Three steps closer to a polio free Africa

Andrew Moscrop Edinburgh

Last month witnessed the final effort in a massive three stage polio vaccination campaign in war torn central Africa. Tens of thousands of door to door teams will complete the last of three synchronised rounds of national immunisation days in Angola, Congo, the Democratic Republic of the Congo (formerly Zaire), and Gabon.

The campaign has been coordinated by the Global Polio Eradication Initiative, a collaborative group comprising members of WHO, Unicef, Rotary International, and the US Centres for Disease Control and Prevention. Experts hope that the efforts made in these African countries (four of only 20 nations in which wild poliovirus is believed to still exist) will contribute significantly to the initiative's objective of declaring the world polio free in 2005.

The aim of the campaign has been to provide a complete three dose course of oral polio vaccine to 16 million children. To ensure maximum efficacy, the days were spaced one month apart. A single dose of vaccine was given to all children under 5 at each round. The three doses will provide immunisation for the first time to many, as well as boosting the lifelong immunity of previously immunised children.

Continuing conflicts have hampered previous immunisation strategies in the four targeted countries. It is also thought that the fighting may have worsened the disease profile in the region. In 1999 an outbreak of polio occurred in the capital of Angola among families who had fled from the fighting to live in the city's overcrowded slums. Some 1103 children were paralysed and 89 died in the epidemic.

Civil war remains the biggest obstacle to polio eradication in the area. The United Nations secretary general, Kofi Annan, called for "days of tranquillity" to allow safe passage of vaccinators during the national immunisation days. Despite this, two vaccinators were killed and five more were abducted and beaten by members of one of the warring factions in the Democratic Republic of the Congo. Security threats limited the activities of other teams operating in the area.

In Angola members of Rotary International negotiated temporary ceasefires in order to allow vaccinators into trouble spots. They also borrowed corporate jets and helicopters to move immunisation teams around the landmined countryside.



studentBMJ 2001;09:357-398 October ISSN 0966-6494