In the early 1980s, there were an estimated 300,000-400,000 polio cases each year worldwide. Today, polio has almost been completely eradicated globally — except in Pakistan and Afghanistan. Efforts towards eradication took off in 1988 when the World Health Organization passed a resolution to eradicate polio, creating the Global Polio Eradication Initiative. Since then, global polio cases have decreased by 99 percent, from 350,000 cases in 1988 to six reported cases in 2021. Though the efforts for polio eradication were not entirely successful, and only one out of three polio strains remains endemic, this strain is seen solely in Pakistan and Afghanistan. A combination of political instability, prolonged conflict, human migration, and weakened healthcare systems has prevented polio’s elimination in these two countries. Particularly in Afghanistan, the violence and radical beliefs of the Taliban in the last 30 years have been major contributors to overall instability and conflict in the country, which directly impacts the healthcare sector’s abilities to effectively carry out polio vaccination efforts.

Twenty years after the U.S intervention in Afghanistan, in an attempt to collapse the Taliban, the group has now regained control over the country as of August of 2021, forcing the internally backed President Ashraf Ghani to flee. The Taliban have used their authority to implement an extremely harsh interpretation of Islamic law which harms the autonomy and rights of women, as well as minority religious and ethnic populations. A major sector of Afghani life that has struggled as a result of Taliban rule is healthcare.

Even before the Taliban retook Kabul 2021 and became the leading political power group in the country,  the political instability and violence perpetrated by the Taliban negatively impacted overall access to healthcare, especially for women and children. This can be seen in the withholding of medical care, intimidation out of accessing care, and legal and infrastructure roadblocks to care. Under any form of Taliban rule, women must be accompanied by a mahram, or male family member, when traveling distances. Women who do not have a mahram are therefore left in  political limbo; unable to travel and unable to access healthcare. There are also cases of even when a woman can travel on her own, Taliban authorities will still prevent medical treatment if she is not with a mahram. Additionally, the healthcare infrastructure in Afghanistan is failing. In September of 2021, the World Health Organization found only 17 percent of Afghani hospitals were fully functional. This meant that even those who could access healthcare facilities would not be able to be given proper care.

In regards particularly to polio, eradication efforts primarily rely on the vaccination of children in combination with ongoing surveillance and monitoring efforts for new cases. In the context of the existing barriers to healthcare, the manner in which polio vaccination and eradication interventions are carried out comes in both direct and indirect conflict with Taliban control. The Taliban have a long history of opposition to vaccination through rhetoric, policies, and violence. Even before taking control of Kabul in August of 2021, the Taliban had control and political influence over many provinces in Afghanistan. From 2018 to 2021, the Taliban had a ban in place to restrict door to door polio vaccinations. This ban set polio vaccination efforts back significantly in Afghanistan and led to approximately 3.4 million Afghani children being unvaccinated and, as a result, from 2019 to 2020, the country saw a doubling in cases of polio spiking from 29 cases in 2019 to 56 cases in 2020.

A breakthrough came in November of 2021, when the Taliban agreed to resume door-to-door vaccination efforts. This came after the Taliban overtook Kabul.With this assurance of stability, the Taliban allowed polio vaccination efforts to resume seeing as the door-to-door tactics used by vaccinations no longer posed a significant threat to Taliban surveillance and control. With this resumption of vaccination efforts, the UN, WHO and other NGOs focused on healthcare were able to reach three million children in rural parts of the country that have previously been determined to be inaccessible due to Taliban policies. In 2022, UNICEF, WHO and the National Emergency Operations Center in Afghanistan were able to vaccinate 9.4 million children in the country. After this resumption, 30,000 polio social mobilizers and educators were able to conduct efforts in Afghanistan to not only roll out vaccinations, but educate and inform communities about polio.

Unfortunately, polio vaccination efforts have been curtailed by Taliban policies once again as of September 2024. Giving no official reason, the Taliban suspended polio vaccination campaigns in Afghanistan before the start of the September cycle. Not only is this a major setback for the Afghan-based effort to eradicate polio, but concerns have risen regarding the spillover effect this ban could have on Pakistan, as there is frequent human movement between the two states. The WHO has confirmed 18 cases of polio in Afghanistan, an increase in 6 cases from 2023. 

In addition to legal restrictions, intimidation and violence from Taliban members has created a physical and psychological barrier for many healthcare workers. There has been an emphasis on the need for security and protection from violence in healthcare following a series of violent attacks against polio vaccinators. In a single incident in 2018, prior to the Taliban’s full control of Afghanistan but during a period where the group still held significant power, at least five polio vaccine workers were shot dead in the eastern city of Jalalabad. Although the Taliban formally denied responsibility, the international community largely placed the blame for these attacks on the group, citing many other occurrences of civil sector workers being harassed or killed by Taliban members. The Taliban’s history of using violence to enforce their stances on not only vaccines, but all aspects of life, makes it very likely that Taliban members were responsible for these attacks. 

Polio eradication efforts in Afghanistan is a public health initiative that has faced significant barriers, both politically and socially from the Taliban group. Even when not formally in power, the Taliban has managed to exert control over the efforts through violence and intimidation. In power, the Taliban has the ability to enact bans and restrictions on the efforts of healthcare providers. The continuous barriers created by the Taliban will only continue to perpetuate endemic polio in Afghanistan, and potentially its neighbor Pakistan which is why it is imperative that the WHO and other global health organizations continue to campaign against polio in Afghanistan.