Polio vaccination campaigns have resumed in Afghanistan and Pakistan – the last two countries where the crippling disease has a foothold – after a reported “surge” in cases.

Child vaccination drives, including against polio, were stopped in March due to concerns that they might increase the risk of COVID-19 transmission to children, their caregivers and vaccinators. The precautions left 50 million children without their polio vaccine, according to the UN Children’s Fund (UNICEF). Since the suspension of vaccination drives, Afghanistan has reported 34 cases and Pakistan 63. In Pakistan, the disruption has also caused the disease to expand and be introduced into new areas of the country that were previously polio-free.

“It’s a surge,” Akmal Samsour, an Afghanistan health ministry spokesperson, told The Guardian.

Polio is a “highly-infectious, crippling and sometimes fatal disease,” according to UNICEF, that mainly affects children under five years of age. But it can be avoided with a vaccine and is on the brink of eradication, thanks to vaccination campaigns. Since 1988, polio cases have been reduced by more than 99 percent, from more than 350,000 reported cases in 125 countries then to 33 reported cases in 2018. Today, Afghanistan and Pakistan are the last two remaining polio-endemic countries, meaning they have yet to interrupt the transmission of wild poliovirus. This month, the WHO is expected to declare the African Region free of wild poliovirus, after Nigeria recorded no new cases in three years in August 2019.

Polio immunization programmes restarted in three provinces in Afghanistan in July. Later that month, Pakistan also resumed an initial round of vaccinations, covering about 780,000 children.  This month, broader campaigns in both countries will begin, covering almost half of Afghanistan and across Pakistan. Vaccinators are using personal protective equipment and following new guidelines to reduce the risk of COVID-19 transmission. For example, parents are being asked to hold their children while the vaccinators administer oral drops, thereby minimizing the vaccinators’ contact with children and their caretakers.

“These life-saving vaccinations are critical if children are to avoid yet another health emergency,” said Jean Gough, UNICEF Regional Director for South Asia, in a press release. “As the world has come to see only too well, viruses know no borders and no child is safe from polio until every child is safe.”

However, UNICEF says that as many as 1 million children in Afghanistan could still miss out on their vaccines, because door-to-door vaccinations aren’t possible in some areas, meaning parents in those places will have to bring their children to health clinics. Some families may not have the means to make the trip, and some may be wary of going to a health clinic during a global pandemic.

In Pakistan, there may also be concerns about safety and misinformation. Last year, in the northwestern city of Peshawar, religious hardliners spread a rumor that children were falling ill because of the vaccine. This resulted in fear, backlash and attacks on health-care workers and centers in Pakistan’s conservative Khyber Pakhtunkhwa province, which is near the border of Afghanistan and where most of Pakistan’s polio cases have been detected. This year, however, the biggest challenge to finally eradicating polio appears to be COVID-19.

“Although we have experienced new challenges and a setback in the fight against polio because of COVID-19, the eradication of this contagious disease will get back on track and is firmly within our reach,” Gough said.

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How the Coronavirus Pandemic is Interrupting Childhood Vaccinations Worldwide, and interview with Barbara Saitta is a nurse with Doctors without Borders / Medicines Sans Frontiers who specializes in vaccination campaigns, primarily in poorer countries.

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