Chasing Bellamy, chasing polio

Bellamy arrives amid a media frenzy. Bellamy vaccinates children against polio. Bellamy saves children from the crush. Bellamy addresses a mass audience of Congolese. It may have not been the French of Balzac, but the message of the executive director of UNICEF was clear: polio could and would be eradicated from the earth by 2005, for the sake of the children. Addressing a large gathering of residents on her arrival from Angola in the port town of Matadi, in southwestern Democratic Republic of Congo (DRC), Bellamy was greeted with flowers and kisses from a young polio victim, who supported herself with crutches and leg braces. A moment later, Bellamy was surrounded by local and national media, delighted that the head of a UN agency would make the arduous journey to their town and eager to know what UNICEF might do to improve their lives. Thus would begin a six-day whirlwind tour to coincide with the second of three rounds of polio vaccination taking place in Angola, DRC, Gabon and the Republic of Congo. For the first time, the four countries have synchronised their polio National Immunisation Days (NIDs) in an effort to reach some 16 million children. The success of these coordinated rounds is key to halting transmission in the central African region, one of the world’s last reservoirs of wild polio virus. During these immunisation rounds, locally-trained vaccination teams walk door-to-door through villages, towns and city slums, traveling on foot for hours each day. With colourful “Kick Polio Out of Africa” insulated boxes strapped over their shoulders, the vaccinators carry the thumb-size plastic tubes of oral polio vaccine, kept cool as required by an ice pack at the bottom of the box. The door-to-door outreach system is crucial to the eradication effort; 10 to 20 percent of children would otherwise remain unreached during NIDs, which generally rely on parents bringing their children to central immunisation locations. Through the door-to-door campaign during round one in July, some one million children under five years were immunised against polio for the first time. The vaccine must be administered several times for a child to be fully protected from polio. Preliminary results from the first round in the DRC indicated that an estimated 84 percent of the targeted population, or 9.76 million of approximately 11.6 million children under age five, have been vaccinated. The third and final round of this year’s effort will take place in September. Poliomyelitis (polio) is a highly infectious disease caused by a virus which invades the nervous system, and can cause paralysis within hours. The virus enters the body through the mouth and multiplies in the intestines. Initial symptoms include fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis, usually in the legs. Of those paralysed, 5 to 10 percent die when their breathing muscles become immobilised. Bellamy and UNICEF have made polio vaccination a centerpiece of their development platform, following a global initiative launched in 1988 to eradicate poliomyelitis by the end of the year 2000, and progress during the 1980s towards elimination of the polio virus in the Americas. The global initiative is spearheaded by UNICEF, the World Health Organisation (WHO), the Centers for Disease Control and Prevention (CDC) in the US, and Rotary International. It also includes national governments, development banks, and corporate partners. In the 13 years since the polio eradication initiative was launched, the number of cases has fallen by 99 percent - from an estimated 350,000 cases to 3,500 in 2000. At the end of 2000, the number of polio-infected countries was no more than 20, having fallen from 125. The new target date for certification of the world as polio-free is 2005. [For more details on the global campaign, go to: http://www.polioeradication.org] This was Bellamy’s 21st official visit to Africa since she became executive director of UNICEF, and her fourth visit to the DRC. Asked why she has attached such importance to the issue of polio eradication, to the extent of making repeated trips to some very difficult areas, Bellamy recalled a meeting she had had with Dr Gro Harlem Brundtland from WHO a couple of years prior, during which they agreed they would lend their our own personal energy to a final push to see the campaign through. Asked how she would respond to critics who suggest that perhaps there are more pressing and widespread health concerns, she said polio was something of an exception. “I think there’s no question that this polio campaign is a very vertical campaign - and on balance it is UNICEF’s policy not to support major vertical types of campaigns but to support the development of health systems - but we are so close globally to winning this extraordinary war and wiping out a major disease that it would be, I think, unconscionable to lose all the effort that’s gone on for all these years that have brought us to the brink of success,” she said. Bellamy also stressed that the capacity-building involved in mounting the anti-polio campaign, including the improvement of the cold chain and the training of community immunisation workers, would lend itself to other campaigns against tetanus, malaria, or a myriad of other diseases. “Because polio does not exist, to speak of, in the north, it’s not seen as a critical matter. But polio, if you don’t contain it, ultimately it’s going to come back and affect others [now free of the disease],” she warned. To highlight the fact that polio knows no borders, Bellamy and her colleagues from UNICEF, WHO and national health ministries criss-crossed among countries to witness the massive door-to-door vaccination, to meet with local and national authorities, partner UN agencies and NGOs, and to speak to the public about the danger of polio and the need to vaccinate. In Matadi, after presenting several refrigerators to be used by local authorities to store polio vaccine and a ceremonial - though real - administration of the vaccine to a number of local children, Bellamy’s delegation sped off to a nearby village, on the border with Angola, to vaccinate additional children with a couple drops of oral polio vaccine. It passed the shell of an ambulance, a small sign of the dilapidated state of healthcare in the Congo, where years of civil war and decades of mismanagement have left the population among the most desperate in the world. [A recent mission by UNICEF and the WHO found that up to 70 percent of the Congolese population was now excluded from basic health services, while all forms of preventive public health activities were “severely curtailed”. For more details, go to: http://www.who.int/eha/disasters] The towns and countryside are peppered with shells of partially-built houses now overgrown with grass, people’s dreams on hold until some kind of normalcy can be restored - which just may begin with preliminary talks taking place this week in Gaborone, Botswana, in advance of the inter-Congolese dialogue; that is intended to bring together representatives of the warring Congo factions, their allies, political leaders and members of civil society in an effort to map out a blueprint for the future of the DRC. Knowing that polio does not respect borders and remains a threat to everyone, and as a symbol of regional countries’ goodwill to coordinate their efforts on polio eradication, the gates between DRC and Angola were opened wide - allowing Bellamy’s delegation to venture into Angola in pursuit of the deadly virus. After another administration of polio vaccine to local children, the Bellamy contingent rushed back to Matadi to open a regional UNICEF office. Seemingly tireless, Bellamy took advantage of a couple of spare minutes as the crowd filed in to introduce herself to journalists. “Hi, I don’t think we’ve had the chance to meet. I’m Carol Bellamy of UNICEF,” she told one, before being ushered off for a tour of the new office. Bellamy’s day concluded with a reception with local officials, at which she told those in attendance that the anti-polio campaign in the DRC was “among the best in the world”, despite enormous difficulties. [for more details, see “DRC: IRIN Interview with UNICEF Executive Director Carol” of 23 August 2002.] She was then informed that DRC President Joseph Kabila had expressed his interest in meeting her early the next day before he left the capital on official business, so it was back to her hotel to get some sleep before the 6am flight to Kinshasa. The next couple of days would see Bellamy continue non-stop around the capital, meeting with officials, holding press conferences and administering polio vaccine to any child she met that was not yet immunised. After a brief trip across the Congo River to Brazzaville in the neighbouring Republic of Congo, Bellamy flew four hours to (rebel-controlled) eastern DRC for more non-stop visits to Goma and Kalemie, where her days would once again be filled with meetings, press conferences and vaccinations. Apart from perennial funding shortages and the particular logistical difficulties of undertaking the campaign in such a massive and war-torn country as the DRC, Bellamy emphasised that humanitarian workers had to sell the value of vaccination to the Congolese people and address any concerns they had about the exercise. “We have to not dismiss people’s fears, whether cultural or otherwise, and I think we have to work with our community advocates and mobilisers to keep getting the message out [that vaccination is safe, necessary and worthwhile] Radio is a great way to get the message out, and neighbours; that’s why we use vaccinators who are from the community,” she said. “I think there has to be a trust in who is doing it, as well as the fact that we can scientifically stand behind the medical facts,” she added.