Winning the battle against polio

The child took his turn calmly, opening his mouth to receive two drops of liquid from the vaccinator, who was carrying a cold box over his shoulders.

He was one of hundreds of children who had been brought to the southern Sudanese capital of Juba on Monday for the first day of a national campaign against polio. The campaign aims to reach 2.7 million children in southern Sudan, out of 8.7 million targeted across Sudan.

The project is being spearheaded by government health departments, supported with vaccines, technical support and funding from the United Nations Children’s Fund (UNICEF), the UN World Health Organization (WHO) and other partners.

"High levels of coverage during these campaigns, complemented by improved routine vaccination of children as part of their ongoing healthcare, are critical to Sudan remaining polio-free," Mohamed Abdurrah, WHO country representative in Sudan, said.

"With Sudan surrounded by a number of countries where polio is endemic, we must remain ever-vigilant, and this week’s national immunisation days will play an important part in protecting Sudan from the crippling polio virus," he added.

About 16,000 vaccinators have been hired to traverse the vast war-ravaged region in airplanes, cars, bicycles, canoes and boats.

"If we are to ensure that no new cases of polio emerge in Sudan, vaccination teams must be able to access every community, every household, and every child under five," said UNICEF’s representative in Sudan, Ted Chaiban.

"That means ensuring that adequate stocks of vaccine are available, necessary logistical systems are in place, vaccinators are properly trained on how to locate and register children being vaccinated, and that we press home the message that polio immunisation is a priority for every family in Sudan," he added.

The campaign is the latest of several carried out in recent years - helped by the January 2005 peace deal that ended the war in southern Sudan. Thanks to that agreement, the vaccinators expect to cover former garrison towns as well.

"Campaigns are costly and never cover 100 percent," said Abdullahi Ahmed of WHO Sudan office. "With routine immunisation you stand a much better chance, although the initial investment is high. We are moving towards a routine immunisation system, away from large single-event funding."
 
Good coverage - known as herd immunity - is vital to short-circuit the virus in a community. "When you do not cover over 70 to 80 percent, there is a possibility of re-introduction of the virus," he added.

Getting there

In southern Sudan, transport challenges also make the door-to-door exercise more difficult, Jones Okoro, head of the UNICEF vaccination team in Juba, said. It is predicted that the house-to-house method will only attain 90 percent coverage – a figure even more difficult to estimate in the south because population figures are sketchy.

But the determination to contain the disease remains. Last week the Global Alliance for Vaccine Initiatives (GAVI) agreed to an initial contribution of between US$3 million and $5 million to help build up the infrastructure, including mobile clinics, needed for a shift towards routine immunisation.
 
"There is a huge global commitment to eradicating polio, and funding and technical support are at the highest level," said Okoro.

There is a huge global commitment to eradicating polio, and funding and technical support are at the highest level

The current campaign is also benefiting from the UNICEF/WHO-funded Mass Measles Campaign, which has a network of trained vaccinators and a crucial cold chain – a system of fridges and freezers to keep the vaccines usable – in various state capitals of southern Sudan.

The last case of polio in southern Sudan was recorded in February 2005, and the two-year gap makes health officials optimistic about the progress of eradication. Before that, the country had been polio-free since April 2001.

Abdurrah said the success of polio immunisation efforts in 2006 had resulted in no cases being reported in Sudan compared with 155 in 2004-2005. However, insecurity in other parts of the country remained a potential obstacle to the vaccination effort.

For example, UNICEF estimates that 200,000 children in the western Darfur region may not have been reached in the last polio immunisation campaign in November 2006, because of insecurity.

Experts believe the disease was reintroduced in the country through cross-border movement between Chad and Sudan. Conflict in the western region of Darfur, where the first of the 11 cases was noticed, could have been a factor.

This time, the partners have called on all parties in the ongoing conflict in Darfur to respect the humanitarian mandate of the vaccination teams, and guarantee their safe passage across the three states in the western region.

According to WHO, Poliomyelitis (polio) is a highly infectious disease caused by a virus that invades the nervous system and can cause crippling paralysis, sometimes in a matter of hours. It generally affects children younger than three, but adults can contract it as well; and many of those infected will show no symptoms at all but can pass on the virus to others.

The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms include fever, weakness, headache, vomiting and pain in the limbs, but a lifelong paralysis can set in quickly. The disease is incurable but it can be prevented easily through immunisation.

"Gradually we are getting there," said Okoro. "But the system is incredibly fragile; a case in Nigeria can quickly migrate to Pakistan."

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