Angola Greatest Threat to Polio Eradication in Africa - WHO

(HN, October 2, 2010) - An immunization campaign is taking place this weekend in Angola to stop a polio outbreak in the country and to prevent the disease from being exported to neighbouring countries on the continent.

Rod Curtis of the World Health Organization (WHO) said only three countries in Africa have recorded any polio cases in the past four months, namely Nigeria, Angola, and the Democratic Republic of Congo.

He said the DRC was infected with polio across the boarder from Angola. Also, areas in Angola that had previously been polio-free have been re-infected this year from an expanding outbreak.

According to data from the Global Polio Eradication Initiative (GPEI) there have been 24 recorded cases of polio in Angola in the past 12 months - the most in this period of all African countries. Other infected countries in the continent are: Nigeria, DRC, Chad, Mali, Senegal, Mauritania, Niger, Liberia and Sierra Leone. GPEI says Angola has the highest number of wild polio virus (WPV1) cases in Africa - and the third-highest number in the world this year, behind only Tajikistan and Pakistan.

The good news is West Africa remains polio free, Curtis told a news briefing in Geneva monitored by HUMNEWS.

The vaccination campaigns in Angola target 5.6 million children with 7 million doses of oral polio vaccine. There was also a need to close existing immunization gaps. Up to 30 per cent of children were missed in campaigns and this had become a real focus for the national immunization days. WHO believed that the outbreak can be rapidly stopped, even by the end of the year, if these gaps are closed.

Marixie Mercado of the United Nations Children's Fund (UNICEF) said given the upsurge in cases, UNICEF and WHO emphasized that, now more than ever, the key to ending polio is the full mobilization and commitment of all sectors and all stakeholders - especially local-level administrative leadership in planning and implementing the campaigns.

This weekend - and again at the end of the month - UNICEF, WHO and Rotary International are supporting tens of thousands of volunteers, health workers, parents, communities and traditional leaders to go from house to house and village to village in Angola to make sure that every child under the age of 5 iss reached with a polio vaccine.

Field Notes from Nigeria Day 3 – Scenes from the global Polio eradication campaign in Makarya Ward

("Sarkin Yaki" leads a sensitization session in Makarya Ward.)

(HN, April 30, 2010)  At first appearance, Alhaji Aliyu Wada is an imposing man.  As he sprints out of his souped-up Toyota Landcruiser, his people bow to him in reverence. 

Wada - the "Sarkin Yaki" (Hausa translation: people's warrior) is the traditional leader of this region of Nigeria – and takes us to witness a `sensitization’ session for village leaders in Makarya Ward; a pristine settlement in comparison to the others we have visited this past week.

By the time we arrive, people of all ages are sitting and standing patiently as the enormous dust cloud our 4x4 vehicles have kicked up, settles around them. I immediately noticed that the temporary immunization post had already begun vaccinating children though - well before Wada arrived.  Health workers seem not only to be conducting the process to the letter – but children's hands are marked immediately after receiving the drops and are given sweets and soap – and also an official vaccination card to help their parents keep track of future jabs of the vaccine dosings.

Later, we follow a vaccination team as they meticulously make their way through the village streets lined with simple mud huts and where goats and chickens compete for space along the sidelines. Again, in this village as opposed to others we’ve seen, everything is done according to the book by health workers - right down to marking the outdoor hut walls with white chalk to indicate that all children aged 0-5 years old have been vaccinated.

The heat at this time of day is absolutely punishing, and I make a mental note that I probably have another 20 minutes or so left before the searing heat does me in. I notice that even the local men are perspiring profusely. Yet the vaccination teams go about their business - one worker even carrying a young baby on her back.  The rest of the team of five carries the cold box with the vaccines, the case containing the so-called plusses for vaccination recipients (sweets or soap), and two of the five tasked with a marker and a tally sheet.

("Sarkin Yaki" speaks in the field.)

Earlier Wada spoke emphatically to his people, stressing in the local Hausa dialect the importance of vaccination for polio to the gathering of attentive parents. It’s an outdoor session, and even though it’s meant for the ears of male village leaders, people of all ages have come to see what the fuss is about. Young men sit on tree branches to get a better view of Sarkin Yaki, dressed in intricate blue and white robes, weigh forth on polio.

Listening even just a few minutes to Wada, you quickly realize why traditional leaders like him are such potent ammunition in the protracted fight against polio which has struck over 350,000 people in Nigeria, but is now close to eradication.

Wada bristles when asked about so-called non-compliant families who refuse to vaccinate their children. The head of the household should be threatened with legal action, and he authoritatively cites the exact number of a northern Nigerian states law (#138) which mandates this.

"It is the instruction of the Emir (of Kano) that no one should be spared," Wada said on camera, slowing down his words to emphasize the word "spared." He goes on: "If he tries to say 'no' well perhaps he should be taken away...and that house MUST be vaccinated. Maybe he should be locked up for a day or two. As a matter a fact, if you don't comply you can be locked up for up to two years. But we don't want to do that (lock people up). We start by talking and talking and we keep talking - convincing people of the need to get vaccinated.  We'll then tell them that if you are not vaccinated, you might possibly pick up the disease.”

"If we were able to vaccinate 200 people in this area,” he goes on, “and one single individual family refuses us to vaccinate his child, the child might pick up the polio. And you know once he has it, he can spread it to the entire population. Meaning, we are going five steps forward and ten steps back.”

"We will not allow this,” he says. “We have to protect the people. We will not allow any single individual to fall out of vogue and refuse to get vaccinated. And then, we allow him to go free with it. No way!  I promise you that in the next three, four or five months you will be seeing a much better performance."

Later, in his palace, Wada elaborates on his earlier statements on using tough justice for people who refuse to vaccinate.

"Sometimes you have to be cruel to be kind," he says, as he beckons us to help ourselves to a third serving of Nigerian pepper soup, pigeon and `roadrunner chicken’. (YUM!)

Wada says his words carry, by far, more weight than the average Nigerian politician because his position is inherited and he is with his people “twenty-four, seven”. He adds: "Even if I get a call in the middle of the night, I will go check into a problem for my people."

(A young boy receives a pair of polio drops in Makarya Ward.)

He said the night before he had received word of a non-compliant family.  He sent his driver with a group of vaccinators and the family immediately came around and allowed their children to receive the polio drops. "Even if the parents are not there, I will authorize the team to go in on my behalf and ensure that they vaccinate."

When an aid (who, by the way, has four wives and 24 children; Wada has only one) comes in to inform him of an urgent matter requiring his attention, Wada apologetically excuses himself and asks us to help ourselves to more home-cooked Nigerian food and talk about our efforts for tomorrow.

--- Reporting for HUMNEWS, Michael Bociurkiw is in Nigeria documenting polio eradication efforts for UNICEF.

Field Notes from Nigeria – Stories from the Polio Eradication Campaign

(HN, April 28, 2010)  Its only 10am and already the outdoor thermometer on the dashboard of the UNICEF 4x4 reads 34 degrees Celsius.

We are a 90 minute drive away from our destination: the Rogo Local Government Area (LGA) in the most populous state in Nigeria, Kano. "This is one of the high risk LGA's in Northern Nigeria for polio," said Josephine Kamara, a UNICEF official in charge of social mobilization for UNICEF.  A native of Sierra Leone, Josephine has been working in Nigeria for the last five years and the last five months with UNICEF.

Josephine describes her job as convincing communities to vaccinate - a seemingly impossible task at times, especially when some parents regard Western-made vaccines as tools for sterilization - or worse.  Others can’t understand why their children need to receive up to a dozen rounds of the polio drops.

Explains Josephine: "One of the things I learned is to blend in...to dress like them, speak their language and being respectful of their religion and customs. Once you get all those things, you get accepted in the community and everything else will fall into place. For me as a foreigner that works for me."

Indeed once we arrive in Rogo and meet with the revered traditional leader of Rogo, Ahmed Muhammad Maharaz - resplendent in flowing white robes - he immediately greets Josephine warmly and asks if she is the same Josephine he used to listen to reporting on Voice of America from several African countries.  (Yes)

Articulate, passionate and warm, Maharaz speaks for about 30 minutes to his citizens about the importance of vaccination.  Later he tells me in halting English that convincing arguments can be made to dispel fears among skeptical parents about the vaccines.  "I tell them do you think these foreigners would spend all this money to get rid of us? There are faster and cheaper ways. I also remind them that when their children get sick the first thing they do is take them to a clinic for life saving medicine, which are made in the West. And then their children get cured."

Listening to Maharaz, it quickly becomes clear why the so-called traditional leaders have become such a powerful, integral component in the battle to eradicate polio. They carry, by far, more moral authority than Nigeria's elected leaders. And because Kano is a state where polio vaccination was opposed some years ago, turning over hearts and minds can be challenging, to say the least.

Josephine explains that while the use of the traditional leaders has proven key to lowering the incidence of polio - there has been only one recorded case in the country so far this year, compared to 193 at the same time last year - fixing other bottlenecks has proven vexing. One frustration is ensuring the integrity of the vaccines as they make their way from regional stores to the mouths of children. In the punishing heat of the desert - where temperatures soar to 45 degrees Celsius and where power outages are frequent - it’s easy for vaccines to lose their effectiveness.

An Expert Review Committee of Nigerians, UNICEF, WHO, Rotary and other partners has recommended a minimum of eight rounds of polio drops - down from 12 doses in previous years.

One WHO field worker said Monday that a freezer generator procured specially for the polio vaccination campaign in Kano state broke within minutes because it hadn’t been installed properly.  In some areas solar powered refrigerators are used but have life spans of only one or two years because they are not maintained properly.

Later, at a meeting of state partners that was held in the dark due to power outages, we heard that a handful of LGAs have delayed vaccination because they haven't put into place supplies of so-called plusses - soap, sweets and other handouts that have been proven to attract mothers and their kids to vaccination days.  Indeed I saw for myself how every mother grasped for the handouts as soon as their children received the polio drop.

Out here in rural areas, where some communities have only a dozen children, health workers need to travel long distances just to reach a small pocket of kids. And when the rainy season strikes, many villages are inaccessible - even by motorcycle. The WHO point person in Rogo LGA told us, "In urban areas reaching 750 children is easily done in one day. Out here some health workers consider a day successful if they have reached 15 children."

He went on to emphatically explain that all it takes is one missed child to infect others. "That one child we missed can be a big problem," he said, adding that he has more than half a million children to track for vaccination in more than 600 communities.

Experts estimate that just one infected child could put another 200 at risk.

The 600,000-plus children targeted for vaccination in this LGA is part of the critical second round of a synchronized effort to stop a polio outbreak across West and Central Africa. In all, more than 77 million children in 16 countries will be vaccinated over the next few months. Each vaccination team will carry the vaccine in special carriers, filled with ice packs to ensure the vaccine remains below the required 8ºC. 

To end this outbreak two drops of oral polio vaccine (OPV) will be administered to every child in 16 countries, including Nigeria.  An army of more than 300,000 volunteers and health workers will work up to 12 hours per day, travelling on foot or bicycles, in cars and boats and on motorcycles, in often trying conditions – dedicated to the ultimate goal of ending polio on the planet as we know it, for everyone.

--- Reporting for HUMNEWS, Michael Bociurkiw is in Nigeria documenting polio eradication efforts for UNICEF.