Despite the discovery of a new polio case in Egypt, the Second National Campaign to Eradicate Polio Disease is proving successful, Dena Rashed reports With a big colourful balloon, red carpets and a gathering of Egyptian and foreign officials, Al-Omrania public health centre in Giza celebrates the launch of the Second National Campaign to Eradicate Polio Disease from Egypt. The launch is attended by the Japanese ambassador, Kunihiko Makita, representatives of the Ministry of Health and UNICEF. Behind the official scene, nurses have been ready since 8am to vaccinate children against polio. As the day passes, the vaccination process goes very smoothly and quietly, apart from the cries of little boys and girls who are frightened by the sight of nurses and doctors. Al-Omrania public health office was one of the 6,000 health centres in Egypt that were put on alert on 14 October to immunise as many children as possible on the same day all across the country. At the same time, 45,000 mobile nursing teams were moving door-to-door to immunise children at their houses. Launched a year ago, the national campaign is being organised under the auspices of Mrs Suzanne Mubarak, with the support of UNICEF, WHO, USAID, and the Japanese government. Over the past years, eradicating the disease has become increasingly important, and today it is not simply a health priority, but a major item on the government's political agenda. Thanks to a song calling people to immunise their children by the famous Egyptian singer Mohamed Mounir, and regular awareness campaigns, polio has become a national concern not just for the state but for the people too. With the decrease in the number of polio cases, many Egyptians came to believe that the disease does not exist anymore in Egypt. Years ago, it was common to see paralysed children. Today, there are almost none. And though one new polio case was discovered in 2004, efforts continue to achieve a polio-free Egypt at the first possible opportunity. "There is a world goal to eradicate the disease from all countries by 2005," said Mohamed Tantawi, a specialist in Motherhood and Childhood Department at the Ministry of Health. "Unfortunately there are still seven countries in the world that have polio cases, and Egypt is one of them." Tantawi points out that for years children have been routinely vaccinated against polio. However, "this national campaign is a major advance, since it aims at immunising all children from zero to five years old, at the same time, with the same vaccine." The idea behind vaccinating all kids at the same time, Tantawi explains, is to strengthen the immunity of all children at the societal level, and at the same time, to top up the vaccination of children who have not yet received full doses. "Every child needs full three or four vaccine doses -- depending on the kind of vaccine used -- to provide complete and lasting immunity against the disease. This is what this campaign aims at achieving." Egypt has faced many different problems over the years in fighting polio. Philippe Testot-Ferry, senior programme officer at UNICEF, argues that overcrowded residential areas have played an important role in transmitting the disease. "Sudan, contrary to Egypt, is polio-free," says Ferry. "In Egypt, the density of the population plays a critical role in transmitting diseases. With almost 90 per cent of the population living on only seven per cent of the land, the transmission of the virus is much easier and faster." For Ferry, "it is a big challenge to immunise 14,000 children on the same day, several times a year. But the quality of the campaign so far has proved to be very good. Seven years ago, Egypt had 600 polio cases, and this year there has only been one case." Everything necessary for a strong immunisation campaign is now in place. According to Ferry, all public health centre staff have been mobilised, and the vaccines are of high quality and well preserved. Tantawi sees things in a slightly different way, however. For him, there are three factors that determine the transmission of the virus and which need to be taken into account. The three risk factors are immunisation, age and geographical location. "Children who were not immunised or who were only partially immunised, who are under six months old, or live in rural areas and shanty towns, are more vulnerable to catching the disease," argues Tantawi. According to Essam Allam, assistant project officer for health and nutrition at UNICEF, the campaign has managed to overcome these problems. "In shanty areas, we have volunteer residents from the community who accompany the nurses to ensure that all children are vaccinated," said Allam. "But we still lack the cooperation of high-income people, who don't understand that all kids have to be vaccinated by the same vaccine, since it raises their collective immunity." For many of the nurses working on the campaign, their mission to vaccinate children at home does not run as smoothly in the high-income districts. "It is odd, but it is the highly-educated people who refuse to let us vaccinate their children," said Saida Mohamed, who has been a nurse for the past 30 years. "Highly educated and high-income people prefer to vaccinate their children at private clinics. They tell us they don't trust the vaccines we have," added Mohamed. Her colleague Saadia Mohamed is more optimistic. "We were not often welcomed during the first campaign last year, but this year many people who refused the vaccination before are changing their minds, because they know now that it is a national programme, and this has given it more credibility." The campaign will not stop, however, when Egypt is declared polio-free. "Egypt has maintained routine immunisation for over 95 per cent of the population since 1996," said Ferry. "Even after the eradication of the disease, we will need to maintain a strong immunisation system, so as to prevent the country from getting the disease back." "When a whole year passes without discovering a new polio case, we will be able to say we have eradicated the disease," Ferry anticipates. "But to be certain that we have won the battle, the campaign will continue for two years after the eradication has been achieved."
