Polio epidemic threatens Africa

By Trevor Johnson
31 July 2004

The global rate of polio infection declined in recent decades to the point where the disease was almost eradicated. This year, the disease has experienced a resurgence, as basic health care collapses in large parts of Africa and in other poor countries around the world.

Poliomyelitis is a waterborne disease that most often infects children under five. It is caused by a virus that invades the nervous system, leading to muscular atrophy, deformation, paralysis or even death. A simple oral immunisation can prevent this.

The Global Polio Eradication Initiative, a mass immunisation programme started in 1988, cut the number of cases from 350,000 cases per year in 125 countries when the programme started to 783 cases in 6 countries in 2003. The “Kick polio out of Africa” campaign run by the World Health Organisation (WHO) cut the rate of polio infection in Africa from 205 cases a day in 1996 to just 1 case a day in 2003.

That trend has now been reversed. In the first four months of the year, the global number of polio cases reached 339, double the figure for the same period last year. That is already almost half of last year’s total of 783, and the peak season has not yet been reached.

Dr. David Heymann of the WHO said, “There is no question that the virus is spreading at an alarming pace.”

Heymann, who oversees the campaign to eradicate the disease, explained, “At the beginning of 2003, only two countries in sub-Saharan Africa were polio-endemic. Today, however, Africa accounts for nearly 90 percent of the global polio burden, with children now paralysed in ten previously polio-free countries across the continent.” (The disease is taken to be “endemic” if the chain of transmission has not been stopped within 6 to 12 months.)

There were 62 new cases of polio in Nigeria in the two weeks at the end of June. The total number of Nigerian confirmed polio cases so far in 2004 was 259, compared with 56 in the same period in 2003. Health officials acknowledge that these figures are probably an underestimate of the scale of the growing epidemic.

In west and central Africa, five times as many children have been left paralysed by polio so far in 2004 compared with the same period in 2003. In Nigeria, 197 children have been paralysed this year alone.

At a global level in 2003, there were six countries—Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan—where polio was considered endemic. According to the WHO, four countries—Egypt, Pakistan, Afghanistan and India—are still on target to eradicate the disease before the end of 2004.

In Africa, cases of polio have recently been reported in Sudan. In addition to Nigeria and Niger, the disease has now been found in nine other countries since last August: Benin, Botswana, Burkina Faso, Cameroon, Central African Republic, Chad, Ghana, Ivory Coast and Togo—all countries that have been polio-free until now, but to which the infection has spread from Nigeria. In three of these countries—Burkina Faso, Chad and Ivory Coast—polio has been spreading from one person to another. Botswana reported its first new infection in February.

WHO officials say it could still be possible to eradicate the disease if they succeed in meeting their immunisation targets by the end of autumn. To do this, however, the WHO needs $25 million by August 1 to launch the new vaccination campaign, with an additional $100 million to immunise 74 million children in 22 African nations in October and November 2004.

The increase in the disease is due to the breakdown of vaccination programmes. The level of polio vaccination in 14 sub-Saharan African countries dropped by more than 10 percent between 1990 and 1992. But plummeting spending on health in the 1980s and 1990s led to the closure of hundreds of health facilities, and those that remained open suffered from a lack of both staff and medicines, with even rudimentary vaccines in short supply.

Compounding the general problem of lack of resources and trained personnel, the immunisation programme in Kano State, Nigeria, was suspended by its governor, Ibrahim Shekarau, in September 2003. This followed claims by Muslim leaders that vaccines from Western countries had been modified to reduce fertility and to carry HIV, as part of a US plot against the followers of Islam. Several other northern, mainly Muslim, Nigerian states joined the boycott at first, but then reversed their decision after government scientists stated that impurities in the vaccines were at too low a level to cause harm. In May 2004, Shekarau also asked the WHO for help in restarting the immunisation campaign, but the date for this to start has been delayed.

The director general of the WHO, Dr. Lee Jong-Wook, said, “To date, the ongoing suspension of immunisation campaigns in Kano has put thousands of children in African countries at risk of polio paralysis. The suspension has also resulted in the re-emergence of polio in countries which had been polio-free. If the campaigns were not resumed in Kano, [the] billion-dollar effort involving 20 million people would be in jeopardy.”

The WHO has confirmed that a child was paralysed by polio on May 20 in Darfur, the first case in Sudan in more than three years. Health experts have been warning of epidemics in Darfur for some time, since thousands have been killed and more than 1 million left homeless in the 15-month-long conflict.

Showing the same disregard for human life in Africa as with the AIDS pandemic, the Western countries have been cutting their aid budgets, meaning that even an easily preventable disease like polio is still stalking the continent after being eradicated from Europe, the Americas, much of Asia, and Australia.

The privatisation of health care in Africa has made matters worse by widening the gap in health provision between the rich and poor. Ignoring the dire effects of these policies, the World Bank and the IMF are still demanding the privatisation of those health services still in the hands of the state. In addition, the same agencies are promoting the privatisation of water systems and the reduction of state subsidies for clean water. In the poorer countries of the world, more than 2 million people—many of them children—die every year due to preventable diseases spread by contaminated water supplies, and polio is one of these diseases.

In most of the African countries affected by polio, spending on health is dwarfed by the money spent on debt repayments to Western countries. The sudden increase in the incidence of polio provides further proof that, in spite of the many loudly trumpeted “debt reduction programmes,” the plight of the world’s poorest people is getting worse rather than better.

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