Report on the Meeting of the Technical Advisory Group for the Eradication of Poliomyelitis in Afghanistan [2021, March]

"TAG emphasizes the vital role of [the] One Team approach in achieving the eradication goals and highlights the critical importance of fully integrating operational and communication strategies and activities."

In its virtual meeting, held March 17, 18, and 20 2021, the Technical Advisory Group (TAG) recognised the challenges faced by the Polio Eradication Initiative (PEI) in Afghanistan, including co-circulation of both wild poliovirus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) in the context of a deteriorating security situation across the country and the spread of COVID-19 around the world. In the midst of such challenges, TAG notes resilience in maintaining core programme functions, political commitment at the highest level, and continuing courage of the programme's frontline workers (FLWs), who have been subjected to violence.

TAG stresses that the PEI now has an opportunity to renew its efforts and to again interrupt WPV. Lack of sustained vaccination access due to continued bans on house-to-house (H2H) mass vaccination campaigns by anti-government elements (AGE) remains the biggest hindrance to eradication. (In this vein, TAG strongly endorses the commitment of all partners and stakeholders to the absolute neutrality of the polio programme.) In accessible areas, all energies must be focused on driving down to an absolute minimum all children missed - for any reason - during all supplementary immunisation activities (SIAs). Among the suggested strategies: identify community leaders in hardcore refusal areas with whom to initiate community engagement, and use dialogue/focus group discussions (FGDs) to determine community concerns and identify solutions for acceptable vaccine delivery (e.g., location-based FLW recruitment). In critical localities in accessible areas (e.g., in the south), communication and operations teams should work in an integrated way to achieve coherent effects in:

1. Evidence-driven community engagement interventions
2. Local cadres of neighbourhood leaders to positively influence households
3. Trusted FLWs and mobilisers at the doorstep
4. Partnerships focused on improving the provision of community-level services
5. Supportive credible and locally appropriate media messaging environment

TAG appreciates the bottom-up approach to developing the National Emergency Action Plan (NEAP) 2021, which includes details of interventions to address region-specific challenges. TAG recommends various additions to interventions in the NEAP 2021. For example the PEI can work to integrate gender by:

• Articulating specific gender objectives;
• Including women at all levels of the programme beyond FLWs, in a safe and secure environment, in community engagement and in communication;
• Developing clear national and regional criteria for recruitment of women at all levels of the programme, and addressing challenges related to their recruitment and supervision;
• Building partnerships with women's organisations; and
• Integrating sex-disaggregated data for all evidence generated.

TAG welcomes the development of an integrated national communications strategy to be incorporated in the NEAP and emphasises the importance of effective evidence-based community engagement strategies to maintain and improve household vaccine uptake. Mass and social media play an important role in creating an enabling information context, but they are no substitute for locally accepted community engagement strategies and investments. TAG offers specific recommendations on communication, including:

• Focus community engagement on neighbourhood strategies to reduce missed children of all kinds in accessible areas, and tailor as per the needs of communities.
• Develop cross-border coordination to identify key influencers and elders on all sides.
• Integrate communication strategies in operational plans to maximise acceptance of alternate vaccination modalities in inaccessible areas.
• Continue to broaden local engagement communication by FLWs and mobilisers to focus on maternal health, child welfare, referrals, and vaccination - not just polio and the oral polio vaccine (OPV).
• Review capacity needs for effective community engagement, and evaluate the impact of facility-based female mobilser vaccinators (FMVs) on core programme objectives.
• Ensure that communication and community engagement interventions are guided by evidence and evaluated through a monitoring and evaluation (M&E) framework.
• Maintain mass, social, and local media strategies, measuring impact on community awareness of SIAs, confidence in OPV, and attitudes about the Expanded Programme on Immunization (EPI).

In going forward in a highly unpredictable operating environment, as the country enters a phase of increased political and security uncertainty, the PEI can build new opportunities for progress on the following pillars of resilience:

• Rigorous humanitarian neutrality and commitment to universal child health
• Strong One Team approach
• Maintenance of programme essential functions
• Achievement and sustenance of gains in accessible areas
• Flexible multi-pronged approach to access negotiation
• Agility using every opportunity to vaccinate in a dynamic environment
• Creative solutions to local vaccination and strengthening of the EPI