IRIN interview with UNICEF on imminent vaccination effort

The United Nations announced on Friday that children inside Afghanistan would be vaccinated against polio this week, despite growing concerns that reprisals against Afghanistan in the wake of the 11 September terrorist attacks on the US could be imminent. The vaccination programme of up to five million children is being mobilised by UNICEF and the World Health Organisation (WHO), in consultation with the ruling Taliban's Ministry of Health and that of the opposition Northern Alliance. At the same time, in the past week, fears of US strikes have led to tens of thousands of Afghans leaving their homes in urban areas. Many have fled to the borders, trying to cross into neighbouring countries and insecurity inside Afghanistan has also increased steadily. The timing of the vaccination programme has been questioned by some aid workers, and the head of UNICEF in Afghanistan, Dr Eric Laroche, explained to IRIN why the programme was going ahead. QUESTION: Some people are concerned that the lives of children may be at risk if this programme goes ahead. What do you say to this? ANSWER: It is precisely because it is so difficult that it is very relevant to go ahead. There are many aspects to justify this. The first one is that the children to be vaccinated, unless they are vaccinated now, are more prone to get polio in the weeks to come - the reason being that, probably they will be displaced, probably they will become malnourished in the weeks and months to come, so they will be weakened and, therefore, more prone to get the virus. So, it is more timely to protect them now. As for the question of whether or not it is the right time: In view of what everyone is fearing may happen in Afghanistan, we don't even try to find an answer to that, but we decided we should just go ahead. In any case, if anything happens we will stop. That is it. But we will have the chance to reach some of the children. It is important to note that the Afghanistan eradication programme has been a success so far, very successful. It is successful in two ways. It is successful in reaching a lot of children, it is successful also in decreasing the number of polio cases. All of the polio cases that have been recorded since the beginning of the year have totalled only eight. Theses cases are all situated in and around Kandahar. The movement between populations that is going to occur with refugees and new refugees and new displacement is probably going to be a way to increase the new cases inside Afghanistan and therefore it is important to do something now. There is also the economic point of view which is that we still have a lot, almost one million US dollars worth, of vaccine inside Afghanistan. If there is any breakdown in the cold chain this vaccine is going to be useless in a few months, if not a few weeks, and so I think this is a good opportunity to try to use what is available in terms of resources. Q: You just mentioned that you wanted to vaccinate children before they start moving, but people are already moving out and some say that up to one million are leaving their homes. How will his affect your planning? A: Not all of them have gone to the border. Many have gone to places inside the country. This movement in any case does not mean much for us because our vaccination programme adopts a door-to-door strategy. We don't try to gather people together in one place. The vaccinators go from door to door. But it's true that the micro-planning we have done needs to be revised in light of these population movements. In any case, we know that this programme is going to be effective because it is targeting the population that could be most at risk and this population comprises those that are going to be gathered somewhere, be it in a village, or a camp or are on the border. This is precisely where the virus can thrive and develop, so I think it still makes sense in terms of epidemology [to go ahead]. In fact, before deciding this we have been contacting the highest scientific authorities on the virus in the world. Q: People are said to be moving out from the cities into remote places. How are you going to ensure that you reach children in such areas? A: All of these places have already been recorded in our planning, so all of the houses have been recorded. We have vaccinators, social mobilisers in each and every village. The distribution of vaccine has still not started yet so there is still time now to revise roughly the figures in that if you know you have twice as much children in one place as you would have had before the move of people then you just ask for twice as many doses, and this is just a matter of transport. The transport is still going to be the same - the number of doses is just going to be doubled, that's all. Q. Now that all international aid workers have left Afghanistan, who will carry out the immunisation programme? UNICEF has only 67 national staff. Is this going to be enough? A: National staff are not the vaccinators. The national staff are helping to organise planning; training and helping delivery of vaccine and in fact all these things have been done. In fact it was done before the 11th, and after the 11th we have been finishing the training and micro planning, so everything is posed for the event. Q: How many people are going to be carrying out the immunisation? And if there are air strikes how will you ensure their safety? A: Altogether as many as 35,000 volunteers, social mobilisers, national UN and local NGO staff will be involved. If there is air strikes, I do not think there will be such a huge casualty [rate] because they will just stop. We are not talking about gathering people in one place or another. We are talking about house-to-house strategy, which means someone goes from one house to another. So the population will be - with or without vaccination - in their homes. The only additional person with them in that home will be the vaccinator. So you see, it is not as if you would have 2,000 mothers and children in one place being hit by a rocket. That would create a lot of casualties. This is completely different. Having said that we do recognise that there is a risk and we have to take risk in life. It seems to us much more important to try to do something because otherwise we run the risk of kids suffering from an additional disease to the ones they already have and this making worse the problems they already have and so on. Q: Have you heard from the volunteers over the last week or so in the current situation and are they happy to carry on? A: Well, it is a mix. Some have disappeared and we try to find them and to remobilise these people and to ask them come back. A lot are coming back, some are not. Q: What is your strategy if there are air strikes and what instructions have been given to staff? A: To stop. Q: How big is the problem with polio at the moment in Afghanistan? A: The polio eradication programme in Afghanistan is one of the most successful programmes in the world. I was in Geneva in a big gathering of all of these specialists in WHO at the beginning of the year and I must say that the programme that has had the most success in all the presentations that were made was the Afghan programme. Everyone was amazed to see that people were capable of decreasing the number of polio cases and to have, at each time what we called the "days of tranqulity" which is when they stopped the fighting on both sides, between the Northern Alliance and the Taliban armies. We had a written agreement that they were going to stop bombardment and they did stop for two or three days. The entire world was amazed to see how fast the evolution of the eradication was going in this country. So this is work being done and at least this is a gift that we can make to the kids, which is to assure them that they will not be crippled by polio as well as by mines. Q: How long will this campaign take and how do you plan to track down those who are on the move? A: Normally we would expect two three days but I can not tell you for this one. It could take a little bit longer. In the circumstances, we won't cover everyone this time, but hopefully there will be another NID (National Immunisation Day) in weeks to come, if the scenarios that are put on the table are correct. But in the next one we are going to try to do everything that is possible to reach these others. A lot of people have gathered at the frontier and are across the border so we will try to do what we call the cross-border activity. We hand over all of the necessary equipment, syringes, vaccines and so on across the border and the people inside - the Afghans - can take care of themselves. For this time, it is clear that everyone who is inside Pakistan will be vaccinated. We have vaccines here from the Afghan programme that is going to be given to the Pakistani authorities to vaccinate the kids inside Pakistan. Q. Given the uncertainty of what is happening right now, would it not be better to postpone this programme? A: No, I don't think so. We can always postpone the programme, that is not a problem. I think it is much more risky to hesitate and get things done in a couple of weeks time than to do it tomorrow. Q: How serious is polio in Afghanistan; for example how many cases have there been? A: There have been 18 proven cases, but the fact is it is like a competition. It is about all replacing a wild virus population which is creating the disease with a tame virus population. If you leave a crack all of a sudden, the wild virus being more virulent is going to be multiplying faster that the other one so it is like a population growing in terms of space. The one that grows faster gets in. So for the time being we have been able to push, push, push, the wild virus but if we stop, the wild virus is going to take the ground back, therefore creating many cases of polio and children dying. This is particularly the case in conditions where children are going to be gathered together in large groups and unsanitary conditions, then you are going to see more cases. This is why we want to have cross border operations and why refugee camps are a particular target.