Africa's battle to eradicate polio goes door to door

LOME, Togo — In an unfinished but inhabited concrete house near the international airport, a young girl opened her mouth for two drops of liquid that would protect her against the paralyzing effects of polio.

But then her father appeared from a back room.

“No,” he said in English. “We will give her a shot at the hospital.”

Volunteers who knocked on the door as part of an immunization campaign explained they had the blessing of the government and they are not administering shots, just liquid drops.

“No,” the father responded. He ushered them to the door.

So close. The worldwide polio eradication campaign is practically that close to victory. Polio was endemic in 125 countries 25 years ago. Today the disease is prevalent in just four countires: Nigeria, India, Pakistan and Afghanistan, but there are outbreaks in several other countries.

The numbers of new cases of polio are also declining. There were 350,000 new cases in 1988, when  the campaign was launched to immunize children under 5 years old. There have been just 760 new cases through October this year, according to those working in the campaign including Rotary International, the World Health Organization, UNICEF and the Centers for Disease Control.

“We’ve had more than a 99 percent reduction, but our goal is zero cases,” said Dr. John Sever, a Rotarian who proposed the global campaign in the early 1980s when he was infectious diseases chief at the U.S. National Institutes of Health.

“We’re very close. But polio could rebound to 10 million cases in the next 40 years if we don’t lock this down,” Sever told GlobalPost in Washington. 

Locking down polio is proving difficult. Until polio is stopped in the endemic countries, outbreaks are inevitable elsewhere because the virus travels so easily.

Angola, in southwestern Africa, had been polio-free for several years before a 2007 outbreak, traced to India. But Angola hasn’t been able to contain the virus, which crossed borders this year to the Democratic Republic of Congo.

That outbreak has taken an alarming turn with 154 deaths from 344 new cases since Oct. 1. It’s an unusually high mortality rate and most of the victims are young adults, meaning they weren’t immunized as children. An emergency immunization campaign was launched in November to reach 3 million people of all ages in the region.

In Nigeria several years ago, Muslims in the north of the country refused the vaccine because of a rumor that Western powers were using it to spread HIV. As a result, polio from Nigeria traveled and caused thousands of new cases in 20 previously polio-free countries, as far away as Indonesia.

Today, intensive public education campaigns appear to have worked. There were only 11 new cases in Nigeria through mid-November, compared to 383 new cases at the same time last year.

West African countries like Ghana and Togo, because of their proximity to Nigeria, “have put in a lot of efforts to eradicate polio, only to re-eradicate it and now re-eradicate it a third time,” said Oliver Rosenbauer, a spokesman for the WHO.

Togo hasn’t had a new case since March 2009, but volunteer vaccinator Joseph Adoubou remains vigilant. He knows polio victims in poor countries like Togo have a harder life than most, losing out on educational and job opportunities because of physical limitations.

Polio attacks the nervous system and can cause irreversible paralysis within hours, and sometimes death. Polio was a major public health threat in the United States — parents were offered polio insurance for their newborns — before Jonas Salk’s vaccine was introduced in 1955.

Adoubou, during the recent door-to-door immunization campaign in Togo, said the father who refused the vaccine for his daughter was Nigerian. In his eight years as a vaccinator, he said refusals are common among Nigerians.

“We can win the fight against polio,” he said. “But there still are reticent parents. We need to continue an education and publicity campaign with these parents to have a successful campaign.”

The Nigerian father declined to give his name and did not want to be interviewed, so it’s unknown if he ever sought immunization for his daughter. Health officials in Benin and Ghana said they had no similar reports of Nigerians in their countries refusing vaccinations in large numbers.

Occasional refusals don’t threaten the success of the campaign — but missing entire towns or villages because of poor planning does, Rosenbauer said.

“That is, and has always been, the primary obstacle to successfully stopping polio,” he said.

Still, there is risk for individual households. A 4-year-old boy in the northeastern Nigerian city of Maiduguri contracted polio with paralysis Oct. 9. The boy “was from a non-compliant household and had never received any doses,” according to the WHO’s weekly data update, published on Nov. 16.

“Those who oppose are playing with the future of their own children, as well as other children in their country of residence,” said Ashok Mirchandani, director of Rotary International’s polio eradication campaign in Benin, which borders Nigeria.

Rotary International helped the world focus on polio in the 1980s. Sever, the former NIH infectious diseases chief, urged the volunteer organization with hundreds of clubs around the world to tackle the issue. The WHO, UNICEF and the CDC joined a few years later after seeing Rotary’s success in raising money and mobilizing volunteers.

The U.S. government gives about $130 million per year to the eradication campaign. The Bill and Melinda Gates Foundation recently donated $350 million.

Sever, 78, said he's confident they'll beat polio.

"We're quite close but we're not there yet," he said. "You have to get all the way there, just like smallpox, which is the only other disease which has been eradicated. Until you get everybody under immunization, and the disease stopped, it could flare up at any time and come back again. It's a constant effort to complete this job."

Reporting conducted in Togo and Washington, D.C.