The impact of the regime change on polio outbreaks in Afghanistan

Afghanistan is one of the two remaining polio-endemic countries in the world. The collapse of republic government and expected escalation of violence and its consequences associated with the regime change of August 2021 raised concern that polio eradication efforts would deteriorate, resulting in polio outbreaks throughout the country. The research question for this study is as follows: What is the relationship between the 2021 regime change and wild poliovirus type 1 (WPV1) in Afghanistan? This observational study explores the relationship of regime change on polio control in Afghanistan during two periods: (1) the 8-year period (2017-2024) surrounding the coalition departure from Afghanistan in 2021 and (2) the 8-year period 1997-2004 surrounding the coalition regime change in 2001. Two important conclusions can be drawn. First, a polio outbreak did not occur following the withdrawal of US forces from Afghanistan in August 2021. Second, similar patterns of WPV1 outbreak and control are observed in both the 2001 and 2021 regime changes in Afghanistan. The findings also indicate that polio vaccination programme efforts in Afghanistan did not decline following the 2021 regime change. The findings have important implications for understanding the relationship between regime change and polio eradication efforts and for future studies to explore the mechanisms underlying the relationship between regime change and polio control.