Afghanistan: COVID-19 Strategic Situation Report
Country-level Coordination: The revised Afghanistan Humanitarian Response Plan (HRP) for 2018-2021 was published on 9 January. The HRP identifies 18.4 million people – nearly half the population – are 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.
The health and socio-economic impacts of the COVID-19 pandemic have seen the number of people in need almost double in the past year alone. Afghanistan now has the second highest number of people in emergency food insecurity in the world (5.5 million), while nearly one in two children under-five will face acute malnutrition in 2021.
MOPH Figures: As of 21 January, MoPH data shows that 54,483 people across all 34 provinces in Afghanistan are confirmed to have had COVID-19. Some 46,887 people have recovered, and 2,370 people have died – at least 87 of whom are healthcare workers. Only 234,453 people out of a population of 40.4 million have been tested. Afghanistan now has a test-positivity-rate – positive tests as a percentage of total tests – of 23 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 almost 68 per cent of the total COVID-19 confirmed cases in the MoPH data, although this may be the result of overrepresentation of men in testing. Due to limited public health resources and testing capacity, 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 is creating grave risks in the community with people generally not observing physical distancing or mask wearing protocols.
Second Wave: In November 2020, MoPH confirmed that Afghanistan was in a second wave of the COVID-19 pandemic. Following months of consistently lower confirmed COVID-19 cases, MoPH tracking data has seen an uptick in cases, with 80 new COVID-19 cases recorded in the last 24 hours, although numbers now appear to be slowing. WHO Afghanistan remains concerned about mutations of the virus. WHO has sent recent COVID-19 samples for genomic sequencing to track for variants and confirm if the mutation is currently present in Afghanistan. WHO suspects this to be the case and reiterates that vigilance should be maintained.
The rollout of the annual influenza vaccination across Afghanistan this winter is more important than ever to help the health system manage COVID-19 cases. Increasing influenza vaccine coverage can reduce the strain on the health care system and free-up limited health resources to focus on treating more severe cases of COVID-19. Public health experts strongly urge the public to follow health advice on physical distancing, mask wearing, good hygiene, hand washing and other proven strategies that mitigate the risk of COVID-19 transmission.
Health Services: Hospitals and clinics continue to report challenges maintaining or expanding their facilities’ capacity to treat patients with COVID-19, as well as maintaining essential health services, especially in areas of active conflict. WHO stresses the need to balance the demands of responding directly to COVID-19, with simultaneously engaging in strategic planning and coordinated action to maintain essential health service delivery, mitigating against the risk of system collapse.
Almost eight per cent of the total confirmed COVID-19 cases are among healthcare staff. Health facilities across the country continue to report shortfalls in PPE, medical supplies and equipment, further challenging their capacity to treat COVID-19 patients. There is an urgent need to ensure a continued distribution of medical and protective equipment to all corners of the country. While 15 laboratories are now operating in Afghanistan, the capacity of these facilities remains limited and stocks of supplies have periodically run out. National capacity for COVID-19 testing has topped 5,800 a day however these laboratories are not being fully utilised. Humanitarian partners urge the Government to ensure laboratories are appropriately equipped, staff receive timely remuneration and that procured supplies go to under-resourced health centres in a transparent manner so that life-saving support can be delivered to those most in need.
Vaccination: The Government of Afghanistan and the UN have initiated a number of steps to prepare for the rollout of a COVID-19 vaccine across the country, including the development of a National Vaccine Deployment Plan (NVDP). A technical working group comprised of government and UN organisations and chaired by the Ministry of Public Health have developed plans for vaccine operations, cold chain management, communication, surveillance, training and monitoring and evaluation/data and will complement the existing Vice Presidential COVID-19 Task Force. As a preparation for the COVID-19 vaccine deployment, UNICEF will be responsible for vaccine/injection supply procurement, communication and social mobilisation support, and cold chain procurement. WHO’s responsibility, on the other hand, will include: developing training materials and tools; micro-planning; training of health workers; vaccine operation and; monitoring and evaluation. Other UN and NGO organisations will also be involved in preparation and roll out of the vaccine through both existing and new programming. Joint efforts are being coordinated through a recently established technical team. The COVID-19 vaccine is expected to be available in Afghanistan in 2021 through the COVAX Advanced Market Commitment (AMC) facility. While GAVI had provided funding through the COVAX facility to cover vaccine costs for up to 20 per cent of the population, the World Bank and Asia Development Bank have recently committed to provide funds to cover an additional 40 per cent of the population.
Socio-economic impacts: The socio-economic impacts of COVID-19 are translating into a dramatic deterioration in food insecurity with levels, now similar to those seen during the 2018 drought. An estimated 16.9 million people are in crisis or emergency levels of food insecurity through until March. The current climate outlook is also worrying with predictions of reduced precipitation and higher temperatures potentially affecting farmers and pastoralists over the next few months. Food prices are already at elevated levels due to COVID-19. According to WFP’s market monitoring, the average wheat flour price (low price and high price) increased by 13 per cent between 14 March and 20 January, while the cost of pulses, sugar, cooking oil and rice (low quality) increased by 23 per cent, 21 per cent, 46 per cent, and 18 per cent, respectively, over the same period. This price increase is accompanied by declining purchasing power of casual labourers and pastoralists – which have deteriorated by 19 per cent and 18 per cent respectively (compared to 14 March). 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 shows that the primary reason for taking on this debt was to pay for food (53 per cent).
Winterisation support: Afghanistan is enduring a grim winter as people struggle to keep themselves warm amid soaring poverty driven by the economic shock of COVID-19. Given this situation, there is an urgent need for additional funding for winterisation support from both the Government and donors to help struggling households survive the harsh weather ahead. The ICCT’s $137m winterisation plan aims to reach 2.5m people over the winter months with a range of lifesaving support including cash and in-kind heating assistance for households and classrooms, warm clothes, seasonal food support, nutrition treatment, and health services for winter sickness. To date, about half of the funds needed have been committed by donors and the Government ($71.7m), leaving a gap of $65.8m. (DOWNLOAD FULL REPORT)