Pocket of Opposition to Vaccine Threatens Polio Eradication
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The New York Times
http://www.nyt.com
December 9, 2003
By LAWRENCE K. ALTMAN
Opposition to vaccinations against polio by some Islamic leaders
in northern Nigeria has led to the spread of the disease to
neighboring West African countries, jeopardizing the World Health
Organization plan to eradicate it by the end of 2005.
Having reduced the worldwide incidence of paralytic polio by 99
percent over the last 15 years, the organization, a United Na-
tions agency, said it was on the verge of eradicating polio when
the Nigerian setback occurred this year.
Still, the agency, based in Geneva, can meet its goal for 2005,
said Dr. David L. Heymann, the epidemiologist in charge of its
polio program.
"In all countries, except Nigeria, polio is at its lowest-ever
reported levels during the high season of transmission, usually
from June to January," Dr. Heymann said in a telephone interview.
Since the $4.6 billion eradication program began in 1988, the po-
lio incidence has plummeted, to 572 cases in 11 countries from
350,000 cases in 125 countries.
The 572 cases as of the latest update on Dec. 3, are fewer than
half the 1,461 in 9 countries for the comparable period of 2002.
But the world total is higher than the 483 cases reported for all
of 2001.
Nigeria has reported the largest number this year, 251, compared
with 145 for the comparable period last year. Epidemiologists
have traced the spread of polio from Nigeria to four countries
that were previously thought to be polio-free, Burkina Faso,
Chad, Ghana and Togo. Niger, the fifth country, has had a succes-
sion of imported cases.
Four polio cases have also occurred since late June in Lagos in
southern Nigeria, which had been polio free since April 2001.
Epidemiologists track each reported case, and laboratory scien-
tists use molecular tests to identify the virus's lineage. Tests
show that strains of the virus isolated from cases in Nigeria and
neighboring countries are nearly identical, documenting that the
disease was exported from Nigeria.
Dr. Heymann's team is concerned that polio may have been exported
to other West African countries where cases have not been de-
tected.
Nigeria is the last major challenge to the goal of eradication,
Dr. Heymann said. There, the W.H.O. has run into an unexpected
hurdle from accusations by some Islamic leaders that the polio
vaccine leaves young girls infertile.
The United Nations buys its vaccine only from countries that meet
its standards. The vaccines used in Nigeria are the same as the
ones used elsewhere and have not been linked to sterility, Dr.
Heymann said.
Nigeria is testing polio vaccine for evidence of contraceptives
and sterilizing chemicals. The findings are expected to be re-
leased soon.
In three days in October, the health organization helped vacci-
nate 15 million children in Benin, Burkina Faso, Ghana, Niger and
Togo. On Nov. 11, another program vaccinated 1.1 million children
in Chad. Additional programs are scheduled in the next two months
for all those countries, as well as Cameroon and Nigeria.
Vaccination programs customarily stop for Ramadan.
The new vaccination programs are adding $20 million to the W.H.O.
budget, which is already $210 million short in its need to meet
the 2005 goal. The $20 million addition does not include $1 mil-
lion that Ghana spent and the untallied amounts spent by other
countries for recent vaccination programs.
"That is additional money in polio-free countries where they have
done their job but now have to redo it," Dr. Heymann said.
Despite the increase in Nigeria, Dr. Heymann said, "the magnitude
of the cases is much lower when you compare it to India or other
places."
Last year, India experienced a surge in cases of paralytic polio,
to 1,600 from 268 in 2001, attributed in part to a smaller number
of vaccination programs there. One program in the state of Uttar
Pradesh failed to reach 15 percent of Muslim children. But after
improved efforts and greater acceptance among Muslim communities,
the reported cases dropped, to 194 this year.
Setbacks before 2000, including those affecting countries with
civil strife, forced the health agency to revise its original
goal of eradicating polio by 2000.
Despite the obstacles, Dr. Jong Wook Lee, who ran the W.H.O. po-
lio surveillance and immunization program before he became its
director general in July, has promised to eradicate polio before
the end of his five-year term with the support of Unicef, Rotary
International, the United States government and other partners.
"Dr. Lee's goal can be met without further revision," Dr. Heymann
said. "But not until all affected countries become responsible
partners in cleaning up polio within their borders so they no
longer export the disease to neighboring countries
--
Dr Rana Jawad Asghar
Program Manager Child Survival, Mozambique
Provincial Coordinator Sofala Province, Mozambique
Health Alliance International, Seattle, WA, USA
http://depts.washington.edu/haiuw/
Coordinator South Asian Public Health Forum
http://www.saphf.org
mailto:jawad@alumni.washington.edu
http://www.DrJawad.com
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