Epidemic in Tajikistan Setback in Multi-billion Dollar Effort to Eradicate Polio

(HN, May 19, 2010) A polio outbreak in Tajikistan that has infected more than 100 children and claimed the lives of at least 12 has raised alarm bells among agencies fighting the desease.This Nigerian girl has polio. Nigeria is one of four polio endemic countries in the world.

According to the World Health Organization (WHO), more cases are expected in one of the poorest former Soviet republics. A mass polio immunization campaign targeting more than a million children under six is underway in Tajikistan, according to UNICEF. Three rounds of immunization are planned, and the country has received more than 4-million doses of vaccine from WHO and other international partners.

It is thought that the cases originated from nearby Afghanistan - one of four polio endemic countries in the world.

The cases in Tajikistan - as well as two newly-identified case in Russia - are the first to hit WHO's EURO region in more than a decade. Earlier today, Russia's Interfax News Agency reported that three Tajik children have been admitted to a Moscow hospital with suspected polio.

The outbreak comes as a surprise to experts as Tajikistan has relatively high routine immunization rates, despite widespread poverty and difficult-to-access mountain regions. Most of the cases occurred in the south-western border region with Uzbekistan and Afghanistan.

UNICEF Tajikistan Chief of Health, Ayadi Saparbekov, said that in order to halt the outbreak, vaccination must reach children in "remote, isolated and under-served communities."

WHO says there were about 1,600 cases of polio in 23 countries last year. Though significant progress has been made in eradicating the debilitating desease in Nigeria - another polion endemic country, along with Afghanistan, Pakistan and India. Nigeria has recorded only two cases this year, compared to more than 100 last year.

WHO is appealing to the donor community for a budget of $2.6-billion to combat polio between 2010-2012. Aside from WHO, the lead agencies in the fight against polio include UNICEF, the Gates Foundation and Rotary International.

- Staff, files, agencies

CBC NEWS - "THE CURRENT" - FEATURES POLIO REPORTING

In today's episode of the CBC's Radio program, "The Current", UNICEF's efforts to eradicate polio from Nigeria are highlighted. Some of the technology used was provided by HUM. Listen HERE: http://bit.ly/asokix

PART THREE

Polio Eradication - Bruce Aylward

We started this segment with a group of drummers in the Kano district in northern Nigeria. They're playing at the launch of a polio vaccination campaign. Health care workers have come from all over the area to reach this village. And their goal is to vaccinate every child under age of five. The Kano district has been called the epicentre of polio in Africa.

Polio has been eradicated in North America, Europe and parts of Asia. But in pockets of Africa and Asia, there are still outbreaks ... outbreaks that leave children paralyzed or even dead. For a long time, many people in this part of Nigeria didn't get their children vaccinated ... in part because of the widespread belief that the vaccinations are part of a western plot to sterilize girls or transmit HIV. It was only when local leaders embraced the vaccinations that things started to change.

Michael Bociurkiw traveled to Nigera on behalf of UNICEF to document stories from the vaccination campaign. His stories appear on UNICEF and HUM. We heard from Sarkin Yaki Alhaji Ahmed Aliyu Wada. He's a local traditional leader in the Kano district.

But despite his blunt words, health care workers still find people who won't allow their children to be vaccinated. Josephine Kamara works for UNICEF in Nigeria. Last week, she and a local government manager spent three hours negotiating with a defiant father. We heard from her.

The fact that it only takes one unvaccinated child to undermine an entire campaign means that the goal of eradicating polio is a challenging one. In fact, some argue it would be better to focus on managing the disease instead. But the World Health Organization is pushing ahead with its goal of eradicating polio within the next three years. And it is putting forward a new strategic plan, which will be discussed later this month at the World Health Assembly in Geneva.

Bruce Aylward is the Director of the W.H.O.'s Global Polio Eradication Program. He was in Geneva.

Polio Eradication - D.A. Henderson

As we mentioned earlier, not everyone believes that polio can be eradicated. D.A. Henderson is among the skeptics. He's a distinguished scholar at the Centre for Biosecurity. He led the global campaign that eradicated smallpox. He was in Baltimore, Maryland.

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African Leaders Announce New Fight Against Malaria

(HN, May 6, 2010) - In order to reverse the 850,000 deaths caused each year by malaria in Africa, leaders from 26 countries on the continent have announced a new campaign to eliminate the deadly disease using a combination of bed nets, insecticides and medication.

"We believe that if we cover everybody in Africa with bed nets, insecticides and medication by the end of this year, we will have zero deaths or near zero deaths from malaria in Africa by 2015," said Ray Chambers, a U.N. special envoy for malaria and a multi-millionaire investor from Newark, N.J.

Tanzania's President Jakaya Kikwete said the triple-blow approach has yielded impressive results in the archipelago of Zanzibar, where malaria cases fell to below 1 percent from 40 percent. The announcement was made at a news conference of the African Leaders Malaria Alliance on the sidelines of the World Economic Forum on Africa.

U.S. Malaria Coordinator Timothy Ziemer said the U.S. government has made a budget request of $680 million for the fight against malaria in 2011- including $100 million for the Democratic Republic of Congo and Nigeria.

Malaria is caused by parasites transmitted to humans through the bite of an infected mosquito. The disease costs Africa over $40 billion a year in treatment and sick days.

Although insecticide-treated bednets are one of the most effective tools to prevent infection, experts say it is also crucial to supplement this with spraying, removal of breeding areas and education. Making medication cheaper and easier to access is also seen as a crucial step.

---Reporting by HUMNEWS Staff, agencies

Field Notes from Nigeria Day 4 – Scenes from the global polio eradication campaign, child by child

("Non compliant" Umar Kwangwaro in Maraku Ward)

(HN, April 30, 2010) -- We first spotted our “non compliance case” at the end of a motorbike path deep in Kano state, in Kiru Local Government Area (LGA).  The 4x4 was hardly able to negotiate the dusty, bumpy terrain. It was Friday and we were eager to verify the situation before the men left for prayers at the local mosque.

Upon arriving though at the local health post to be briefed by officials, an ice cold cola was thrust into our hands. I thought to myself:  if they can keep cola this cold in this searing heat then their vaccine cold chain which keeps the Polio vaccine live for the eradication campaign, must be in tip-top shape.

This area inhabited by the reluctant villagers is almost completely disconnected from the outside world. No electricity reaches the settlement, people rely daylight, fire and each other for daily living and information, and there is no bore hole for water extraction for the community.  During the rainy season, roads and paths are generally inaccessible, and the children exhibit various signs of malnutrition. The fields are so dry they are hardly able to sustain crops.

Little wonder the locals here have a litany of complaints to share with anyone who will listen.

(Josephine Kamara of UNICEF tries to persuade people in Makaru Ward of the need for polio vaccination.)

It was a demand for better government services that led Umar Kwangwaro to refuse polio vaccination for his own two children. And because he is the de facto village head, no other families brought their children forward to the vaccination team. After about 90 minutes of sometimes passionate persuasion by UNICEF’S Josephine Kamara, it was abundantly clear Kwangwaro wouldn't budge from his position.

In some ways Kwangwaro is no fool. He realizes that the desire among officials and aid workers to vaccinate and eradicate polio is very high. So why not use his demands for water, power and basic infrastructure improvements as a bargaining chip?  Kwangwaro says as soon as a bore hole they have been demanding for fresh springs water is dug, he will allow the vaccination team - which has been sitting patiently all morning - to administer the polio drops.

Clearly there is no issue with the quality of the vaccines. But when Josephine asks this hold-out about the threat of a polio outbreak he is exposing his children to, he shrugs his shoulders and says “it’s God’s will”.

At first Kwangwaro, as the village leader agrees to allow Josephine to speak privately with other villagers. He then quickly retracts the permission when he realizes she is prepared to spend the entire day here, if that's what it takes.

“If one child here gets infected, the whole world is at risk,” says Josephine to Kwangwaro. She continues through a translator: “Tell him he’s really hurt my feelings. I feel very bad for the children. Tell him I love children and he’s really hurt my feelings for the children.”

I comment to Josephine that should this form of blackmail catch on, it could spread like wildfire. But she and others are confident that quick high-level intervention - by the District Head or Traditional Leader - will yield swift, positive results. The current round of vaccination ends in a day or two and there is little inclination to arrange a special mop-up campaign for this settlement.

Later I ask Josephine how she felt to have left the settlement and the unvaccinated children behind: “I left that community with my head down....I felt frustrated that we were not able to make a break-through”.

I ask the district EPI Manager if there is any issue with the vaccine itself. “No - before they used to take it. We have never experienced a case of such non-compliance except for today. It’s only this round; previously they have been receiving it.” 

Some observers say that in order to boost enthusiasm for polio vaccination - which requires several rounds-a-year, extreme micro-planning, detailed social mobilization and a full-proof cold chain - the approach needs to be shifted to address the economic concerns of communities, as well as other child killers such as malaria and water-borne diseases.

But if there is one thing this non-compliance case showed, it's that a rapid response is required to address hold-outs like Kwangwaro, as well as the moral suasion of traditional leaders, or district heads.

(This girl in Kano State contracted polio at a young age.)

Postscript: The following day, after the direct intervention of the traditional leader, Kwangwaro allowed all the eligible children in the settlement to be vaccinated.

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

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.