PHA-Exchange> Polio Cases in West Africa May Thwart W.H.O. Plan

[Aviva]

From: Dr Rana Jawad Asghar <jawad at alumni.washington.edu>

Polio Cases in West Africa May Thwart W.H.O. Plan
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January 11, 2004
By Lawrence K. Altman

http://www.nytimes.com/2004/01/11/international/africa/11POLI.html

Polio has spread to two more countries in West Africa, further
jeopardizing the World Health Organization's goal of wiping out
the crippling disease by next year, an official of the agency
said Friday.

The health organization has come tantalizingly close to reaching
its goal, having reduced the number of new polio cases to the
lowest level since it began its program in 1988 to eliminate the
disease. The W.H.O. said there were 667 paralytic cases in 2003,
about 1 percent of the number in 1988.

But the spread of polio to Benin and Cameroon, which the Geneva-
based United Nations agency is expected to announce this week,
is a discouraging setback in its $4.6 billion effort to have po-
lio join smallpox as the only diseases to be eliminated from the
human population.

W.H.O. officials are placing the blame squarely with Nigeria,
which is Africa's most populous nation and the home of 300 of
the new polio cases in 2003, nearly half the world total.

The chief obstacle is opposition to polio immunization by some
Islamic leaders in the state of Kano, in the northern part of
the country. These opponents contend that the vaccine contains
hormones that sterilize girls.

The W.H.O. strongly disputes the contention.

Ridding the world of its last cases of a disease is one of the
most formidable challenges in public health. As long as one po-
lio case exists anywhere, an infected traveler can export the
disease to start outbreaks elsewhere in the world.

Nigeria and Niger were the only two West African countries that
had never wiped out polio in their own population.

Nigeria has exported polio to at least six West African coun-
tries in recent months, Dr. Heymann said. His team is awaiting
molecular tests to determine whether the viruses isolated from
the Benin and Cameroon cases came from Nigeria or one of the
seven neighboring countries that have reported cases. They are:
Benin, Burkina Faso, Cameroon, Chad, Ghana, Niger and Togo.

But the number of paralytic polio cases is a small fraction of
the number of people infected with the polio virus and capable
of transmitting it to other people who may become crippled.

Outside of West Africa, the five countries affected by polio and
the number of cases are: India (214); Pakistan (96); Afghanistan
(8); Egypt (1); Lebanon (1).

To prevent any further spread of the disease, the W.H.O. is tak-
ing two major steps.

One is to conduct what it calls "mop-up campaigns" to immunize
all susceptible children in an area where a new case has oc-
curred.

Cameroon and Benin are now conducting such campaigns in an ef-
fort to prevent the imported cases from spreading further. But
the immunization campaigns are costly and put an added burden on
countries that had previously eradicated polio because they take
money from other important health programs.

In a second move, the W.H.O. has invited the health ministers
from affected countries to discuss polio eradication at the
agency's headquarters in Geneva on Thursday.

Nigeria's national health minister has made a commitment to at-
tend the meeting, as has a representative of the state of Kano,
where the opposition to polio vaccination programs is centered,
Dr. Heymann said.

In Kano, Muslim and political officials contend that tests per-
formed there found that polio vaccine contains a dangerous level
of the fertility hormone, estrogen, and that this would cause
girls who receive the vaccine to become sterile, according to
Agence France-Presse.

A Muslim doctor, Ibrahim Datti Ahmed, president of the Supreme
Council for Shariah in Nigeria, was quoted by the news agency as
saying: "It's not contamination, it's adulteration. It's an at-
tempt to control the population of the third world."

But the W.H.O. says the vaccine contains only the Sabin polio
virus that protects against the disease.

The Nigerian government appointed a panel of experts that sent
the polio vaccine to two laboratories in the W.H.O. network for
testing.

The Nigerian president, Olusegun Obasanjo, has announced that
the polio vaccine is safe.

Earlier setbacks forced the W.H.O. to revise to 2005 its origi-
nal goal of eradicating polio by 2000.

Dr. Jong Wook Lee, the W.H.O.'s director general, has pledged to
meet that goal with the aid of Unicef, Rotary International, the
United States and other partners. Rotary has contributed about
$500 million.

The W.H.O. says it does not now intend to change the date again
and that it fears that many donors and polio-free countries
where imported cases are occurring will abandon the goal of
eradication.

Dr Rana Jawad Asghar
Program Manager Child Survival, Mozambique
Provincial Coordinator Sofala Province, Mozambique