A child in west Africa receives polio vaccine. Photo: WHO.

More than 190 000 polio vaccinators in 13 countries across west and central Africa will immunize over 116 million children over the next week, to tackle the last remaining stronghold of polio on the continent.

The synchronized vaccination campaign, one of the largest of its kind ever implemented in Africa, is part of urgent measures to permanently stop polio on the continent.  All children under five years of age in the 13 countries – Benin, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria and Sierra Leone – will be simultaneously immunized in a coordinated effort to raise childhood immunity to polio across the continent. In August 2016, four children were paralysed by the disease in security-compromised areas in Borno state, north-eastern Nigeria, widely considered to be the only place on the continent where the virus maintains its grip.

“Twenty years ago, Nelson Mandela launched the pan-African ‘Kick Polio Out of Africa’ campaign,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.  “At that time, every single country on the continent was endemic to polio, and every year, more than 75 000 children were paralysed for life by this terrible disease.  Thanks to the dedication of governments, communities, parents and health workers, this disease is now beaten back to this final reservoir.”

Dr Moeti cautioned, however, that progress was fragile, given the epidemic-prone nature of the virus.  Although confined to a comparatively small region of the continent, experts warned that the virus could easily spread to under-protected areas of neighbouring countries. That is why regional public health ministers from five Lake Chad Basin countries – Cameroon, Central African Republic, Chad, Niger and Nigeria – declared the outbreak a regional public health emergency and have committed to multiple synchronized immunization campaigns.

UNICEF Regional Director for West and Central Africa, Ms Marie-Pierre Poirier, stated that with the strong commitment of Africa’s leaders, there was confidence that this last remaining polio reservoir could be wiped out, hereby protecting all future generations of African children from the crippling effects of this disease once and for all. “Polio eradication will be an unparalleled victory, which will not only save all future generations of children from the grip of a disease that is entirely preventable – but will show the world what Africa can do when it unites behind a common goal.”

To stop the potentially dangerous spread of the disease as soon as possible, volunteers will deliver bivalent oral polio vaccine (bOPV) to every house across all cities, towns and villages of the 13 countries.  To succeed, this army of volunteers and health workers will work up to 12 hours per day, travelling on foot or bicycle, in often stifling humidity and temperatures in excess of 40°C.  Each vaccination team will carry the vaccine in special carrier bags, filled with ice packs to ensure the vaccine remains below the required 8°C.

“This extraordinary coordinated response is precisely what is needed to stop this polio outbreak,” said Michael K McGovern, Chair of Rotary’s International PolioPlus Committee .  “Every aspect of civil society in these African countries is coming together, every community, every parent and every community leader, to achieve one common goal: to protect their children from life-long paralysis caused by this deadly disease.”

The full engagement of political and community leaders at every level – right down to the district – is considered critical to the success of the campaign.  It is only through the full participation of this leadership that all sectors of civil society are mobilized to ensure every child is reached.

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Children in Equatorial Guinea proudly show the dot of ink on their finger that demonstrates they have received a dose of oral polio vaccine.
Children in Equatorial Guinea proudly show the dot of ink on their finger that demonstrates they have received a dose of oral polio vaccine. ©UNICEF/Equatorial Guinea

This week, 18 countries across western and central Africa have been holding synchronised polio immunization campaigns to reach nearly 94 million children with oral polio vaccine (OPV). This is a monumental coordination effort, incorporating strong governmental commitment, global support from international organisations such as the World Health Organization and UNICEF and the motivation of members of communities themselves to mobilize their friends and neighbours to ensure every child is protected.

National Immunization Days in Angola, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d’Ivoire, the Democratic Republic of the Congo, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea Bissau, Mauritania, Niger, Nigeria, the Republic of the Congo and Senegal are working to build immunity across western and central Africa. Each child needs at least 3 doses of OPV to build immunity and end the transmission of the virus, making it crucial that campaigns such as this reach every child.

Africa is closer than ever before to achieving eradication, with only 22 cases across the continent to date in 2014 compared to 232 by the same point in 2013. This decrease of over 90% in one year is due to increased commitment from the governments of the last remaining endemic country in Africa, Nigeria, and the sites of current outbreaks in Cameroon, Equatorial Guinea, Somalia and Ethiopia.

Nigeria saw only 6 cases in 2014 compared to 53 in 2013 by this date. This dramatic improvement can be attributed to measures put in place to avoid missing children from campaigns, and to a surge in staff to the country to support Emergency Operations Centres. The international spread of polio, affecting Cameroon, Equatorial Guinea, Somalia and Ethiopia as well as countries in the Middle East, lead to the declaration of polio as a Public Health Emergency of International Concern (PHEIC) in May 2014 by the Director General of the World Health Organization. With temporary recommendations to stop the international spread of polio, the PHEIC is another step towards ensuring a polio-free Africa.

Through these measures – improved surveillance, innovative community engagement strategies and a surge in staff to affected areas – the past year has seen gains in the eradication effort that must be protected. Synchronized campaigns such as this bring us ever closer to the important milestone of ending transmission in Africa.
These synchronised campaigns demonstrate the commitment of the governments of countries across central and western Africa to ending the transmission of polio once and for all, despite the increased focus on Ebola prevention and response in 2014. In some cases, polio resources are being utilized to strengthen the Ebola response, demonstrating the Global Polio Eradication Initiative’s commitment to securing the polio infrastructure for a polio-free world.

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21 November 2013 – Two children have been paralyzed by wild poliovirus type 1 (WPV1) in the West Region of Cameroon during the month of October. This indicates that wild poliovirus is present in the country, presenting a high risk that the virus will spread.

Genetic sequencing indicates that these viruses are linked to WPV1 last detected in Chad in 2011.

An emergency outbreak response plan is now being finalized, including at least three national immunization days (NIDs), the first of which was previously conducted on 25-27 October 2013. Subnational Immunization Days (SNIDs) will be implemented in December 2013, followed by two subsequent NIDs in January and February 2014. Routine immunization rates are reported to be approximately 85.3% for OPV3. A response in neighbouring countries is also being planned, notably in Chad and Central African Republic.

Surveillance activities across the country and the region are being analyzed to find any gaps.

Given the history of international spread of polio from northern Nigeria across West and Central Africa and subnational surveillance gaps, the World Health Organization (WHO) assesses the risk of further international spread across the region as high.

In 2013, Cameroon also reported four cases due to circulating vaccine-derived poliovirus type 2 (cVDPV2) in the Far North region, linked to circulation in Chad and also detected in Nigeria and Niger. In response, several large-scale supplementary immunization activities (SIAs) had been conducted during the months of August and September, followed by the full NIDs in October. Circulating VDPVs are indicative of poor immunity in the population.

It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importations and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

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West and Central Africa Polio Campaign Enters Decisive Phase

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Every last child must be reached WHO/C. Lamoureux

Brazzaville/Dakar, 21 March 2012 — Health Ministries, UN agencies and communities are uniting with tens of thousands of volunteer immunizers over four days to go door-to-door and hut to hut for a vaccination campaign against polio in 20 African countries starting on 23 March.

The vaccination campaigns are critical to protect children before the ‘high season’ for polio, which starts in the northern hemisphere summer. Due to insufficient funding, the polio eradication initiative is scaling back campaigns planned from March to July in over 20 countries. Many of these countries remain therefore vulnerable to polio outbreaks. The reduction in vaccination activities leaves the eradication effort with a funding shortfall of US$405 million for 2012.

Across West and Central Africa, over 111.1 million children below the age of five are expected to be vaccinated through this campaign. Nigeria, the only polio endemic country in Africa, aims to get two drops of the oral vaccine into the mouths of 57.7 million children. Nineteen other countries, which are at risk of re-infection, are stepping up efforts to reach nearly 53.3 million children.

This gigantic exercise represents a dramatic effort of will by governments and partners, and relies on hundreds of thousands of health workers and volunteers who will be administering the drops to all children under the age of five, irrespective of their previous immunization status.

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