Overcoming the Overlooked: The Role of Nomadic Communities in Polio Eradication

Despite global progress in eliminating polio, Afghanistan and Pakistan remain two of the last frontiers of the disease. The political instability, ongoing conflict, and frequent displacement of communities in both countries create major hurdles for vaccination campaigns. Health workers often face direct physical risks, while the countries’ rugged terrain also makes vaccinating in remote areas a significant challenge. On top of this, misinformation and vaccine hesitancy can complicate efforts to ensure widespread immunization.

However, another distinct challenge for both countries involves nomadic communities, particularly the Kuchi, whose seasonal migration patterns complicate the delivery of vaccines. 

The Kuchi, or Kochi, are Afghanistan’s nomadic herders and traders, estimated to make up 10% of the country’s population. They traditionally migrate across various provinces, from the central highlands to the plains in the east and south, and often cross into neighboring Pakistan. This mobility is central to their cultural identity, with seasonal migrations determining much of their livelihood and family structure. However, this way of life presents significant obstacles for vaccination efforts in both countries.

One of the primary challenges in vaccinating the Kuchi people is accessibility. Their transient lifestyle makes it difficult to track them at key vaccination intervals, as they are constantly on the move between rural, hard-to-reach areas. Mobile healthcare solutions are vital to reaching them, but they require resources, including mobile clinics, teams of health workers, and the ability to anticipate migration routes.

Beyond logistical barriers, education and awareness also present major challenges. The Kuchi community, like many nomadic groups, is deeply rooted in tradition and religion, with strong family and community ties. However, misinformation about vaccines—often perpetuated by rumors, cultural practices, and sometimes misinterpreted religious teachings—remains widespread. Some Kuchi families fear that vaccines could cause infertility or illness, or that they are part of a foreign plot. And while Islam, the predominant religion in Afghanistan, teaches the value of health and wellbeing, interpretations of religious teachings can sometimes clash with health campaigns, particularly when those campaigns are perceived to come from foreign or secular sources. Addressing these deeply ingrained fears requires building trust and engaging local religious and community leaders who have the respect and influence necessary to change attitudes.

Furthermore, gender roles also complicate vaccination efforts. Cultural norms in the Kuchi community often restrict the interaction between female healthcare workers and male family members, reducing the likelihood that mothers and children will be vaccinated. Female healthcare workers, when they are available, play a key role in breaking these barriers. Increasing the number of female healthcare workers and ensuring that they have access to the nomadic population is essential to expanding outreach to women and children. Establishing trust within the community is crucial for any health initiative to succeed, but with the Kuchi, this process takes time and careful engagement.

Pakistan’s role in polio eradication is inextricably linked to Afghanistan’s, particularly when it comes to the Kuchi people. Since the Kuchi often migrate across the border into Pakistan, the success of vaccination campaigns in one country affects the other. Polio is highly contagious, and if a Kuchi family receives only a partial vaccination in one country, they could still be at risk, or they could spread the virus across the border. For this reason, both Afghanistan and Pakistan must work together to coordinate efforts, share information, and ensure that vaccines are available along migratory routes.

However, Pakistan has its own set of challenges. Areas in Pakistan, particularly in the tribal regions near the Afghan border, are affected by similar issues to those in Afghanistan, including insecurity, cultural resistance, and geographical barriers. There have been numerous incidents where health workers in Pakistan have faced attacks from insurgent groups or armed factions who view vaccination campaigns with suspicion. Furthermore, Pakistan’s Kuchi population—who, like their Afghan counterparts, cross over seasonal migration routes—are also hard to track, and health systems on both sides of the border must cooperate to ensure that no child is left behind.

Afghanistan and Pakistan are not alone in facing challenges with nomadic populations. Nigeria, once a polio-endemic country, faced similar hurdles with its Fulani nomads. The Fulani, like the Kuchi, have a deeply rooted pastoralist way of life, constantly on the move to find grazing lands for their herds. In Nigeria, health authorities employed innovative strategies, including the use of mobile vaccination teams that traveled alongside the Fulani herds, offering vaccines wherever the nomads went.

Authorities also engaged community leaders and religious figures, who are highly influential in nomadic cultures, to advocate for vaccinations and dispel misconceptions about the polio vaccine. Additionally, community education programs were launched to target misconceptions and ensure families understood the importance of immunization. By addressing the nomads’ specific needs and working with local influencers, Nigeria was able to make significant progress in its fight against polio.

India’s experience offers further valuable insights, particularly in tracking mobile populations. In states with large nomadic populations, the government implemented digital mapping systems to monitor migration patterns. This technology allowed health workers to predict where nomadic groups would be at any given time and coordinate outreach accordingly. Coordinated vaccination efforts, such as deploying teams at migration hotspots, combined with the use of mobile clinics, ensured that vaccines reached the nomadic populations without delay.

To overcome these challenges in both Afghanistan and Pakistan, several strategies must be adopted.

Strengthening mobile vaccination teams is one of the most effective ways to reach the Kuchi population. By deploying health workers who travel alongside the Kuchis during their seasonal migrations, they can ensure more consistent and widespread coverage. Furthermore, engaging respected community leaders—whether elders, tribal leaders, or religious figures—can help dispel misinformation and encourage vaccination within the community.

Another important strategy is the increased inclusion of female healthcare workers. These workers are essential for reaching mothers and children in communities where gender norms limit the interaction of men with healthcare professionals. To further improve accessibility, technology, such as digital tracking and mobile data collection, can be utilized to anticipate migration patterns and ensure timely vaccinations. Additionally, interpreters fluent in Pashto, the language most Kuchi nomads are familiar with, will be crucial in overcoming language barriers and facilitating better communication between health workers and the Kuchi people.

Polio eradication in Afghanistan and Pakistan is not just a regional goal—it is a global necessity. Until the virus is eliminated in every country, polio remains a threat to all. The migration patterns of the Kuchi people, who frequently cross into neighboring Pakistan, make it even more challenging to ensure they receive timely vaccinations and contribute to the persistence of polio in both Afghanistan and Pakistan. By addressing the unique challenges faced by nomadic communities like the Kuchis, both countries can move closer to becoming polio-free.

Governments, health organizations, and community leaders must work together to ensure that no child—regardless of where they live—remains vulnerable to this preventable disease. The fight against polio is not over, but with targeted strategies, cultural sensitivity, and collective action, we can finally achieve a world free of polio.