Vaccination situation critical

The locks were shot off the doors. Then the looters turned over the shelves and boxes, spilling their precious contents across the floors of the building and the concrete courtyard outside. And then they ripped the vital refrigeration units from the cool stores, and with them the defence for millions of Iraqi children against a host of fatal diseases. This is the scene at Baghdad’s Vaccine and Serum Institute, where looters have destroyed a large part of the country’s vaccination supplies. A series of cool rooms packed with vaccines against such diseases as meningitis, measles, hepatitis, polio, tetanus and yellow fever were wrecked in the attack on what was the country’s main vaccination store. Contributing to the problem, another building at the complex containing vaccines and medicines was bombed by coalition forces as they entered the capital. What vaccines were not stolen or destroyed were rendered useless by the absence of refrigeration, leaving the country to start on its immunisation programme from scratch. Combined with the massive disruption of its health system and administration, Iraq now faces a major challenge in preventing the outbreak of serious diseases. The representative in Iraq for the World Health Organisation (WHO), Dr Ghulam Popal, said it was crucial to restart an immunisation programme as soon as possible to avert the spread of diseases such as measles which could be killers. "If the children will not receive the vaccination and they are exposed to this viral disease, the fatality is very high. So it’s very dangerous. That is why we are trying our best to make sure the vaccinations will be in place," he said. Popal said polio was another critical threat needing to be countered by means of immunisation. "Since January 2000 there had been no cases of polio in Iraq, and the country was on the verge of being certified free of the disease, but now we have to double our efforts and do more to keep it as such". The need for this was highlighted by the looting of a Baghdad laboratory where polio samples were kept. The National Polio and Measles Centre at the Central Public Health Laboratory was attacked by looters after American troops entered the capital in early April. A virologist, Dr Faysal Ghazi al-Hamdani, said when staff returned to the laboratory four days later they found vital pre-2000 polio samples lying on the floor and outside in the street where they had fallen as thieves made off with the refrigerators they had been stored in. There had been 71 polio cases kept, each of which was represented by four different samples, and of these, more than 200 were broken or missing, he said. While the polio virus is sensitive to heat and cannot generally survive for a long time, there was a danger it could have infected some people, he said. Faysal said this could have happened by something as simple as a looter treading on a sample and carrying it back on the soles of his shoes to his home where there were young children. While WHO had earlier said it was unlikely that the smashed and missing samples would cause an outbreak of the disease, its staff have helped the laboratory with its cleanup, and promised to replace missing equipment. At Iraq’s gutted health ministry, one of those trying to rehabilitate the country’s shattered health system, Dr Najm al-Din, said the need to restart immunisations was very important, but the infrastructure, as well as the supplies, had been destroyed. "Today we are facing one problem. Tomorrow maybe we face three. So every day the situation gets worse," he warned. An official with the United Nations Children’s Fund (UNICEF) in Baghdad, Hatim George Hatim, said the system for immunising children had collapsed. The day American troops took over Baghdad - 9 April - was meant to have been a major immunisation day, with a second round of vaccinations planned for children under five years of age who had dropped out of the country’s comprehensive vaccination programme. It had had to be abandoned because of the fighting. Prior to the war, volunteers from groups such as the General Federation of Iraqi Women, a government-backed group, had played a vital role in the campaigns. Now this group and many others no longer existed, Hatim said. "For good or bad, they were tools that could be used. Now the challenge is to think of replacing these networks." But he pointed out that a more urgent need was to replace the destroyed vaccines. "First let’s get the vaccines here and discuss with the health system when do they think a campaign is deemed necessary." UNICEF's representative in Iraq, Carel de Rooy, said it needed to find out what went missing during the war and looting and then make a plan for reconstructing the immunisation system which had used 14,000 volunteers in vaccination campaigns. UNICEF would be passing this information on to the coalition’s Office of Reconstruction and Humanitarian Assistance (ORHA), as it was this body’s responsibility under the Geneva Convention to repair the health system, including routine immunisation, de Rooy said. "We will fill the gaps, but ultimately it’s the responsibility of ORHA to put this country back at least where it was before this war." Replacement vaccination supplies were already in the pipeline, but de Rooy said the potential for children to die unnecessarily due to the disruption of the immunisation programme was great.