Cystic echinococcosis in Afghanistan: addressing evidence gaps through regional one health collaboration with WHO EMRO

Cystic echinococcosis (CE) is a neglected tropical disease endemic in the Middle East and North Africa region. Hospital-based studies indicate that CE continues to impose an important clinical burden in Afghanistan and is likely to contribute to disability, healthcare costs, and productivity losses among affected individuals; however, the true national prevalence remains unknown because of the absence of surveillance and the absence of population-based studies. Afghanistan has a predominantly agricultural and livestock-dependent population, while unregulated home slaughter, free-roaming dogs, poor hygiene, and limited diagnostic capacity are likely to facilitate continued transmission. Available hospital and household screening studies demonstrate local transmission and highlight the need for targeted action. Afghanistan currently has limited capacity to address CE independently and therefore requires regional One Health collaboration. Three contextually feasible, pilot-based priorities are outlined: (i) strengthening equitable access to diagnosis and clinical care; (ii) implementing targeted One Health interventions to reduce transmission; and (iii) strengthening surveillance and research capacity. Formal recognition of CE as a regional public health priority by the WHO Regional Office for the Eastern Mediterranean (EMRO) is an essential first step. The immediate research priority is to determine the epidemiology of CE in Afghanistan through nationally representative population-based prevalence studies using standardized ultrasound and serological surveys. These data are needed to estimate disease burden, identify geographical hotspots, guide resource allocation, and evaluate future control programmes. Strengthened regional coordination through WHO EMRO would support surveillance, research, and integrated One Health approaches. Community education targeting livestock owners, schoolchildren, butchers, and community leaders should accompany these efforts to reduce exposure risks and strengthen acceptance of integrated control strategies.