Report on the Meeting of the Technical Advisory Group for the Eradication of Poliomyelitis in Afghanistan [2019, August]

The Afghanistan Technical Advisory Group (TAG) meeting, held in Dubai, United Arab Emirates, from August 25-26 2019, provided an opportunity to review the status of polio eradication efforts, key challenges, and the way forward in Afghanistan, as well as to develop recommendations for the Afghanistan polio programme to get back on track to success. This summary focuses on the communication elements of the meeting/report.

In brief, the situation is as follows: As of this meeting, Afghanistan had reported 15 polio cases in 2019, 14 of which were from the Southern region - after reporting a total of 21 in 2018. There has been a ban on house to hold (H2H) oral polio vaccine (OPV) campaigns in large parts of Helmand, Kandahar, and Urozgan since May 2018. Subsequently, a ban was announced on polio campaigns throughout the country starting in April 2019. "This is the most important issue for the Afghanistan program to address."

The TAG appreciated the efforts of the Afghanistan polio programme since the January 2019 TAG meeting, noting, for example, the deep engagement of senior leaders of the Afghanistan Government and partners in the polio programme reflected in the active participation of the Minister, the Presidential Focal Point, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) representatives and senior staff of Global Polio Eradication Initiative (GPEI) partners in the TAG meeting. However, the TAG emphasised that the programme is not on track to stop wild polio virus (WPV) transmission. The TAG identified 8 thematic areas where improvements are needed, providing observations and recommendations for each:

1. Addressing inaccessibility - sample recommendation: Use all approaches to gain access, including involving local community and religious influencers.
2. Supplementary immunisation activity (SIA) quality: Planning and preparation - sample recommendation: in areas where only site-to-site (S2S) vaccination may be allowed: Define a S2S communication strategy, designing social mobilisation approaches to get all children to come to the sites, optimising access to newborns, and enhancing metrics for performance monitoring to better understand S2S coverage.
3. Moving towards gender balance - sample recommendation: Address the fact that the GPEI and the TAG are disproportionately led by men, a significant impediment when insight is desperately needed to develop strategies to access and communicate with mothers and female caretakers.
4. One team approach - sample recommendation: The National Emergency Operations Center (NEOC) partners should draft explicit, written norms for communication and decision-making that clarify how people work together, the venues for decision-making (e.g., task teams) across various programme areas, and which people should be responsible, accountable, supporting, consulted, and informed (RASCI).
5. Geographic prioritisation - sample recommendation: In Kandahar City, invest much more substantively and genuinely in vaccinator training.
6. Optimising communication strategies - sample recommendation: In light of the "Peshawar Incident" in Pakistan in April 2019 and the Voice of America (VOA) issue in Kandahar in September 2018, take more serious efforts to thoroughly understand (and to develop an effective response to) the spread of propaganda and misinformation through social media. Also: Review the role and distribution of Immunization Communications Network (ICN) staff and modalities to ensure they are being optimally utilised to reduce missed children.
7. Improving routine immunisation (RI) - sample recommendation: View RI strengthening as a core polio strategy and continue efforts to support RI improvement.
8. Complementary approaches - sample recommendation: Create an enabling environment for eradication and to address basic needs in the most marginalised communities, without exacerbating the perception that polio vaccination (or RI more generally) is transactional such that community refusal to vaccinate can be used to gain other development benefits.

Click here for the 15-page report in PDF format.
Click here for a 28-slide PowerPoint presentation in PDF format featuring draft feedback from the TAG.