Steady progress on polio though problems persist

A good measure of success has been achieved in ongoing efforts to eradicate polio in southern Sudan, the scene of ongoing fierce fighting between the Sudanese government and the rebel Sudan People's Liberation Army (SPLA), according to Carl Tintsman, a senior adviser to the United Nations Children's Fund (UNICEF) and World Health Organisation (WHO). Yet "tremendous challenges" of access to children must still be overcome if southern Sudan was to achieve the WHO goal of being polio free by the end of 2002, he added. Tintsman, an adviser at the headquarters of the Global Polio Eradication Initiative in Geneva, Switzerland, told a news conference in the Kenyan capital, Nairobi, on Tuesday that the warring parties in Sudan had agreed to periods of tranquillity in a number of areas of conflict in order to allow immunisation programmes to be carried out. "We have managed to negotiate for days of tranquillity during immunisation days, and we hope both sides will respect their commitments," he said. "We hope to finish [this year's immunisation round] in the next four months." The UN Office for the Coordination of Humanitarian Affairs (UNOCHA) had requested the government of Sudan and SPLA for cease-fire days on the first Monday to Thursday of each month in order to allow aid workers broad and secure access to children for immunisation. Increased humanitarian space for immunisation efforts, among other activities, was also one of four proposals on which US peace envoy John Danforth won concessions from the warring parties in Sudan. Emergency access had previously been secured on a case-by-case basis for assessments and polio immunisation efforts in particular areas, but the campaign had been hindered by the inability to negotiate free access with the combatants, UN Secretary-General Kofi Annan reported in October 2001. It was vital for relief efforts in critical areas of southern Sudan that aid agencies benefit from "an extension of the humanitarian space" and were allowed to operate with minimal security guarantees, he concluded. "There is an ever-present danger of an outbreak," the UNICEF spokesman for southern Sudan, Martin Dawes, told IRIN earlier this month. "We need these days of tranquillity for health workers to go about their work." National Immunisation Days (NIDs) are scheduled - though not finalised - for Bahr al-Ghazal, Lakes (Al-Buhayrat) region, Upper Nile, Jonglei, Eastern Equatoria and Western Equatoria this month, with additional, sub-national days planned for October and November, according to WHO. Tuesday's press conference in Nairobi, which coincided with similar conferences in seven other cities around the world, was held to draw the world's attention to the progress made so far in global polio eradication efforts, and the challenges remaining. Polio (poliomyelitis) is a highly infectious disease caused by a virus that mainly affects children under five years of age. The disease invades the nervous system and can cause total paralysis within hours. Among the victims of the disease - which has no cure but can be prevented through immunisation - between 5 and 10 percent die when their breathing muscles are paralysed. Only 537 polio cases were reported globally last year in 10 countries, compared with 350,000 cases reported in 1998 when the global polio eradication initiative began. This means that the disease has been pushed to its lowest level in history, according to Urban Jonsson, UNICEF Regional Director for Eastern and Southern Africa. In Sudan, currently listed among five low polio transmission countries in Africa, there has been continued progress in reducing clinical cases of polio from 23 in 2000 to only one case of wild polio virus confirmed in July last year (in western Upper Nile/Unity State, southern Sudan), according to a joint statement released on Tuesday by the four major agencies involved in the global polio eradication initiative: WHO, UNICEF, Rotary International and the US Center for Disease Control (CDC). This positive trend has been attributed to intense supplemental immunisation activities in Sudan, in which at least five NIDs campaigns have been conducted, as well as additional mopping-up in August 2001 in districts around Ruweng County, where the wild polio virus was isolated. [see http://www.irinnews.org/report.asp?ReportID=9979] "The one case last year only occurred in a gap area which could not be reached by NGOs from Khartoum or OLS [Operation Lifeline Sudan, a group of UN agencies and NGOs which run humanitarian relief operations in southern Sudan] because it is an area of conflict," Jonsson said on Tuesday. An initial goal to eradicate polio in the WHO's eastern Mediterranean region by the year 2000 was not met in Sudan, largely because the campaign began late - in 1998, compared with other countries where programmes had been in place since the 1980s - but also because of severe challenges on accessing children, Jeff Partridge, WHO's Polio Technical Officer for Sudan, told IRIN on Thursday. In early April, a group of UN agencies condemned the detention and harassment of some 14 health workers in southern Sudan by SPLA soldiers, and urged the warring parties to allow unhindered access and observe "days of tranquillity" during the next round of NIDs, scheduled for 13-26 April. UNOCHA, UNICEF and WHO warned, in a statement released in New York on 1 April, that the global polio eradication target of 2005 would not be reached unless access and safe passage for health workers could be guaranteed in countries in conflict, such as Sudan. The 14 health workers had been conducting vaccination activities when they were arrested in Nyingol, near Malakal town, Upper Nile, on 15 March by members of the SPLA, according to the statement. Southern Sudan remains one of the challenging areas the initiative faces in its efforts to eradicate polio worldwide, and routine polio immunisation services offered by NGOs have been very limited - largely as a result of insecurity and inadequate access, according to humanitarian sources. For example, OLS figures for 2001 indicate that only 4,985 out of 1.3 million children under five in southern Sudan received the first round of four routine doses of the oral polio vaccine (OPV). Those children who received their second, third and fourth rounds of the OPV numbered 36,722, 26,414, and 17,736 respectively, according to an OLS chart released on Tuesday. Individual children require at least four doses of the oral polio vaccine but the approach used under the global polio eradication campaign targets all children under five years, regardless of whether they have previously received their four vaccination doses, according to Partridge. "In terms of public health initiatives and the eradication process, we use a different methodology. We immunise a child each time. It doesn't matter how many times," he said. The low level of routine vaccination - particularly in southern Sudan - is attributable to the absence of a comprehensive immunisation programme covering the region, outside the global polio campaign, according to Partridge. "The routine programme is a big challenge to us," he told IRIN on Thursday. "Routine immunisation is carried out in southern Sudan in an ad hoc basis, depending on the NGOs on the ground." "The NGOs have different mandates, limiting their capacities to carry out regular immunisation programmes throughout southern Sudan. We are doing extra rounds in the region to stop the virus transmission," he added. "The good news is that the world is on track in achieving polio eradication by 2005," Jonsson said on Tuesday, but eradication efforts were being challenged by a current funding gap of $275 million - as well as by difficulties in gaining access to children, particularly in conflict-torn countries like Sudan.