Afghanistan is at risk of a polio outbreak, health officials have warned, after the Taliban suspended the vaccination campaign over security fears and restrictions on women. The World Health Organization (WHO) has confirmed 18 new cases of polio infection in the country so far this year, a significant increase from the six cases reported in 2023. Local healthcare workers say these numbers could be higher as many cases will not yet have been detected. The Taliban had “temporarily suspended” polio vaccinations in Afghanistan, a health official involved with the campaign confirmed to the Guardian, because of security concerns and women’s involvement in administering vaccines. A highly infectious viral disease, polio can cause paralysis and death, particularly in infants and young children. “The reason behind the postponing of the polio campaign is the issues with the modality of implementation,” the health official explained on condition of anonymity. “The leadership of the current government has ordered us to not conduct door-to door campaigns.” Instead, the Taliban government wants to shift vaccination efforts to local mosques, with the expectation that families would bring their children to get doses. “This is very bad news for the polio programme,” the official said. “For the eradication to be successful, we need to cover more than 95% of the children with two doses of the vaccine. “But without the door-to-door campaigns, we will not be able to reach [that target]. It puts the whole country at risk, even the region.” Afghanistan and Pakistan are the only two remaining countries in the world where the polio virus is endemic. “One of the reasons for banning door-to-door campaigns was security. The south, especially Kandahar, is where the Taliban leaders live, and they are concerned the campaigns could reveal their locations to foreign threats,” the official said. Fake vaccination campaigns in Afghanistan and Pakistan were reportedly used by US intelligence agencies to identify and confirm terrorist hideouts, including those of Osama bin Laden. This led to massive mistrust of the campaigns across the region, with several attacks on polio workers over the past decade. A local healthcare worker in Kandahar said that door-to-door vaccination was already banned in southern Afghanistan. “In Kandahar and even in parts of Uruzgan province, vaccinations have been taking place only in the local mosques for many years now,” one of them said. While the Taliban have banned women from working in various sectors, women in healthcare have largely been allowed to remain in their jobs. However, the healthcare worker said: “Women in the southern region face restrictions from local authorities in participating in the programme, particularly in the rural areas.” The health official agreed. “Women have been crucial to the success of the door-to-door campaigns and raising awareness of the vaccines among mothers and families since, in a deeply conservative society, men would not be allowed into those spaces,” they said. Of the 18 cases reported this year, 11 are in Kandahar. “In the rest of Afghanistan, there are no issues with female polio workers, and in those areas where we have female workers, we don’t have cases of polio. They are directly responsible for the eradication of polio in those parts,” the official added. “When the Taliban took over, I was happy because I thought now we would have the opportunity to completely remove polio from Kandahar,” said one 23-year-old former female polio worker, who asked to be identified only as Farhanaz. “I was eager to travel to remote regions if needed to administer the vaccines. But when I faced restrictions, I was heartbroken,” she said. Farhanaz said she had been working with the local vaccination campaign since she was a teenager but was forced to resign shortly after the Taliban takeover in 2021. “Our work was crucial and effective. Preventing us [women] from doing our job will hurt the country and our children will suffer for no fault of theirs,” she warned. The WHO has been approached for comment.