By Kemo Cham
Despite three decades of effort put into eradicating it, the world is under the threat of poliomyelitis, the UN World Health Organization (WHO) warned last week as it declared the viral disease a "public health emergency of international concern".
It followed a report identifying 10 countries found to have reneged on their obligation to contain the crippling virus which had come close to eradication.
Polio, as it is otherwise called, was close to being the first ever global disease to be eradicated, after smallpox which is the only human disease ever to have been totally isolated to the lab. The deadline set by WHO and its partners to eradicate polio has failed several times, sparking fears that it may never be contained. The current deadline, termed in health circles as the "endgame strategy", is 2018. But any new infection, says WHO, makes this prospect more distant.
The countries concerned were found to have active transmission of the wild poliovirus (within the past six months). Three of them were found to be endemic for the disease while seven were re-infected.
The top three named - Pakistan, Syria and Cameroon - were singled out for having allowed the virus to spread beyond their borders thereby posing the greatest risk of further wild poliovirus exportations in 2014. Consequently, they face stringent measures being considered by the global health body as recommended by the 21-member International Health Regulations Emergency Committee which investigated the matter. If the recommendations are approved, citizens of these three countries may have to go through tedious medical check-up and tests at airports in countries they visit. They will be specifically required to undertake mandatory polio vaccination and show with a certificate whenever they travel abroad. Needless to explain how detrimental such travel restrictions will be to a country's economy.
But also, such is how important the global fight against the polio virus is. Polio usually strikes children under five years of age, it passes easily from person to person and is most often spread through infected water.
The virus multiplies in the intestine from where it usually invades the nervous system and can cause irreversible paralysis within hours - hence the physical handicap common with its victims. Symptoms of infection include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs.
But many infected people don't display symptoms; and when they excrete the virus through their faeces it gets transmitted to others. And among those who get paralyzed, between five and 10 per cent die when their breathing muscles become immobilised. There is no specific cure for polio, but vaccines that control the virus exist - the Oral Polio Virus Vaccine (OPV) and the inactivated poliovirus vaccine (IPV).
No complacency
Last week was the first time ever that the WHO has declared the spread of polio as an international public health emergency, and the second time for such a public health declaration by the UN health agency. The last time such a global public health concern was raised was during the 2009 outbreak of the H1N1 flu pandemic.
Currently, about $1 billion a year is spent on effort to eradicate polio. According to WHO, eradicating the disease would save between $40 - $50 billion in economic losses over the next 20 years. Experts say as long as any single child anywhere in the world remains infected with the virus, children everywhere are at risk. That's why this is of concern to Sierra Leone, agrees Dr Sartie Kenneh, Programme Manager of the Child Health and Expanded Programme on Immunization in the Ministry of Health and Sanitation.
In 1988, Polio was endemic in 125 countries with worldwide recorded cases of 350,000. 25 years later (in 2013), only 417 cases were recorded. This represents a remarkable progress, but one that has been achieved on quite an uncertain experience.
In Sierra Leone, the current case load, according to Dr Kenneh, is zero. He says that through the Health and Sanitation ministry's active surveillance system, there shouldn't be any cause for alarm. But the career medical doctor was quick to point out that there was no room for complacency as what happens in a neighbouring country very much concerns the other. For instance, Sierra Leone was on the verge of being certified polio-free when three years ago (2010) it recorded a single case that was later traced to a neighbouring country. For a country to be certified polio-free, it has to have been free of the disease for three to five years.
Among the 10 countries of concern are Afghanistan, China, Somalia, Nigeria, Ethiopia, and Kenya. Pretty much all these countries share a lot in common with Sierra Leone.
The fight against polio has generated a lot of controversy. In Nigeria, Muslim leaders in the north of the country opposed vaccination campaigns, citing plot to sterilise their women in a bid to curtailing the growth of their population. In Pakistan, the Americans used a medical doctor who pretended to be conducting a polio vaccination while investigating the whereabouts of Osama Bin Laden. The Al Qaeda leader was later killed in a sting operation. Since then, several genuine polio vaccination officials have been the target of extremists in that country.
All these have seriously sabotaged the global effort to contain the virus. In fact, by early 2014, only these two countries, alongside Afghanistan and neighbouring Pakistan, remained polio-endemic. Nigeria is a suspect source for the situation in neighbouring Cameroon, while the situation in Afghanistan is strongly believed to be a spill-over effect from next door Pakistan. "Therefore," says Dr Kenneh, "even with a zero case load, there is no guarantee of immunity once the virus exists elsewhere in the world".
Eradication
For 10 years, from 1999, Sierra Leone did not have any recorded cases of polio. However in July 2009, 12 new cases of the virus were unearthed in the capital Freetown and in five districts - Kambia, Port Loko, Moyamba, Bo and Kenema. But subsequent progress in the fight against the virus saw the country granted provisional polio-free status in 2007. This status was again blotted by a single case of a wild poliovirus type 1 that was confirmed in 2010. By that year, only four countries in West Africa had suffered from an actively circulating polio virus, and they were Senegal, Mauritania, Guinea and Sierra Leone.
The fact that today attention is on Nigeria and Cameroon in the sub-region again explains the funny behaviour of the virus. "Polio is targeted for eradication. To take it out of the surface of the earth, so that it can only be seen in the laboratory, like Smallpox," says Dr Kanneh. And for this to happen, he adds, routine immunisation has to be strong. But while a country does well to sustain its routine
immunisation, how much coverage it has for its population is very crucial.
To be sufficiently protected from the virus, a child needs at least three doses of the vaccine. But experts say the more the better. Sierra Leone currently has just over 90 percent coverage. And part of the reasons for not being able to reach the 100 percent coverage has been attributed to attitude of parents to the vaccination programme. But mainly cross-border movements and lack of proper sanitation, especially in rural communities, pose a natural problem for the eradication of the virus. Freetown is said to record the lowest coverage compared to anywhere else in the country, as people tend to shut their doors on vaccinators. This is contrary to what obtains in other countries where objection to vaccination tends to come from communities that are less educated, says Kenneh.
(C) Politico 15/05/14
