Given the Taliban's hostility to vaccinations, WHO and medical experts fear a rapid and uncontrolled spread of COVID-19 in Afghanistan will await the formation of a new government led by the 'Islamic Scholars'.

The WHO recorded 152,411 confirmed cases of COVID-19 and 7,047 deaths in Afghanistan between 3 January and 19 August. On 15 August, the Taliban took over the Afghan capital of Kabul, signifying the collapse of the government of President Ashraf Ghani.

"As the situation in Afghanistan continues to deteriorate rapidly, WHO is extremely concerned over the unfolding safety and humanitarian needs in the country, including risk of disease outbreaks and rise in COVID-19 transmission," said a 17 August WHO update.

"Disruptions at [the] airport are delaying urgently needed essential health supplies. Crowding at health facilities and IDP (internally displaced people) camps, due to rising conflict in the country will limit implementation of infection prevention protocols, increasing the risk of COVID-19 transmission and outbreaks of other diseases," WHO said in the update.

According to WHO, the country of 40 million people had administered a total of 1,872,268 vaccine doses by 14 August. At least 70 per cent of the population needs to be vaccinated to effectively curb the COVID-19 virus, according to epidemiologists.

In areas where people have fled to seek safety and shelter, including Kabul and other large cities, field reports indicated that there are increasing cases of diarrhoea, malnutrition, high blood pressure, COVID-19-like symptoms and reproductive health complications, said WHO.

Shahid Meezan, a UN consultant who has spent several years in Afghanistan and is now based in Dhaka, says much depends on decisions by local commanders in particular areas. "For example, in East Afghanistan's Paktia district, the Taliban has put up notices warning against vaccinations and discouraged health teams," he tells SciDev.Net.

"If the vaccination process is stopped, COVID-19 will be difficult to control in Afghanistan," says Musa Joya, a lecturer in medical physics at the Kabul University of Medical Sciences but currently pursuing a doctorate at the Tehran University of Medical Sciences, Iran.

"The people do not trust the medical system and avoid going to hospitals, and the country's medical system is not able to provide oxygen and other medications which need to be imported," Joya says. "Besides, most Afghans do not believe in coronavirus mortality prevention by vaccination. They expose themselves to the virus and leave the rest to providence.

"These two factors of no vaccination and no self-protection will surely result in disaster," says Joya.

Carl Latkin, vice chair, Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Maryland, US, says he is pessimistic about Afghanistan's medical ability to handle the COVID-19 pandemic, given the need for medical expertise, money and supply chains.

"COVID-19 can spread quickly and add more pain and misery to a highly volatile and distressing situation," says Latkin. "The current chaos will likely lead to the most vulnerable having few resources to prevent and treat COVID-19."

"However, one unintended consequence of people staying home due to fear of the Taliban might be great social distancing and hence reducing the spread of COVID-19," Latkin adds.

Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, says it is certain that the deteriorating conditions in Afghanistan will directly impact the ability to get COVID-19 vaccines into the population.

There have been concerns in the past regarding the fact that the Taliban has opposed polio vaccination and indeed Afghanistan is one area where wild polio virus still circulates."

Amesh Adalja, Senior Scholar, Johns Hopkins Center for Health Security

Taliban-imposed bans on vaccination have been blamed by the National Emergency Action Plan (NEAP) for the failure to eradicate polio in Afghanistan. The country remains among the last refuges of the wild poliovirus. In 2020, 56 cases of the disease caused by the wild poliovirus were reported in Afghanistan.

The vaccination ban was imposed on all areas held by the Taliban in 2020 while critical areas in the South Region had been deprived of immunisation for nearly three years affecting around 1 million children, and leading to a significant drop in population immunity and heightening the risk of further intensification and geographical spread of the wild poliovirus, the NEAP document said.

According to the document, more than 3 million children are currently inaccessible with the risk worsened by the COVID-19 disruptions in health delivery and there was "immense need to intensify neutral negotiations" with the Taliban.

Latkin recommends Involving the Taliban in the vaccine distribution process as "that may lead them to see the benefits and that vaccines are not a threat."

"Ideally, community health workers should be from the community and known by the community," says Latkin. "However, it remains to be seen if the Taliban will trust the complex and interdependent structure necessary to disseminate vaccines.

"What may make the difference is that the Taliban is now seeking international assistance as well as wider recognition in the world, and this means they will need to cooperate on issues like vaccination," says Meezan.

During their last stint in power from 1996 to 2001, the Taliban were recognised only by Pakistan, Saudi Arabia and the UAE.