A country’s preparedness for a prompt and successful implementation of vaccination programs plays a pivotal role in disease control and prevention. As it stands now, Afghanistan seems to be ill-prepared to embrace a successful implementation of the COVID-19 vaccination program because of a spate of challenges. These include, but are not limited to, the insufficient number of vaccinators, a dearth of fully integrated functioning cold chain, challenging geographical barriers, cultural issues, insecurity, and protracted conflict. The COVID-19 infodemic along with vaccine mistrust in the country will lead to a pervasive public vaccine hesitancy in Afghanistan, which will present serious obstacles to the COVID-19 immunization efforts. The politicization of the Ministry of Public Health (MoPH) and the complaints of embezzlement and misuse of the pandemic aid have already eroded public trust during the pandemic. To ensure a large-scale and equitable distribution of COVID-19 vaccines, the cold chain infrastructure should be strengthened, and the immunization personnel trained. Antivaccination propaganda and misinformation should be tackled with effective communication approaches and effective community engagement, which consider culturally relevant messages appropriate to the culture and people. The allegations of corruption should be addressed to revive public trust in public health interventions, including COVID-19 vaccination.

Tobacco Harm Reduction (THR) offers a promising approach to addressing the significant burden of smoking in Afghanistan. Over three million Afghans smoke daily, making it a leading cause of preventable deaths in the country. While the previous Afghan government implemented various tobacco cessation policies and strategies, these measures were only partially effective in reducing the number of smokers or smoking-related deaths. In 2021, community-based initiatives in Kabul and Herat started advocating for Tobacco Harm Reduction (THR) as a novel, realistic, and practical approach proven to promote smoking abstinence and minimize tobacco harm. However, implementing THR strategies in Afghanistan faces numerous challenges, including a lack of governmental support, funding issues, unfavorable market conditions, the high cost-effectiveness of THR products, and misconceptions about these products. To effectively promote THR in Afghanistan and overcome these challenges, it will be necessary to implement THR policies that support THR products for smokers, regulate the market for these products, produce them locally with healthcare professional oversight, conduct more engaging advocacy campaigns, and secure domestic sponsors.

Almost three million Afghans smoke daily, the majority of whom are teenagers. Smoking is responsible for the deaths of thousands of Afghans every year. The previous Afghan government made significant efforts to control and reduce tobacco use through tobacco cessation policies and strategies. However, these policies were not effective in reducing the number of smokers and smoking-related deaths. Hence, there is a need to introduce and implement novel, realistic, and practical approaches that have been proven effective in smoking abstinence and minimizing tobacco harm. Community-based initiatives in Kabul and Herat have started advocacy campaigns since 2021 and tried to increase people's awareness of the tobacco harm reduction (THR) concept, paving the way for adopting new policies. Implementing these strategies in Afghanistan is likely to face many challenges. The current government’s low priority for tobacco harm reduction research and advocacy, funding issues, unfavorable market conditions for THR products and their high cost-effectiveness, THR product-related misconceptions, and the total prohibition of all tobacco products without any exception in Islam are the significant challenges. These obstacles can be overcome with effective THR policymaking that will promote THR products for smokers, market support and regulation, local and domestic manufacturing with healthcare professional oversight, conducting more engaging advocacy campaigns, and securing domestic sponsors.