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Afghanistan is the first country worldwide to use bivalent oral polio vaccine

© UNICEF/2009/Walther
A child recieves the bivalent polio vaccine from one of 21,000 health agents who were deployed by the Afghan Ministry of Public Health for a three-day immunization campaign.

By Cornelia Walther

KABUL, Afghanistan, 17 December 2009 – Sheila Noor, 18, is one of 21,000 health agents who were deployed by the Afghan Ministry of Public Health for a three-day immunization campaign using the bivalent polio vaccine this month. 

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By using bivalent polio vaccine children can be immunized against two types of polio virus with a single one-drop dose. Afghanistan is the first country worldwide to use the bivalent oral polio vaccine.

“The new vaccine will allow us to save time and energy and reach, eventually, many more children,” said Ms. Noor. “We explain to every mother that this time a new vaccine is used that will protect their child even better. They appreciate it.”

Reaching children

Three different types of the poliovirus exist. Protection against one type does not protect against the others. Bivalent oral polio vaccine is more effective than any other vaccine used before against types one and three. In combination with previously used vaccines it will accelerate the interruption of remaining chains of poliovirus transmission.

A total of 2.8 million children under five are being targeted in regions of Afghanistan where the crippling disease remains endemic.

Four million doses of bivalent vaccine have been purchased by UNICEF with the financial support of the Canadian International Development Agency (CIDA).

“The campaign is going smoothly in the majority of the districts, with the exception of Panjwaiie and Boost district, where 100 per cent and more than 50 per cent of target children, respectively, could not be vaccinated due to the ongoing security situation,” reported UNICEF Health Specialist Zahra Mohammed.

Campaign challenges

Since many women in Afghanistan are not allowed to leave their homes alone, a door-to-door approach is essential to reach a maximum number of children. Additionally, in areas that are affected by conflict, reaching children becomes increasingly difficult.

Ms. Noor went from house to house for three days, counting children and vaccinating those under five. After vaccination, a child’s fingertip is coloured with permanent pen to ensure they will not be immunized twice during the same campaign.

Before leaving each home, Ms. Noor asks the mothers if she has vaccinated all their children.

“Sometimes, they think sleep is more important than the vaccine and don’t wake their babies up, or they do not want us to touch the newborns,” Ms. Noor said. “Usually we manage to get all children and when a house is finished we write the number of children vaccinated with chalk on the door. If a child is absent, we note the name down and come back.”

Overcoming reluctance

One of the reasons why health agents may encounter little resistance on their tour is due to the work of social mobilizers. Before each campaign, volunteers trained by UNICEF, WHO and the Ministry of Public Health visit each home and explain the importance of immunization.

On her way from house to house, Ms. Noor saw a three-year-old girl named Fatima being carried by her brother. Fatima had polio when she was a baby and is paralyzed.

“To see this makes me very angry,” Ms. Noor said.

Fatima had been immunized, but then her parents moved to another area. Because of this, Fatima was only immunized against one type of polio. The bivalent vaccine will increase a child's chances to escape all three types of polio.

“Families are more and more convinced of the importance of polio vaccination, but some continue to be reluctant,” said Ms. Noor.




Dr. Maritel Costales, Senior Health Advisor for UNICEF, describes the importance of the new bivalent oral polio vaccine, now being distributed in Afghanistan.
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