In class on October 28th, Dr. Cohen mentioned an article he recently read in the New York Times about the spread of Polio. The article, “Polio Spreads to New Countries And Increases Where It’s Endemic” does not have a hopeful tone for Nigeria. It states that, “Nigeria, whose northern provinces are the epicenter of Africa’s epidemic, recently dismissed the head of its national vaccination program.” Nigeria has been reluctant to administer the polio vaccine because of fears it may not be safe. “Many Muslims in the north believe that polio vaccination is being used as a ploy by Western countries to inject people with certain chemicals to reduce their fertility or infect them with HIV/AIDS in order to reduce the population of Muslims.” According to the World Health Organization, the number of 2008 year-to-date (Oct. 28, 2008) cases is 736 compared to the 2007 year-to-date cases of 220. The WPV1 cases, however, are very localized and reported in only 6 of Nigeria’s 37 states. The Expert Review Committee (ERC) on Polio Eradication and Routine Immunization (ERC) met on October 27-28, in Abuja. Plans have been finalized for immunizations in November and December. “The group also finalized the SIA dates for the coming months, with mOPV1 to be added to an integrated measles campaign at end-November (in the north) and December (in the south), with separate Immunization Plus Days (IPDs) to be held in high-risk areas in the north in December.”
Polio History (Past 15 Years):
200 countries, 20 million volunteers, US $3 Billion, Largest Public Health Campain
FACTS:
In 1988, the World Health Assembly (WHA) the annual meeting of the ministers of health of all Member States of the World Health Organization, voted to launch a global goal to eradicate polio. As a result of the Global Polio Eradication Initiative - the single largest, internationally-coordinated public health project to date - by the end of 2006, only four countries remained which had never interrupted endemic transmission of wild poliovirus (Nigeria, India, Pakistan and Afghanistan). In 2006, fewer than 2000 cases were reported. Back when the Global Polio Eradication Initiative was launched, wild poliovirus was endemic in more than 125 countries on five continents, paralyzing more than 1000 children every day.
Eight new cases were reported last week in Nigeria (1st week of November 08).
http://www.who.int/features/2004/polio/en/
http://www.polioeradication.org/casecount.asp
http://www.polioeradication.org/content/general/casemap.shtml
http://www.polioeradication.org/content/polionews/PolioNews31.pdf
http://www.scienceinafrica.co.za/2004/march/polio.htm
http://news.bbc.co.uk/2/hi/health/7671070.stm
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7 comments:
I've heard that business about the vaccine spreading infertility or AIDS before. Do anyone suppose that if a "reliably Muslin" country like Iran or some others were to send medical personnel and their own version of the vaccine, they would be better received and we could begin to get a handle on this epidemic?
I do think someone internal or someone who better understands the culture maybe more trustworthy and better able to help educate and vaccinate people. I find it interesting and scary that polio could potentially be used as a biological weapon. Most biological weapons are ones that are highly infectious, deadly, and easily delivered. Polio is not an effective biological weapon, but with genetic engineering, one never really knows.
The attempt to eradicate polio reminds me of a great book, “The Hot Zone” by Richard Preston.
Source:
EMBO Rep. 2003 June; 4(Supp1): S57–S60
In a pulic health class I took this semester, we discussed the attempted to eradicate polio from the world. As stated in the post, only 4 countries continue to have cases of polio and thus those that have eliminated polio must continue to vaccinate against it. In our public health class the point was brought up that while polio is a problem in these four remanining countries, it may not be a significant problem compared to others. Therefore, govenments may not be as willing to allocate resources to eliminating polio as we in the US (or other countries) would like them to be.
Dr. Cohen, you make a good point.
I took an international healthcare course last semester with Dr. Kennedy in the school of public health... we had a guest speaker from Harvard School of Public Medicine that worked in some Sub-Saharan countries in Africa. Her work was on infant/childhood nutrition - BUT I think there was a greater lesson to be learned from her presentation.
She emphasized the use of POSITIVE DEVIANTS (mothers in the area whose children were flourishing) to coach/lead other mothers how provide the nutritional requirements for their children.
In healthcare, especially children's healthcare, trust is essential. Providing an infrastructure for programs/initiatives that will mobilize trusted and familiar figures, I believe, would undoubtedly result in compliance/acceptance.
Yes, I agree that Nigeria may not see polio eradication as a top priority compared to all the other major problems the country has. But good news as of December 3, 2008 despite 10 new cases: the northern states of Nigeria November polio campaign was successful! (Integrated measles and mOPV1)
"State-level planning is continuing to urgently address key operational challenges in the highest-risk states, where upwards of 60% of children remain under-immunized (fewer than four doses). The key to overcoming these challenges is full engagement and accountability by state governors and Local Government Area (LGA, i.e. district) political leaders. In states where such political engagement has been renewed, such as Jigawa and Kebbi states, a marked improvement in campaign quality has been noted. However, such state-level engagement has not been mirrored consistently in other high-risk states in the north.
The second-wave of the activity in the southern states will be held on 10-14 December, again with mOPV1 added.
Yeah!
More good news: (UPDATE)
Between November 26-30, 2008,
it's my understanding that close to 30 million children in Nigeria were vaccinated against polio and measles.
This involved 200,000 health workers!
Nigeria paid for all or most of the vaccines.
"The Nigerian government paid for the vaccines as well as half of the operational cost of about $20 million."
http://www.voanews.com/english/2008-11-25-voa67.cfm
It is really heartening to hear that Nigeria picked up most of the expense. When I was in Rwanda I asked the medical residents how much immunization costs there, and they just looked at me: It doesn't cost anything, of course. I wish we could say that here in our somewhat richer country.
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