Posted by Bill Boyd
As at 8 April, Afghanistan had 3 cases this year as again 29 for the full year last year. In the month of February there were 6.7 million children vaccinated but 1.9 million children were missed as they were in areas that were inaccessible. They have 19 cross border posts which vaccinated 1.8 million children as the amount of movement between Afghanistan and Pakistan is considerable. In their country they have 2926 social mobilisers, who organise and vaccinate.
Pakistan is a much bigger problem. In January there were 18.3 million children vaccinated which is an amazing achievement but many were still missed. The population is so dense, particularly in the slum areas, that it a very difficult to ensure all children are seen. They have 376 permanent transit points, which includes bus stops, railway stations and highways and they vaccinate many children in these but much of the work is a hard slog through slums. In Pakistan as at 8 April this year there were 37 cases as against 149 for the full year last year.
One of the surveillance techniques used in many countries to check that polio is not  circulating is to take and analyse environmental samples, which is a polite way of saying that samples are taken from sewage and then laboratory tested, and in Pakistan this means taking samples from ditches and creeks. Not a very desirable job! In January they found 27 positive samples.
Covid19 has now changed the landscape as it was necessary to stop vaccination activity everywhere in mid-March with a target resumption of July 1. The polio workforce has now transferred its activities to covid19. Sadly, it is accepted that this will mean more cases of polio. Not all activity has ceased however as surveillance, planning and training continues and new more effective vaccine, mOPV2, will become available in August/September.
In India, during the successful polio eradication, Rotary formed an alliance with the Ulema Council which is made up of some of the most senior Muslim clerics in India and that alliance has been rekindled to fight covid19. Yet another example of our polio campaign building health structures that will fight other health issues.
An ongoing challenge in the background is the amount of vaccine derived polio in Africa and this is a problem that will only be beaten when the wild polio virus is eradicated. Clearing vaccine derived polio cannot occur until we can stop vaccinating and then it will be just a matter of money and time.
As a final comment, the Bill and Melinda Gates Foundation will stay in the polio effort with Rotary and will again next year provide the subsidy of US$100 million if we raise US$50 million.