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.
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| 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.
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