Last chance to eradicate polio, WHO official says

Efforts to eradicate polio from the world in 2004 failed, but the Central African Republic (CAR), as well as 21 other African countries, launched a new, more coordinated campaign on Thursday, which, officials say, must succeed. "This is our last chance," Leodegal Bazira, the CAR representative of the UN World Health Organization (WHO), told IRIN at the national campaign launch in Bossangoa, a provincial town 305 km northwest of the capital, Bangui. "I don't think the donors are willing to provide further funding if we fail again," he added. The cost of the new campaign in the CAR alone is US $1.2 million. It is being carried out by the WHO, the UN Children's Fund (UNICEF) and the Ministry of Public Health and Population in three rounds between now and December. The disease affects mostly children aged below five years, paralysing them for life. Around 350,000 children worldwide were being infected by polio each year before the first worldwide effort to eradicate it began in 1988. By 2000, the number had dropped to 2,500, but unless the disease is eradicated completely it could always return in epidemic proportions. In the CAR, polio had reportedly been eradicated in 2000, but four years later health workers detected 30 new cases. "We believe the virus travelled to CAR via Chad from northern Nigeria," Bazira said. "The eradication programme failed there because religious leaders were misinforming parents saying that the vaccine was designed to sterilise their daughters." The virus also spread to Benin, Burkina Faso, Cameroon, Cote d'Ivoire, Ghana, Togo, Mali and Sudan. Why CAR failed to eradicate polio again in 2004 remains an open question for many. Problems with refrigeration, say some experts. The vaccine, a liquid given on the tongue, spoils if it is not kept cold until it is administered. Another reason for failure to eradicate the disease may have been the CAR's armed conflict, some health officials said. Thousands of Central Africans have been displaced by fighting with many of them still reportedly living in the forest. Unidentified armed groups continue to attack villages and connecting roads. Vaccination A UN convoy of health officials responsible for the vaccination campaign travelled from Bangui to Bossangoa and back, escorted by well-armed government troops.

-Military escort with WHO convoy on the road between Bossangoa and Bangui.-

"Lack of security, poor communications and infrastructure are certainly all obstacles," Dr Jean Moke Kipela, the WHO coordinator of the polio campaign in CAR, told IRIN. "But the way we are overcoming many of these problems this year is by better planning and by recruiting vaccinators locally. "That way the vaccinators know the families of the children, know the children missing - so they can follow up," he said. Some 2,000 vaccinators were deployed throughout the country on Thursday with the aim of vaccinating some 700,000 children. However, on Friday, the first day of vaccinations, there were still problems in some of the villages. At the village of Ndjoh, 50 km south from Bossangoa, the chief told residents not to allow their children to take the vaccine because it would cause diarrhoea. "He did the same thing last year," Kipela said. "We still have two days to convince him that the vaccine is safe, otherwise we will vaccinate the children by force, as we did before." In 2004, soldiers encircled the village, while vaccinators went from house to house. In Bangui on Saturday, the second day of the campaign, there were other problems. The chief doctor at a health clinic in the neighbourhood of Ouango, Dr Edith Sakho, said many of the children had gone fishing with their parents and other parents were refusing to allow their children take part.

-Team of local vaccinators in Bassangoa to pick up the polio vaccine.-

At a meeting of the vaccinators on Saturday in Bangui, team leaders read out the number of children who had been missed and the various reasons. The group then discussed the reasons as well as strategies to ensure the children got vaccinated by Sunday, the final day of the campaign. "By Sunday evening, the number of children in Bangui known to have missed had dropped to 12. We extend the campaign and keep trying tomorrow but we can never hope to get all of them," Kipela said. He added, "We have to hope that the ones we miss had been vaccinated previously or that they will be vaccinated in the next two rounds. "I think we have a good chance of succeeding. From the data I have seen it is epidemiologically feasible that transmission of the polio virus in the CAR can be stopped by the end of this year." That is not the same as eradication though. "Only after three years of careful surveillance will we know for sure that, this time, the disease has gone for ever," Kipela said.