","accessed":{"date-parts":[["2025",8,21]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [2]. Although over 99.9% of cases have been eliminated worldwide, even a single WPV1 case remains a serious global public health threat ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"5UJx3JG5","properties":{"formattedCitation":"[15]","plainCitation":"[15]","noteIndex":0},"citationItems":[{"id":407,"uris":["http://zotero.org/users/16428907/items/W9ZWHMG7"],"itemData":{"id":407,"type":"document","publisher":"Global Polio Erdaication Initiative","title":"General factsheet","URL":"https://polioeradication.org/wp-content/uploads/2025/04/GPEI-general-factsheet-20250401.pdf","issued":{"date-parts":[["2025",4,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [15]. The virus can be carried by travelers, migrants, or displaced populations into previously polio-free regions, sparking outbreaks where immunity has waned ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Kwz35SjJ","properties":{"formattedCitation":"[2,37]","plainCitation":"[2,37]","noteIndex":0},"citationItems":[{"id":383,"uris":["http://zotero.org/users/16428907/items/X483EY79"],"itemData":{"id":383,"type":"webpage","language":"en","title":"Poliomyelitis","URL":"https://www.who.int/news-room/questions-and-answers/item/poliomyelitis","accessed":{"date-parts":[["2025",8,21]]}}},{"id":454,"uris":["http://zotero.org/users/16428907/items/3LI9BQBZ"],"itemData":{"id":454,"type":"article-journal","abstract":"Education, policy, and interventions to promote visitor health are needed., Human mobility has always been associated with the spread of infection, and mobility of nonimmigrant visitors and temporary residents to the United States is increasing, from ≈12 million in 1987 to ≈37 million in 2007. Lack of information about the health status of these populations upon arrival and their need for and use of medical services in the United States hinders development of public health policy, education, and provision of adequate clinical care. After these issues and needs are clarified, intervention programs should be developed to increase access and decrease the disparities of care experienced by these populations.","container-title":"Emerging Infectious Diseases","DOI":"10.3201/eid1511.090938","ISSN":"1080-6040","issue":"11","journalAbbreviation":"Emerg Infect Dis","note":"PMID: 19891856\nPMCID: PMC2857256","page":"1715-1720","source":"PubMed Central","title":"Health Status of Visitors and Temporary Residents, United States","volume":"15","author":[{"family":"Yanni","given":"Emad A."},{"family":"Marano","given":"Nina"},{"family":"Stauffer","given":"William M."},{"family":"Barnett","given":"Elizabeth D."},{"family":"Cano","given":"Maria"},{"family":"Cetron","given":"Martin S."}],"issued":{"date-parts":[["2009",11]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [2,37]. This “last fraction of a percent” of cases underscores the fragility of eradication efforts, demanding sustained vigilance through surveillance and vaccination until all transmission is interrupted ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"cZsQMeEK","properties":{"formattedCitation":"[2]","plainCitation":"[2]","noteIndex":0},"citationItems":[{"id":383,"uris":["http://zotero.org/users/16428907/items/X483EY79"],"itemData":{"id":383,"type":"webpage","language":"en","title":"Poliomyelitis","URL":"https://www.who.int/news-room/questions-and-answers/item/poliomyelitis","accessed":{"date-parts":[["2025",8,21]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [2].Afghanistan shows how hard disease control can be in conflict-affected areas. Decades of war, political instability, and bans on house-to-house vaccination campaigns, especially the Taliban restrictions from 2018 to 2021, have created major access barriers and increased mistrust of vaccines. WHO reports that immunization gaps linked to vaccine hesitancy remain especially pronounced in the southern and southeastern provinces ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"cDSN9eof","properties":{"formattedCitation":"[38]","plainCitation":"[38]","noteIndex":0},"citationItems":[{"id":457,"uris":["http://zotero.org/users/16428907/items/ZET6KPSA"],"itemData":{"id":457,"type":"webpage","container-title":"World Health Organization - Regional Office for the Eastern Mediterranean","language":"en-gb","title":"Afghanistan","URL":"http://www.emro.who.int/polio-eradication/priority-countries/afghanistan.html","author":[{"family":"Administrator","given":""}],"accessed":{"date-parts":[["2025",8,30]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [38]. In this environment, eradication has required more than biomedical tools; it has depended on high-level diplomacy and negotiation. The resumption of door-to-door campaigns in late 2021 followed direct engagement with Taliban leaders and local elders, who provided security guarantees and logistical support ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"LLFkEx91","properties":{"formattedCitation":"[39]","plainCitation":"[39]","noteIndex":0},"citationItems":[{"id":459,"uris":["http://zotero.org/users/16428907/items/WWITXRC9"],"itemData":{"id":459,"type":"article-journal","container-title":"The Lancet Infectious Diseases","DOI":"10.1016/S1473-3099(22)00004-4","ISSN":"1473-3099, 1474-4457","issue":"2","journalAbbreviation":"The Lancet Infectious Diseases","language":"English","note":"publisher: Elsevier\nPMID: 35092792","page":"168-169","source":"www.thelancet.com","title":"Polio amid a humanitarian crisis in Afghanistan: challenges and recommendations","title-short":"Polio amid a humanitarian crisis in Afghanistan","volume":"22","author":[{"family":"Tharwani","given":"Zoaib Habib"},{"family":"Shaeen","given":"Sean Kaisser"},{"family":"Arshad","given":"Muhammad Saad"},{"family":"Khalid","given":"Muhammad Abdullah"},{"family":"Islam","given":"Zarmina"},{"family":"Nemat","given":"Arash"},{"family":"Essar","given":"Mohammad Yasir"}],"issued":{"date-parts":[["2022",2,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [39]. The Technical Advisory Group (TAG) has similarly emphasized the need for full involvement of provincial and district authorities, health leaders, and religious figures to create an enabling environment for vaccination ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"8Dd45JBZ","properties":{"formattedCitation":"[40]","plainCitation":"[40]","noteIndex":0},"citationItems":[{"id":462,"uris":["http://zotero.org/users/16428907/items/GNSK3SS5"],"itemData":{"id":462,"type":"post-weblog","abstract":"The Technical Advisory Group (TAG) on polio eradication convened in Kabul on 19 and 20 February to review Afghanistan’s modified strategy for optimizing","language":"en-GB","title":"Technical Advisory Group urges strong action to eradicate polio in Afghanistan - GPEI","URL":"https://polioeradication.org/news/technical-advisory-group-urges-strong-action-to-eradicate-polio-in-afghanistan/","accessed":{"date-parts":[["2025",8,30]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [40]. At the same time, historical episodes such as the CIA’s use of a fake vaccination campaign in Pakistan have further undermined public trust, illustrating how political events shape health interventions ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"DCX2q5n3","properties":{"formattedCitation":"[41]","plainCitation":"[41]","noteIndex":0},"citationItems":[{"id":464,"uris":["http://zotero.org/users/16428907/items/NHTHHPDV"],"itemData":{"id":464,"type":"webpage","abstract":"In early January 2013, a dozen deans from America's premier public health schools wrote President Obama a letter protesting the CIA's use of a faked vaccination campaign in the hunt for Osama bin Laden.","language":"en","title":"Fake CIA Vaccine Campaign: When the End Doesn’t Justify the Means | Smart Global Health | CSIS","title-short":"Fake CIA Vaccine Campaign","URL":"https://www.csis.org/blogs/smart-global-health/fake-cia-vaccine-campaign-when-end-doesnt-justify-means","accessed":{"date-parts":[["2025",8,30]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [41].The collapse of foreign aid following the 2021 regime change has further strained Afghanistan’s fragile health system. Human Rights Watch documented that donor governments cut most development funding, including health programs, resulting in clinic closures and medicine shortages ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"L8gnFIvr","properties":{"formattedCitation":"[42]","plainCitation":"[42]","noteIndex":0},"citationItems":[{"id":466,"uris":["http://zotero.org/users/16428907/items/FTISYWN6"],"itemData":{"id":466,"type":"article-journal","abstract":"The 38-page report, “‘A Disaster for the Foreseeable Future’: Afghanistan’s Healthcare Crisis,” describes how the collapse of Afghanistan’s economy after the Taliban takeover in August 2021 inflicted severe harm on the country’s healthcare infrastructure. Donors’ decisions to reduce humanitarian aid have further weakened health care access, destabilized the economy, and worsened food insecurity. The Taliban’s abusive policies and practices have greatly exacerbated the crisis. Bans on education for women and girls have blocked most training for future female healthcare workers, ensuring shortages for the foreseeable future.","container-title":"Human Rights Watch","language":"en","source":"Human Rights Watch","title":"“A Disaster for the Foreseeable Future”","URL":"https://www.hrw.org/report/2024/02/12/disaster-foreseeable-future/afghanistans-healthcare-crisis","author":[{"family":"Abbasi","given":"Fereshta"}],"accessed":{"date-parts":[["2025",8,30]]},"issued":{"date-parts":[["2024",2,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [42]. In this context, the polio program has provided vital infrastructure. It maintains a nationwide surveillance network for AFP and environmental sampling ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"06tKGhWz","properties":{"formattedCitation":"[43]","plainCitation":"[43]","noteIndex":0},"citationItems":[{"id":468,"uris":["http://zotero.org/users/16428907/items/KVBHE88Y"],"itemData":{"id":468,"type":"webpage","container-title":"World Health Organization - Regional Office for the Eastern Mediterranean","language":"en-gb","title":"Afghanistan","URL":"http://www.emro.who.int/polio-eradication/priority-countries/afghanistan.html","author":[{"family":"Administrator","given":""}],"accessed":{"date-parts":[["2025",8,30]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [43] and has preserved cold-chain systems even as routine immunization services declined. Comparative studies show that eradication funding has financed cold-chain upgrades that also strengthened routine vaccine delivery ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"kGr07Klq","properties":{"formattedCitation":"[44]","plainCitation":"[44]","noteIndex":0},"citationItems":[{"id":470,"uris":["http://zotero.org/users/16428907/items/BI83TVPX"],"itemData":{"id":470,"type":"article-journal","abstract":"BACKGROUND: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).\nMETHODS: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.\nRESULTS: Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year.\nCONCLUSIONS: Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.","container-title":"The Journal of Infectious Diseases","DOI":"10.1093/infdis/jit232","ISSN":"1537-6613","issue":"Suppl 1","journalAbbreviation":"J Infect Dis","language":"eng","note":"PMID: 24690667\nPMCID: PMC4197907","page":"S504-513","source":"PubMed","title":"The impact of polio eradication on routine immunization and primary health care: a mixed-methods study","title-short":"The impact of polio eradication on routine immunization and primary health care","volume":"210 Suppl 1","author":[{"family":"Closser","given":"Svea"},{"family":"Cox","given":"Kelly"},{"family":"Parris","given":"Thomas M."},{"family":"Landis","given":"R. Matthew"},{"family":"Justice","given":"Judith"},{"family":"Gopinath","given":"Ranjani"},{"family":"Maes","given":"Kenneth"},{"family":"Banteyerga Amaha","given":"Hailom"},{"family":"Mohammed","given":"Ismaila Zango"},{"family":"Dukku","given":"Aminu Mohammed"},{"family":"Omidian","given":"Patricia A."},{"family":"Varley","given":"Emma"},{"family":"Tedoff","given":"Pauley"},{"family":"Koon","given":"Adam D."},{"family":"Nyirazinyoye","given":"Laetitia"},{"family":"Luck","given":"Matthew A."},{"family":"Pont","given":"W. Frank"},{"family":"Neergheen","given":"Vanessa"},{"family":"Rosenthal","given":"Anat"},{"family":"Nsubuga","given":"Peter"},{"family":"Thacker","given":"Naveen"},{"family":"Jooma","given":"Rashid"},{"family":"Nuttall","given":"Elizabeth"}],"issued":{"date-parts":[["2014",11,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [44]. During the 2023 nationwide measles campaign, WHO reported that the polio program leveraged its operational capacity to recruit vaccinators, organize sites, and manage logistics transporting both measles and oral polio vaccines under strict cold chain conditions across all provinces ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"kGd9WjHj","properties":{"formattedCitation":"[45]","plainCitation":"[45]","noteIndex":0},"citationItems":[{"id":473,"uris":["http://zotero.org/users/16428907/items/BNI9MWYW"],"itemData":{"id":473,"type":"post-weblog","abstract":"Across Afghanistan, community advocacy to increase vaccine uptake for polio and other deadly diseases has some unsung champions: the local women","language":"en-GB","title":"GPEI-Closing the gap: the Afghan women gaining ground against vaccine refusals and zero dose children","title-short":"GPEI-Closing the gap","URL":"https://www.archive.polioeradication.org/countries/afghanistan/","accessed":{"date-parts":[["2025",8,30]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [45]. These examples highlight how vertical programs like polio eradication can enhance health-system resilience and support the control of other vaccine-preventable diseases ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PdICHpty","properties":{"formattedCitation":"[2,44]","plainCitation":"[2,44]","noteIndex":0},"citationItems":[{"id":383,"uris":["http://zotero.org/users/16428907/items/X483EY79"],"itemData":{"id":383,"type":"webpage","language":"en","title":"Poliomyelitis","URL":"https://www.who.int/news-room/questions-and-answers/item/poliomyelitis","accessed":{"date-parts":[["2025",8,21]]}}},{"id":470,"uris":["http://zotero.org/users/16428907/items/BI83TVPX"],"itemData":{"id":470,"type":"article-journal","abstract":"BACKGROUND: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).\nMETHODS: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.\nRESULTS: Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year.\nCONCLUSIONS: Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.","container-title":"The Journal of Infectious Diseases","DOI":"10.1093/infdis/jit232","ISSN":"1537-6613","issue":"Suppl 1","journalAbbreviation":"J Infect Dis","language":"eng","note":"PMID: 24690667\nPMCID: PMC4197907","page":"S504-513","source":"PubMed","title":"The impact of polio eradication on routine immunization and primary health care: a mixed-methods study","title-short":"The impact of polio eradication on routine immunization and primary health care","volume":"210 Suppl 1","author":[{"family":"Closser","given":"Svea"},{"family":"Cox","given":"Kelly"},{"family":"Parris","given":"Thomas M."},{"family":"Landis","given":"R. Matthew"},{"family":"Justice","given":"Judith"},{"family":"Gopinath","given":"Ranjani"},{"family":"Maes","given":"Kenneth"},{"family":"Banteyerga Amaha","given":"Hailom"},{"family":"Mohammed","given":"Ismaila Zango"},{"family":"Dukku","given":"Aminu Mohammed"},{"family":"Omidian","given":"Patricia A."},{"family":"Varley","given":"Emma"},{"family":"Tedoff","given":"Pauley"},{"family":"Koon","given":"Adam D."},{"family":"Nyirazinyoye","given":"Laetitia"},{"family":"Luck","given":"Matthew A."},{"family":"Pont","given":"W. Frank"},{"family":"Neergheen","given":"Vanessa"},{"family":"Rosenthal","given":"Anat"},{"family":"Nsubuga","given":"Peter"},{"family":"Thacker","given":"Naveen"},{"family":"Jooma","given":"Rashid"},{"family":"Nuttall","given":"Elizabeth"}],"issued":{"date-parts":[["2014",11,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [2,44].For long-term sustainability, polio eradication must be integrated into broader health systems. Afghanistan’s polio campaigns have often operated parallel to routine services, risking fragmentation. Evidence shows that combining polio vaccination with child health interventions, such as vitamin A supplementation, has improved both health outcomes and community trust ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"HssUdpHQ","properties":{"formattedCitation":"[2,31]","plainCitation":"[2,31]","noteIndex":0},"citationItems":[{"id":383,"uris":["http://zotero.org/users/16428907/items/X483EY79"],"itemData":{"id":383,"type":"webpage","language":"en","title":"Poliomyelitis","URL":"https://www.who.int/news-room/questions-and-answers/item/poliomyelitis","accessed":{"date-parts":[["2025",8,21]]}}},{"id":583,"uris":["http://zotero.org/users/16428907/items/Q4HPIP29"],"itemData":{"id":583,"type":"webpage","abstract":"News and Press Release in English on Nigeria; published on 14 Jun 2010 by TNH","language":"en","title":"NIGERIA: Vitamin A handouts boost polio vaccine acceptance - Nigeria | ReliefWeb","title-short":"NIGERIA","URL":"https://reliefweb.int/report/nigeria/nigeria-vitamin-handouts-boost-polio-vaccine-acceptance","accessed":{"date-parts":[["2025",9,14]]},"issued":{"date-parts":[["2010",6,14]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [2,31]. More broadly, positioning polio eradication within Afghanistan’s progress toward universal health coverage (UHC) and the Sustainable Development Goals (SDGs) is essential. Embedding polio staff and assets into routine primary care rather than maintaining siloed, polio-only teams will help sustain population immunity and protect progress against political or financial shocks ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"7dSDgPGi","properties":{"formattedCitation":"[2,44]","plainCitation":"[2,44]","noteIndex":0},"citationItems":[{"id":383,"uris":["http://zotero.org/users/16428907/items/X483EY79"],"itemData":{"id":383,"type":"webpage","language":"en","title":"Poliomyelitis","URL":"https://www.who.int/news-room/questions-and-answers/item/poliomyelitis","accessed":{"date-parts":[["2025",8,21]]}}},{"id":470,"uris":["http://zotero.org/users/16428907/items/BI83TVPX"],"itemData":{"id":470,"type":"article-journal","abstract":"BACKGROUND: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).\nMETHODS: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.\nRESULTS: Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year.\nCONCLUSIONS: Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.","container-title":"The Journal of Infectious Diseases","DOI":"10.1093/infdis/jit232","ISSN":"1537-6613","issue":"Suppl 1","journalAbbreviation":"J Infect Dis","language":"eng","note":"PMID: 24690667\nPMCID: PMC4197907","page":"S504-513","source":"PubMed","title":"The impact of polio eradication on routine immunization and primary health care: a mixed-methods study","title-short":"The impact of polio eradication on routine immunization and primary health care","volume":"210 Suppl 1","author":[{"family":"Closser","given":"Svea"},{"family":"Cox","given":"Kelly"},{"family":"Parris","given":"Thomas M."},{"family":"Landis","given":"R. Matthew"},{"family":"Justice","given":"Judith"},{"family":"Gopinath","given":"Ranjani"},{"family":"Maes","given":"Kenneth"},{"family":"Banteyerga Amaha","given":"Hailom"},{"family":"Mohammed","given":"Ismaila Zango"},{"family":"Dukku","given":"Aminu Mohammed"},{"family":"Omidian","given":"Patricia A."},{"family":"Varley","given":"Emma"},{"family":"Tedoff","given":"Pauley"},{"family":"Koon","given":"Adam D."},{"family":"Nyirazinyoye","given":"Laetitia"},{"family":"Luck","given":"Matthew A."},{"family":"Pont","given":"W. Frank"},{"family":"Neergheen","given":"Vanessa"},{"family":"Rosenthal","given":"Anat"},{"family":"Nsubuga","given":"Peter"},{"family":"Thacker","given":"Naveen"},{"family":"Jooma","given":"Rashid"},{"family":"Nuttall","given":"Elizabeth"}],"issued":{"date-parts":[["2014",11,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [2,44].Finally, the polio eradication endgame has produced tools and innovations now central to global health security. Environmental surveillance of wastewater, rapid genomic sequencing, GIS-based microplanning, and the establishment of EOCs were pioneered for polio and have since been adapted for outbreaks of Ebola and COVID-19 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vtQ6yXNE","properties":{"formattedCitation":"[46,47]","plainCitation":"[46,47]","noteIndex":0},"citationItems":[{"id":475,"uris":["http://zotero.org/users/16428907/items/2LX83IPH"],"itemData":{"id":475,"type":"article-journal","abstract":"This article summarizes the status of environmental surveillance (ES) used by the Global Polio Eradication Initiative, provides the rationale for ES, gives examples of ES methods and findings, and summarizes how these data are used to achieve poliovirus eradication. ES complements clinical acute flaccid paralysis (AFP) surveillance for possible polio cases. ES detects poliovirus circulation in environmental sewage and is used to monitor transmission in communities. If detected, the genetic sequences of polioviruses isolated from ES are compared with those of isolates from clinical cases to evaluate the relationships among viruses. To evaluate poliovirus transmission, ES programs must be developed in a manner that is sensitive, with sufficiently frequent sampling, appropriate isolation methods, and specifically targeted sampling sites in locations at highest risk for poliovirus transmission. After poliovirus ceased to be detected in human cases, ES documented the absence of endemic WPV transmission and detected imported WPV. ES provides valuable information, particularly in high-density populations where AFP surveillance is of poor quality, persistent virus circulation is suspected, or frequent virus reintroduction is perceived. Given the benefits of ES, GPEI plans to continue and expand ES as part of its strategic plan and as a supplement to AFP surveillance.","container-title":"The Journal of Infectious Diseases","DOI":"10.1093/infdis/jiu384","ISSN":"1537-6613","issue":"Suppl 1","journalAbbreviation":"J Infect Dis","language":"eng","note":"PMID: 25316848\nPMCID: PMC10578309","page":"S294-303","source":"PubMed","title":"Environmental surveillance for polioviruses in the Global Polio Eradication Initiative","volume":"210 Suppl 1","author":[{"family":"Asghar","given":"Humayun"},{"family":"Diop","given":"Ousmane M."},{"family":"Weldegebriel","given":"Goitom"},{"family":"Malik","given":"Farzana"},{"family":"Shetty","given":"Sushmitha"},{"family":"El Bassioni","given":"Laila"},{"family":"Akande","given":"Adefunke O."},{"family":"Al Maamoun","given":"Eman"},{"family":"Zaidi","given":"Sohail"},{"family":"Adeniji","given":"Adekunle J."},{"family":"Burns","given":"Cara C."},{"family":"Deshpande","given":"Jagadish"},{"family":"Oberste","given":"M. Steve"},{"family":"Lowther","given":"Sara A."}],"issued":{"date-parts":[["2014",11,1]]}}},{"id":477,"uris":["http://zotero.org/users/16428907/items/ALNIDYF6"],"itemData":{"id":477,"type":"webpage","abstract":"Emergency Operations Centers (EOCs) play a vital role as community command centers in the fight against infectious diseases, from Ebola and polio to COVID-19.","language":"en","title":"How Emergency Operations Centers are aiding the COVID-19 response","URL":"https://www.gatesfoundation.org/ideas/articles/emergency-operations-centers","accessed":{"date-parts":[["2025",8,30]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [46,47]. In Nigeria, repurposed polio EOCs proved critical for Ebola and COVID-19 response, strengthening local outbreak preparedness and response capacity ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"pOUAHI4d","properties":{"formattedCitation":"[47]","plainCitation":"[47]","noteIndex":0},"citationItems":[{"id":477,"uris":["http://zotero.org/users/16428907/items/ALNIDYF6"],"itemData":{"id":477,"type":"webpage","abstract":"Emergency Operations Centers (EOCs) play a vital role as community command centers in the fight against infectious diseases, from Ebola and polio to COVID-19.","language":"en","title":"How Emergency Operations Centers are aiding the COVID-19 response","URL":"https://www.gatesfoundation.org/ideas/articles/emergency-operations-centers","accessed":{"date-parts":[["2025",8,30]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} [47]. Policymakers should therefore view the polio program not only as a vertical eradication effort but also as a platform for international health security. Continued funding, community engagement, and cross-border coordination remain indispensable until polio is certified eradicated and its legacy infrastructure fully transitioned to broader health priorities.ConclusionPolio eradication in Afghanistan is at a critical point. Despite decades of progress, the continued presence of WPV1 shows how easily gains can be lost when political instability, mistrust, and weak infrastructure come together. Current epidemiological patterns marked by silent circulation and cross-border linkages show that vaccination campaigns alone are insufficient. Success will require integrating polio services into routine healthcare, enhancing surveillance, addressing vaccine hesitancy with culturally grounded approaches, and ensuring synchronized cross-border action. Lessons from India and Nigeria demonstrate that eradication is possible when political commitment, community trust, and technological innovation align. For Afghanistan, the polio program must be recognized not only as a public health emergency but as a strategic investment in health system resilience. Failure to interrupt transmission risks undermining global eradication and forfeiting the chance to transform polio assets into a foundation for universal health coverage and preparedness for future outbreaks.DeclarationFunding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Conflicts of Interest: The authors declare no conflicts of interest related to this review.Ethical Approval: Not applicable, as this study is a review of previously published literature and does not involve human participants or animals.Consent for Publication: Not applicable.Authors’ Contributions: A.H.G. and M.F.W. conceptualized the manuscript; A.H.G. and M.F.W. wrote the initial draft and prepared the tables; A.H.G. and M.F.W. revised and edited the manuscript; A.S.A. supervised the manuscript. 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