A new polio outbreak spreading from Nigeria to neighbouring countries is putting 15 million children at risk, requiring a massive immunization campaign across five countries in west and central Africa. Beginning today, hundreds of thousands of volunteers and health workers in Benin, Burkina Faso, Ghana, Niger and Togo will aim to reach every child in those countries with polio vaccine in just three days.
The campaign, organized at a cost of more than US$ 10 million, comes in response to nearly a dozen children being paralyzed in Burkina Faso, Ghana, Niger and Togo, from poliovirus genetically traced to northern Nigeria. A further case recently reported in Chad means similar campaigns are planned in that country and Cameroon for mid-November. The polio-infected states in Nigeria, centering around the state of Kano, have re-infected other areas of the country, most worryingly the city of Lagos with its ten million inhabitants.
“Nigeria is now the country with the greatest number of polio cases in the world,” said Dr David Heymann, Representative of the Director-General for Polio Eradication, WHO. “Polio continues to spread within Nigeria to areas which were polio-free and also to neighbouring countries. Polio and other infectious diseases know no national boundaries. We face a grave public health threat, and our goal of a polio-free world is in jeopardy.”
Senior epidemiologists from the Global Polio Eradication Initiative convened a high-level meeting with the Nigerian Minister of Health at the end of September, at which the Minister provided his assurance and commitment to eradicate polio in Nigeria by end-2004. To successfully meet this goal, strong political support must be established or strengthened at the sub-national level. Political and community leaders must be engaged to facilitate the logistical organization of immunization campaigns, and ensure all children are reached during the activities.
“Nigeria is the most populous nation in the region, and in many ways it has been a good neighbour, contributing to peacekeeping in west Africa,” commented Carol Bellamy, UNICEF’s Executive Director. “Now it has another crucial role to play in the region, and that is stomping out polio once and for all. We need all Nigerians, particularly community leaders, to step up and do their part to end polio.”
Dr Bruce Aylward, Global Co-ordinator Polio Eradication Initiative, WHO, said that the situation in Nigeria had become the last major challenge on the road to global polio eradication: “Because of the tremendous progress made in 2002, the polio eradication tactics and resources were shifted in 2003 to focus on just those few remaining countries which remained endemic. But the situation in Nigeria is now forcing us to go back to countries which had already eliminated polio. We simply cannot afford to see these isolated viruses again paralyzing children in areas which had previously been polio-free. That is why this massive campaign is critical.”
Epidemiologists attribute the marked increase in cases in Nigeria, around the state of Kano, to insufficient coverage during both polio immunization campaigns and routine services. Monitoring data have highlighted that in at least one state, as few as 16 percent of children have been sufficiently immunized against polio. A difficult environment has severely compromised the quality of polio campaigns and helped spread rumours about the safety of the oral polio vaccine.
Despite the apparent setback, epidemiologists are convinced polio can be eradicated from Nigeria. “Polio eradication is feasible in Nigeria,” said Dr Walter Orenstein, Director National Immunization Program, US Centers for Disease Control and Prevention (CDC). “Much of the country was already polio-free for over two years, including Lagos. The challenge now is to increase the quality of polio campaigns in the key endemic areas of the Nigeria, and reach all children during activities.”
Rotary International has made ending polio its main philanthropic goal since 1985. “At Rotary, we are dedicated to wiping out this terrible disease, having committed over US$500 million to the effort,” said Jonathan Majiyagbe, President of Rotary International. “Today, I call on the international community to urgently provide the necessary funds as quickly as possible – for the sake of the children across western Africa.”
Further resources are required for this unforeseen campaign. The Nigeria outbreak is only one global risk to the goal of a polio-free world, as globally the Initiative continues to face a funding gap of US$210 million for activities through 2005.
The Global Polio Eradication Initiative is spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention and UNICEF. The poliovirus is now circulating in only seven countries, down from over 125 when the Global Polio Eradication Initiative was launched in 1988. The seven countries with indigenous wild poliovirus are: Nigeria, India, Pakistan, Egypt, Afghanistan, Niger and Somalia. Additionally, in 2003, polioviruses from endemic countries have been imported into Burkina Faso, Ghana, Lebanon, Niger and Togo.
The polio eradication coalition includes governments of countries affected by polio; private foundations (e.g. United Nations Foundation, Bill & Melinda Gates Foundation); development banks (e.g. the World Bank); donor governments (e.g. Australia, Austria, Belgium, Canada, Denmark, Finland, Germany, Ireland, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Norway, the United Kingdom and the United States of America); the European Commission; humanitarian and nongovernmental organizations (e.g. the International Red Cross and Red Crescent societies) and corporate partners (e.g. Aventis Pasteur, De Beers). Volunteers in developing countries also play a key role; 20 million have participated in mass immunization campaigns.