Africa has achieved a year without any new cases of wild polio for the first time, but experts warn that violent insurgencies could yet prove their “achilles heel” in finally eradicating the disease.
|A health official administers a polio vaccine to a child in Nigeria|
The poliomyelitis virus attacks the nervous system and can cause irreversible paralysis within hours of infection. No cases have been identified in Africa since 11 August last year in the Hobyo district of Mudug province in Somalia, meaning that the continent is two years away from being certified polio-free.
But both Somalia and Nigeria, which also saw its last polio case in 2014, are battling Islamist militant groups – al-Shabaab and Boko Haram respectively – raising fears that vaccines will not reach children displaced by conflict.
“I just hope Boko Haram will not be the achilles heel of our work,” said Oyewale Tomori, professor of virology at the Nigerian Academy of Science, who has dedicated four decades of his life to polio research. “Unless we get rid of the insurgency, we cannot be sure we will eradicate polio.”
In Nigeria there is a target cohort of 5 million to 6 million children each year, he added, and vaccines must reach 90%-95% of them to prevent polio recurring. “Getting vaccines to displaced people will be crucial,” said Tomori.
Boko Haram’s bid to carve out an Islamic caliphate in northern Nigeria has cost tens of thousands of lives. The group lost territory this year but showed its sustained ability to carry out bombings and targeted killings. Similarly, al-Shabaab, while suffering military setbacks, continues to strike in Somalia.
Despite the turmoil, Nigeria could soon be removed by the World Health Organisation (WHO) from the list of countries where polio is endemic. As recently as 2012 the country had more than half of all the world’s cases, but numbers fell by 92% between 2013 and 2014. Somalia suffered 194 cases of polio in 2013, most of them children, but this was cut to just five in 2014, all in the north-east region of Puntland.
Africa’s progress intensifies pressure for action in the only two other polio-endemic countries, Pakistan and Afghanistan, where there have been 28 and six cases respectively so far this year. Global health experts hope that by 2018 polio will become the second human infectious disease, after smallpox, to be wiped out.
The Gates Foundation and Rotary International are among the biggest donors to polio eradication. Carol Pandak, director of Rotary’s global PolioPlus programme, which has contributed $688.5m in Africa, said: “Africa’s milestone of one year without a case of paralysis caused by wild poliovirus is an unprecedented and important advancement in the 30-year, worldwide effort to end polio.
“However, it is too soon to celebrate. We need to keep polio eradication a high priority – immunisation campaigns and high quality surveillance activities must continue throughout Africa, as does improvement in routine immunisation, to ensure that the virus does not return.”
Nigeria had struggled to contain polio since some northern states imposed a year-long boycott of the vaccine in 2003. Some state governors and religious leaders in the predominantly Islamic north alleged that the vaccines were contaminated by western powers to spread sterility and HIV and Aids among Muslims.
But in 2009 traditional leaders across the country agreed to back immunisation campaigns and encourage parents to have their children vaccinated. The government also set up emergency operations centres to coordinate vaccination campaigns and reach children in previously inaccessible areas.
Tomori reflected: “We finally got our act together after so many years. We had many obstacles at leadership level and at community level. We realised we couldn’t reach the community with vaccines without the traditional leaders. Nigeria used to be the main problem. Now there is hope for Africa. We have to make sure polio does not come back.”
Polio often spreads among young children and in areas with poor sanitation, but since the Global Polio Eradication Initiative launched in 1988, there has been a reduction in cases worldwide of more than 99%. At that time the disease was endemic in 125 countries and caused paralysis in nearly 1,000 children a day.