April 2005

Views expressed are those of the authors, not necessarily of the AFSC.

A Million Vaccinators Struggle to Eradicate Polio

Information from a WHO/Rotary International/CDC/UNICEF fact-sheet and a Peacework interview with Claire Hajaj, the chief spokesperson for UNICEF's polio eradication program. For more information, please see www.who.int/topics/poliomyelitis/en/. To make a donation to eradicate polio, please see www.polioeradication.org/howtocontribute.asp.

More than one million polio vaccinators in 23 African countries embarked on a massive immunization campaign over four days in October, 2004, aiming to immunize 80 million children across sub-Saharan Africa against polio. This effort is a direct response to an ongoing polio epidemic in the region, which puts thousands of children at risk of lifelong paralysis.

Women and children waiting in line for vaccinations in Togo. Photo: UNICEF/Thierry Delvigne-Jean

In 1998, the year the Global Polio Eradication Initiative began, there were 350,000 polio cases per year worldwide. Since then, the Initiative has succeeded in reducing the incidence of polio by over 99.9%. Despite this success, the goal of eradicating polio has been elusive. The Initiative faces daunting challenges including misinformation about the vaccine's safety, the difficulty of conducting vaccination campaigns in war-torn regions, the lack of health-care infrastructure, sexist restrictions, and a paucity of resources.

By 2001, the Eradication Initiative, which has involved over 20 million volunteers worldwide, had stopped polio in all countries in sub-Saharan Africa except Nigeria and Niger. In 2004, worldwide, there were 1263 reported polio cases from 18 countries (1068 of these cases were in sub-Saharan Africa, the rest primarily in India and Pakistan).

Polio swept back through sub-Saharan Africa during the last two years because of the suspension of polio campaigns in mid-2003 in Kano, Nigeria (due to unfounded concerns of Muslim clerics regarding the safety of the oral polio vaccine), and low routine immunization coverage in countries surrounding Nigeria. After intensive efforts to inform Muslim clerics, local politicians, and grassroots organizations in Nigeria about the safety of the vaccine, anti-polio campaigns resumed in Kano, Nigeria on July 31, 2004. The massive new campaign was launched on October 2, 2004 at a celebration in Kano. As part of the proceedings, Nigerian President Obasanjo personally immunized the daughter of the Governor of Kano.

The eradication campaign is being slowed by warfare. From northern Nigeria, polio spread to Chad, across the border into the Darfur region of the Sudan, and from there to Khartoum. Similarly, the war in Cote d'Ivoire prevented a mass immunization campaign in the fall of 2004, though there is hope that a UN-brokered cease-fire will allow vaccination to resume in 2005. The plan in Cote d'Ivoire is for international agencies to helicopter materials into the north, where camel trains, horseback caravans, bicycle routes, and boats are prepared to take the vaccine to remote areas and islands. The vaccine needs to be kept cold, and heroic efforts have been expended to preserve it. When the electricity failed in one village in Cote d'Ivoire, villagers donated their own scarce fuel to keep the generators, and therefore the refrigerators holding the vaccine, running.

The widespread community-based commitment to maintain vaccination has helped create common ground between warring factions. In Somalia, ethnic borders are often demarcated by rivers. During the 2002-2003 immunization campaign, militias from rival factions actually met in the middle of a river to pass vaccinators from one side to the other so that children on both sides could get the vaccine.

Polio hits hardest in the most marginalized communities with little or no health care infrastructure: remote villages, islands, refugee camps, internally displaced person centers, and the shantytowns of large cities. During the October 2004 campaign, tens of thousands of traditional and religious leaders, teachers, parents, and Rotary club members joined nurses and a vast array of other volunteers and health workers to systematically go house-to-house and village-to-village. The goal was to hand-deliver the vaccine to every child under the age of five. Vaccinators covered half of the African continent.

The effort in some areas faces intense cultural challenges. For example, in parts of Pakistan and Muslim-dominated areas of Nigeria, men aren't allowed into other people's houses, because that is women's bailiwick, but it's very difficult for women to travel the streets to go door-to-door. So, vaccinators are now formed into teams of women and men who travel together. Muslim clerics in Nigeria, reassured about the vaccine's safety, have now become central supporters of the effort. Some women in the community, and even some male community leaders, are saying, "Unless we empower women, we'll always have this disease."

In some areas, vaccinators, aged 16 and up, are paid and are recruited from local communities. Many trained vaccinators, especially young women, now aspire to become nurses and doctors.

This year, the results of the campaign look promising. During the first three months of 2005, there have been only 64 cases of polio in five countries worldwide. The worldwide polio campaign cost $500 million in 2004 (about what the US Pentagon spends every 11 hours), with 171 campaigns in 45 countries inoculating 372 million children. An additional $200 million is urgently needed to sustain the momentum of the programs through 2005.

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