Africa is facing one of the worst public health calamities of recent times; the race is now on to save thousands of children on the continent from paralysis, writes Colette Kinsella Africa is on the brink of one of the worst polio epidemics in recent years, according to statement issued by the Global Polio Eradication Initiative (GPEI), an international organisation run under the auspices of United Nations, on 22 June. The outbreak is due to the refusal of a single northern Nigerian state to vaccinate children against the disease, and epidemiologists say the virus is spreading at an alarming rate to other countries in the region. According to Dr David Heymann, the World Health Organisation (WHO) representative for polio eradication, at the start of 2003 only two countries in sub-Saharan Africa were polio-endemic, but now children have been paralysed in 10 African countries which were previously polio-free. The virus has spread from the Nigerian epicentre to Sudan, which has not seen a case for more than three years, as well as Benin, Burkina Faso, Central African Republic, Chad and Ivory Coast, and even as far south as Botswana. The strain of the virus found in Sudan is genetically linked with that endemic to northern Nigeria. This, says Heymann, "is concrete evidence of the need to support a massive immunisation response right across west and central Africa". Nigeria is one of the two African countries in which polio was endemic at the beginning of last year, and an immunisation programme was launched by the UN in May 2002 in the northern state of Kano, but was halted by the state governor in August 2003 amid rumours about the safety of the vaccine. Some Islamic clerics were preaching that the vaccine had been deliberately contaminated by Western powers in order to sterilise Muslim women, and the vaccine was also said to be carcinogenic. The authorities were actively seeking a "safe" vaccine in Asia, and a spokesperson for the governor said the campaign would not be resumed until it had been found. The claims were investigated by the WHO and were proven to be unfounded. "The United Nations Children's Fund [UNICEF] supplies all the vaccine used in the polio eradication initiative. We have supplied 10 billion doses of vaccine, which has protected children in more than 100 countries around the world. Because of this vaccine, 5 million children are walking today who would otherwise be paralysed by polio," Claire Hajaj of UNICEF told Al-Ahram Weekly. In a statement released by the WHO last week, however, the governor of Kano confirmed his intention to restart the immunisation campaign in early July. He said he accepted that the oral polio vaccine was safe, and training is already underway for staff taking part in the initiative. The decision by the governor of Kano to halt immunisation in 2003 put the lives of thousands of children at risk throughout the continent. According to figures released by the GPEI, 197 children have been paralysed in Nigeria since the suspension of the immunisation campaign, and five times as many children in western and central Africa have been paralysed so far in 2004 compared with the same period in 2003. The countries surrounding Nigeria are particularly vulnerable as less than half the children are routinely vaccinated against polio. Epidemiologists say the only way to halt the spread of polio from Nigeria and avert a massive health tragedy in the autumn -- the high season for polio transmission -- is to launch an extensive synchronised immunisation campaign across Africa in October and November of this year. "We have to act fast and on a massive scale," Hajaj told the Weekly. "First we have to immunise 74 million children across 22 countries in Africa, taking the vaccine directly to their doorsteps. The campaigns will take place this October/November, and we'll repeat them early in 2005." The vaccines will be provided by UNICEF, who will be organising funds and health staff to carry out the immunisation. The main problem, says Hajaj, will be to rebuild public trust in the campaign. "Many families are still concerned in the wake of hearing rumours from Nigeria about the vaccine," she commented. Polio is a highly infectious viral disease which can damage the nervous system and cause paralysis within a matter of hours. It mostly affects children under the age of three in 50 per cent of cases, but immune or partially immune adults and children can contract the virus and act as carriers, transmitting it from country to country. The virus multiplies in the intestine, and enters the body through the mouth and transmission is via person-to-person contact. Not everybody infected with the virus will develop the disease. Usually only one in 200 people will develop polio paralysis or any of the other symptoms. The GPEI was launched in 1988 with the aim of making the world polio-free by 2005, and is one of the largest global public health initiatives to date. The campaign is spearheaded by the World Health Organisation, Rotary International, the United States Centers for Disease Control and Prevention and UNICEF, and has been highly successful in eradicating the disease from a large number of countries. At the start of the campaign 125 countries were polio-endemic, and this has been reduced to six, namely, Egypt, India, Pakistan, Afghanistan, Niger and Nigeria. The number of cases reported globally in 2003 was 785, down from 1,918 in the previous year. This year, however, 257 of the 333 global cases reported were in Nigeria. Africa accounts for 90 per cent of the global burden, with Nigeria accounting for 77 per cent of African cases. The African epidemic represents a serious setback to the aim of eradicating the disease by 2005, and efforts to avert a health tragedy in Africa are being further hampered by lack of funds. Since 1988 $3 billion has been spent globally on the initiative; $25 million is required by August, and according to the GPEI another $25 is needed by the end of the year if the campaigns are to be successful. The polio virus can also infect people who have been vaccinated against the disease, and the WHO has issued a warning to all travellers to northern Nigeria to ensure their polio vaccinations are up to date.
