FIGHTING POLIO: The War Has Started [Archives:1997/47/Health]
By: Shakib Al-Maqtari, Ministry of Health.
Years have passed since to last case of polio was reported in most parts of the world. Yet the wild polio virus is still a common source of tension for the world community. Fear of this disease stands over everybody’s shoulder. We are haunted by visions of greatly suffering disabled people in wheelchairs, using wooden legs or the crippled begging in the street. This wild virus respects neither social barriers nor international boundaries. Unless it is eradicated globally we can’t guarantee good future for tomorrow’s men. Lifelong immunity against this disease is gained through immunization as a result of natural infection by the polio virus. Two different kinds of polio vaccines are available. The first is the inactivated (killed) Injectable Polio Vaccine called IPV, which was developed in 1955 by Dr. Salts.
The other kind which is used in Yemen is OPV or Oral Polio Vaccine. It was developed by Dr. Sabin in 1961. It is a weakened or a live attenuated oral polio vaccine. OPV works by inducing not only serum immunity, but also secretory immunity particularly inside the intestines – the primary site for polio virus. It causes multiplication as well as inducing individual protection against polio. OPV also limits the multiplication of “wild,” naturally occurring virus inside the gut. Immunization with OPV, therefore, creates an effective barrier against circulation of the wild virus by reducing fecal excretion of the virus. However, a helpful outcome of immunization with OPV is the short shedding of the vaccine virus in the stool of recently immunized children. In areas where hygiene and sanitation are poor and incidence of polio is highest, immunization with OPV can result in passive immunization of close contacts through the spread of vaccine virus shed in the stool. The global goal is to eradicate polio, not just controlling the disease. So raising the routine immunization coverage would reduce the circulation of the wild virus but does not stop it. Thus, the WHO adopted a polio-eradication strategy that involves mass immunization campaigns, door to door immunization, rapid response to suspected polio cases, and investigative work to identify cases that may have been missed. It also includes viral detective work in the laboratory to isolate polio viruses and pin point the original source in areas where polio is no longer occurring. The same investigative methods are needed to provide conclusive evidence that the wild virus is no longer in circulation. Excluding Somalia, Yemen is the last country to hold national immunization days against polio in the region. It was said “better late than never.” The beginning was last year. The whole nation took part and there was a very high political commitment at all governmental levels, in addition to community participation and a strong international support. Yemen achieved the desired global target in the two rounds of the first stage of immunization. The first round of the first stage started on October 26, 1997. President Saleh, in meeting with members of High Committee of the Polio Campaign, called the nation to promote this child-saving effort. Shakib Mensur Al-Maqtari, on behalf of Yemen Times talked to the following senior members of MOPM, WHO and UNICEF.
Dr. Mohammed Hajar is an advisor to the Ministry of Health and the General Director of Public Health. He is one of longest serving senior staff doctors and is regarded as the godfather of EPI/public health trail.
“About 19 years ago, during the early days of President Saleh’s era, conditions were much more difficult. There were less paved roads, little transportation and communication facilities, and a very bad shortage of qualified national medical staff. We achieved 100% coverage for the small pox eradication. “Today, there are far more health centers, paved roads, and transportation facilities, and qualified national medical staff. We even use helicopters in some regions. Much more national and international resources, a stronger political will, and a great community commitment and participation were employed in the immunization campaign. The achieved results make me optimistic that we will create a polio-free society by the year 2000.
Dr. Abdullwahb Al-Anisi is the General Director of Health Education.
“There is a great progress which is directly attributable to the efforts of the government, the WHO, UNICEF, and the CDC Atlanta Rotary International. “Our media strategy was able to reach every child in every house. For the future, great efforts will be made to raise our community’s health awareness. “I am very impressed by the results, which are greater than we expected. We were able to achieve the target because of our clear plan, sound program strategies, political will, and good resources.
Mr. Ahmed Saeed Zaied is a long standing senior health worker. He is the Director of the National Program on Immunization.
“I really appreciate the government’s contribution of $600,000 to the total cost of the campaign which was $1,552,818 . “The 1996 campaign played a major role in achieving national, regional, and global goals of polio eradication. It solidified the government’s commitment to strength its Expanded Program on Immunization (EPI) and to eradicate polio by the year 2000. This will be achieved by implementing the following strategies: 1) strengthening routine immunization services to achieve and sustain a high level of vaccination coverage; 2) conducting national immunization days to deliverer polio vaccines to all children less than five year of age; and 3) developing strong and reliable surveillance for acute flaccid paralysis (AFP) including viral surveillance. “The second round will be conducted on November 24-26. The exact number of children who received a dose of OPV (coverage) is not yet available. But its much more than we immunized in the 1st round of the 1st stage. The targeted number of children is 3,456,526. “The Yemen Hunt Oil Company agreed to allocate $50,000 as part of it contribution. But on its other donation, Hunt gave the brush off when requested to present the sum. As a result, there is a shortage of $50,000. Therefore, I am appealing through the Yemen Times on any one who would like to be a kind donor. He is invited to offer the above amount. “For this global child-saving endeavor, 5452 health workers and 12,938 volunteers took part in the campaign in 227 districts of the country.”
Dr. Elias Duri is a WHO medical officer.
“There is a very strong international support for the campaign to eradicate polio by the WHO, UNICEF, CDC Atlanta Rotary International, the Japanese and Italian governments, and the EC. What was missing at the central level was the local private sector and the NGO support and participation. “The WHO is the main agency of the UN for health. It organizes the global campaign against polio. The WHO assigned two advisors for EPI. It contributed $138,000 for the company and is strongly supporting the establishment of a surveillance system. “CDC Atlanta supplies most of the vaccine for the campaign. This will continue till the year 2000. “There are satisfactory results, but the effort must be continuously supported at all local levels.”
Dr. Zayne Al-Saqqaf is the UNICEF Health and Nutrition Officer in Yemen.
“Impressive gains had been made in both the coverage and quality of service. Emphasis must be placed on implementing the strategy of sustainability and in providing more extensive routine immunization service on National Immunization Days. “UNICEF is the major supporter of the routine immunization. It offers $ 1 million per year in the form of vaccine and other materials. It contributed $126,000 in the campaign for social mobilization. In addition, UNICEF will be distributing 2.5 million vitamin capsules in co-operation with the High Committee for the Campaign. The aim is to reduce child mortality by 13%, prevent blindness, and reduce the impact of infections on children. The distribution will begin in the second round of the second stage.”
Mr. Aidroos Mahmoud is the Operation Officer in Aden and Lahaj.
“Besides all governmental support, Aden acted exceptionally by means of efforts made by its governor Taha Ahmed Ganim. A large a sum of money was donated by businessmen. This sum was four times the governorate contribution. Despite the natural obstacles such as heavy rain, everything went smoothly. Immunization was completed as targeted.”
Mr. Ahmed Asharji is the Sanaa GUT operation officer.
In addition to the governmental health facilities in Sana’a, 38 private hospitals and health centers, 89 schools, 15 mosques, and many local community leaders were involved in the immunization campaign. The Sana’a Chamber of Commerce, however, was not involved.”
Mr. Abdulkarim Ahmed Al-Towafy is the Mahweet and Hodeidah operation officer. ý
“Despite the heavy rain in some areas, everything went smoothly. There was a great community participation. The Hodiedah Chamber of Commerce donated cash money for the campaign.”