Afghanistan Flash Update | COVID-19 | Strategic Situation Report No. 95 | 22 April 2021
Afghanistan Flash Update | COVID-19 | Strategic Situation Report No. 95 | 22 April 2021
Situation Overview: UPDATED
Global Update: According to John Hopkins University, more than 3 million people have now died with COVID-19 across the world. The pandemic is affecting 192 countries with some 143 million confirmed cases globally, as of 22 April. WHO reports that while the emergence of new virus variants is common, those with higher speed of transmission or potentially increased pathogenicity (i.e. the capacity of a microbe to cause damage in a host) are very concerning. Crucial investigations are underway to comprehensively understand the behaviour of the new virus mutation (B117) and steer the response accordingly.
MOPH Figures: As of 22 April, MoPH data shows that 58,346 people across all 34 provinces in Afghanistan are confirmed to have had COVID-19. Some 52,307 people have recovered, and 2,561 people have died – at least 91 of whom are healthcare workers. Only 388,760 people out of a population of 40.4 million have been tested. While numbers remain far below those seen during the peak of the first and second waves, recent official MOPH case numbers indicate a deterioration of the situation, potentially signalling a third wave. According to WHO, the eastern region in particular has witnessed a sharp increase in COVID-19 cases and hospitalisations over the last two weeks. Afghanistan now has a test-positivity-rate – positive tests as a percentage of total tests – of 15 per cent, suggesting overall under-testing of potential cases. The majority of recorded deaths were men between the ages of 50 and 79. Men account for more than 66 per cent of the total COVID-19 confirmed cases in the MoPH data, although this may be the result of over-representation of men in testing. Due to limited public health resources, lack of people coming forward for testing, as well as the absence of a national death register, confirmed cases of and deaths from COVID-19 are likely to be under-reported overall in Afghanistan. Stigma is considered a major factor in people choosing not to get tests and risk communications work is critical to turning this around. WHO warns that widespread complacency and failure to follow public health advice in Afghanistan is creating grave risks in the community with people generally not observing physical distancing or mask wearing protocols. WHO Afghanistan remains concerned about mutations of the virus, cases of which have been confirmed in Afghanistan. There is a significant increase in cases of the new, more infectious variant in Pakistan and Iran. The Ministry of Public Health is preparing contingencies for a third wave which includes scaling-up surveillance at borders and improving testing.
More than 7 per cent of the total confirmed COVID-19 cases are among healthcare staff and they are currently the highest priority for vaccination. There is an urgent need to ensure continued distribution of medical and protective equipment to frontline workers all corners of the country. 23 laboratories are now operating in Afghanistan – with plans to scale-up to at least one laboratory per province by June 2021. National laboratories are testing 7,200 samples a day. WHO reports that laboratories have capacity to test up to 8,500 samples but low demand means technicians are actually working reduced hours.
Vaccination: The first batch of 468,000 COVID-19 vaccination doses through the COVAX facility arrived in Afghanistan on 8 March. In total, Afghanistan has now received 968,000 doses of the vaccine – 468,000 from the COVAX facility and 500,000 directly from the government of India -- enabling the vaccination for some 484,000 people. COVID-19 vaccination through the Ministry of Public Health has now been opened to all those above 18 years of age. Vaccination is currently available in select health facilities and through mobile vaccination teams. More than 240,000 people have been vaccinated in Afghanistan to date, including some 89,000 health workers, 38,000 teachers, 13,000 people with co-morbidities and 13,000 prisoners. WHO weekly data shows that on average over 10,000 vaccinations are being administered every day across Afghanistan.
Overall, however, there remains some concern around low demand among healthcare workers and the equitable access to vaccines among all Afghans, especially vulnerable groups such as IDPs, returnees and nomadic populations and people living in hard-to-reach areas. IOM reports that vaccination coverage is extremely limited amongst all migrant populations due to negative perceptions and barriers to accessing care. Much more focus is needed to ensure migrant groups are vaccinated on pace with settled populations given the impact mobility has as a vector for transmission, especially with the more contagious viral variants now in Afghanistan. Additional efforts are also needed to reach women and people living in non-government-controlled areas with vaccines. Vaccine uptake remains slow and continued risk communication and community engagement efforts are needed to ensure high-risk populations and frontline staff understand the benefits of the vaccine and can effectively dispel misinformation. Countering negative rumours about the vaccine is a priority. As cases increase, humanitarian partners continue to urge the Government to ensure laboratories and frontline staff are appropriately equipped and that procured supplies – including vaccines – go to under-resourced health centres across the entire country in a transparent manner, so that life-saving support can be delivered to those most in need. WHO reports that additional deliveries from the COVAX facility will likely be delayed due to global shortages. However, additional vaccines may become available through bilateral channels.
The UN has received 5,000 doses of the AstraZeneca vaccine for personnel so they can continue to deliver life-saving services to people in Afghanistan. Eligible groups include UN and INGO staff. In order to access the UN vaccination scheme, eligible individuals must register on the UN COVID-19 vaccine portal. In order to access the portal, INGOs are requested to develop a sponsorship agreement with their main UN partner. NNGO staff are able to be vaccinated through the Government’s vaccination scheme. Please see the UN COVID-19 Vaccination page for more information. Vaccinations under the UN scheme began in Afghanistan on 13 April.
The WHO Global Advisory Committee for Vaccine Safety (GACVS) recently noted that a causal relationship between the vaccine and the occurrence of rare blood clots is considered plausible but is yet to be confirmed. More data from regions outside of Europe and the UK is needed to fully understand the potential relationship between vaccination and possible risk factors. The GACVS emphasised that while concerning, the clotting events under assessment are extremely rare and should be assessed against the risk of deaths from COVID-19 and the potential of the vaccines to prevent infections and reduce deaths. Accordingly, WHO advises that the benefit of the vaccine still far outweighs the risks and WHO’s advice about taking the AstraZeneca vaccine remains unchanged.
Socio-economic impacts: The socio-economic impacts of COVID-19 have translated into a dramatic deterioration in food insecurity with levels similar to those seen during the 2018 drought. An updated IPC analysis just released estimates that 14.1 million people are in crisis or emergency levels of food insecurity through until the end of May 2021. Cumulative precipitation has been below average over the wet season with reduced precipitation and higher temperatures likely to affect farmers and pastoralists, as well as water availability over the next few months. Food prices are already at elevated levels due to COVID-19 and are likely to increase given the dry spell’s likely impact on first and second crops in 2021. These factors, combined with COVID-19 related interruptions to informal employment and decreased remittances, are driving people into crippling debt. Data from the 2020 Whole of Afghanistan Assessment showed that the primary reason for taking on this debt last year was to pay for food (53 per cent).
Humanitarian Needs and Response Planning: The 2021 edition of the multi-year revised Afghanistan HRP identifies 18.4 million people in humanitarian need in 2021, as a result of COVID-19, ongoing conflict and natural disasters. Approximately six times the number of people are in need of humanitarian assistance in 2021 compared to four years ago when the multi-year HRP was first developed. Recognising the multiple, overlapping challenges facing the people of Afghanistan over the spring season – including low rainfall, intensifying conflict, and ongoing COVID-19 challenges – the ICCT conducted a multi-sectoral analysis of likely needs across highly-impacted provinces and has published a Spring Disaster Contingency Plan identifying the most urgent needs from March-June, with $390 million required for response. Securing additional funding for this spring plan and the broader HRP is urgent with only 8.5 per cent of HRP requirements received to date.