The Struggle to Eradicate Polio in Africa

Microsoft founder Bill Gates visited Nigeria last week, where he collaborated with Africa’s wealthiest man and the governors of several northern states on a new campaign to fight polio and other vaccine-preventable diseases. The governors of four northern states gathered in the city of Kaduna to sign memoranda of understanding with the Bill & Melinda Gates Foundation and the Dangote Foundation of Africa’s richest man, Aliko Dangote, along with the U.S. ambassador to Nigeria. The MOUs kick-off programs that aim to raise childhood vaccination coverage to 80 percent by 2018.  Gates Foundation country representative Mairo Mandara says Borno, Yobe, Sokoto and Kaduna states were chosen because they have the greatest need. They join Kano and Bauchi states, which renewed their pre-existing agreements. “If you look at the whole country, the lowest level of immunization are in these states where these MOUs are signed,” Mandara said. He says vaccination rates are as low as 30 percent in some northern states. Under the terms of the agreements, the Gates and Dangote foundations and the state governments will split the cost of initiatives like sending out teams to vaccinate children. Africa has made great strides towards eradicating polio but the job remains to be finished through strengthened immunization campaigns and surveillance measures, according to the United Nations. Observing on August 12, 2015 the one year mark since the last case of wild polio was confirmed on the African continent, the world body has recalled that despite such laudatory progress, the milestone could not yet be considered “official” by the Organization’s strict standards. Nigeria, the last endemic country in the African region, marked one year without a case of wild polio on July 24, 2015. If continued lab results in the coming weeks confirm no new cases in Nigeria, and if the UN World Health Organization (WHO) African Region then goes two more years without a case of wild polio in the face of strong surveillance, it could be certified polio-free by the Africa Regional Certification Commission. Similarly, transmission in Kenya and Ethiopia has also been interrupted. “We need to maintain the immunity of children, the herd immunity so that when children travel to other areas they do not import the disease and bring it back,” Mandara said. “Globally, we are on the verge of totally eradicating a disease for only the second time in history,” remarked Peter Crowley, the head of the UN Children Fund’s (UNICEF) Polio unit, on his blog. According to the UN, African leadership has been instrumental in reaching the milestone and pushing towards wider eradication through the African "Kick Polio out of Africa" campaign. Likewise, the support of the international community has also been key to success and continued support remains essential to achieve a polio-free Africa through improved vaccination campaign quality and surveillance, particularly in the Horn and Central Africa. Surveillance has become a type of taboo word in the West, with many associating it with big governments and corporations peeking into our private lives. However, in the parts of the world where polio remains a threat, surveillance is an essential tool for saving millions of children from the threat of polio. Surveillance teams from the WHO search for acute flaccid paralysis (AFP) in millions of children. AFP is the symptom that indicates the possible presence of poliovirus, and thus it's vital that any case of AFP is investigated for polio. Surveillance teams need to make sure 100 percent that the AFP symptoms are from a different source in order to close out a polio outbreak. The most at-risk communities are also the hardest for surveillance, potentially leaving thousands of children without vaccination or proper surveillance. For example, in Somalia, only 68 of 115 districts are fully accessible, leaving around 350,000 under 5s unreached by polio vaccines. For every 100,000 children under the age of 15, a strong surveillance system would expect to pick up one to two cases of AFP. Every district that does not identify and report this one case per 100,000 is therefore labeled a ‘silent’ district, as those AFP cases are not reaching the ears of those in the surveillance system. In all countries, being able to test that one case for polio in a laboratory is the one thing that enables the system to reliably vouch for the presence or absence of polio. The development of these types of surveillance markers has been instrumental in the eradication of polio throughout the world. Since the 2013 outbreaks in central Africa and the Horn of Africa, innovations have enabled more children to be reached than ever before. “Strategies such as transit vaccination posts set up around areas of insecurity, so that families leaving the area get the vaccinations they need, helped to reach some of the children missed by vaccines,” explains Dr. Hemant Shukla, who works with the WHO on vaccination. “With Africa now on track, we are left with only two countries where polio transmission has never been interrupted: Pakistan and Afghanistan,” Crowley explained. “Here too, despite enormous challenges, communities, governments and partners are working with courage and determination to end polio once and for all.” Many Islamist groups across the Middle East and Africa have blocked the spread of polio vaccines. For example, some northern states of Nigeria imposed a year-long boycott of the vaccine in 2003, with state governors and religious leaders in the predominantly Islamic north alleging that the vaccines were contaminated by western powers to spread sterility and HIV and Aids among Muslims. While the leaders in Nigeria agreed to lift the ban and back immunization in 2009, these kind of dangerous policies still persist in Taliban controlled or influenced regions of Afghanistan and Pakistan. In summer of 2014, the Taliban banned the polio vaccine in Afghanistan's Helmand province, claiming that WHO officials were spying on Taliban activities. Many in Pakistan who administer the polio vaccine face threats from armed religious groups such as the Tehreek-e-Taliban Pakistan (TTP) and its allies. Since July 2012, at least 70 people have been killed in attacks on polio vaccination teams across Pakistan. In the meantime, 306 cases of polio were reported in Pakistan in 2014, making up 85.2 percent of the total cases worldwide. However, there is some hope in Pakistan for more widespread vaccination: this March, Pakistani authorities conducted their first-ever mass arrest of parents for refusing to allow their children to be vaccinated against polio. The authorities in Peshawar detained 471 people, who were only freed once they pledged in writing to vaccinate their children. It's a drastic measure, but one that seems justified. As polio begins to decrease in prevalence throughout Afghanistan and Pakistan, some international relation scholars view the vaccine as an important source of soft power for the West. The vaccine can serve as indisputable evidence of the good intentions of international organizations like the WHO, and help build important ties on the ground with the people of the region.   UN Photo by Olivier Chassot