Fears that polio-free countries in Africa could be on the verge of a new polio epidemic triggered a massive emergency immunization campaign in Botswana. The campaign has now reached a quarter of a million children across the country. UNICEF Communication Officer Sarah Crowe witnessed Botswana’s emergency polio immunization campaign.
GABORONE, 18 June 2004 – Botswana has been polio-free for 13 years, but an imported case of wild poliovirus genetically traced to Nigeria, which is some 2,500 km north of this southern African country, led to a house-to-house, nationwide sweep. Some 222,000 children under five years of age were targeted for their second dose of oral polio vaccine between 14 and 18 June. (The first dose was given during National Immunization Days in May.)
All sorts of tools were used in the polio campaign – the most modern technology, messaging via mobile phones, radio and television ads, brochures and posters. Churches, schools and traditional meeting places, or ‘Kgotla’, were also used to make sure that people knew the vaccinators were coming.
The immunization teams fanned out from the capital Gaborone across the sparsely populated countryside – from the home of the San people in the Kalahari desert in the south, to the watery Okavango swamps of the hippopotamus and crocodile in the north, to the rich diamond mines. At the frontier posts of Botswana’s three neighbours – South Africa, Namibia and Zimbabwe – the teams reached both foreign and local children.
Health workers used helicopters, ‘mokgoro’ (wooden canoes), four-by-fours and every available government vehicle, or often just went on foot, bearing the live virus in refrigerator packs – part of the essential ‘cold chain equipment’ for the 700,000 vaccines donated by UNICEF and the World Health Organisation.
The door of each house, mansion or shack, was stamped with a sticker stating that the occupants had done their duty and had their children immunized. After getting their drops, the children were marked with a sign: An ink mark on the arm, or gentian violet on the finger, a temporary testimony to a solid health system.
The national campaign was resisted by a small group of people, known as Bazezeru, who refused to have their children immunized due to their religious beliefs, forcing the government to obtain a court order.
“What worried me most in the whole campaign was the way in which some people were using religion not to have their children immunized,“ said the Minister of Health, Lesego Motsumi. “We shouldn’t be irresponsible in the name of the Lord. We have convinced them but I had hoped we would not have to use the courts.”
“Some South Africans working on the mines in Jwaneng also refused to allow their children to be immunized,” she said. “We cannot allow a situation like that. As parents we have an obligation to ensure the safety and health of our children.”
The recent polio scare which triggered the mass campaign was a rare example of long-distance importation of the disease. The virus in this case was identified as a Nigerian strain. Botswana had to act quickly: Just one case of polio can expose 100,000 people to the swiftly-spreading disease. It is still not clear how the eight-year-old child contracted polio but he has now regained his ability to walk.
Botswana has a solid health care infrastructure and the government paid for the bulk of the campaign budget of $1.2m and the rest was made up by UNICEF and WHO, by supplying vaccines and cold chain equipment, training health workers, and helping to mobilize communities and getting the message out.
It’s an expensive undertaking, but there’s no price tag on the end result:
“Political commitment and leadership doesn’t cost a thing,” said Gordon Jonathan Lewis, UNICEF’s Representative in Botswana. “If other countries can demonstrate to the international community that they are committed and they want to eradicate polio, then resources can start to flow from there.”
Diseases know no boundaries and the Botswana authorities have warned that neighbouring countries in particular have to be vigilant in the fight to kick polio out of Africa. Any suspected case of paralysis should be investigated immediately.
For the 22 other countries in Africa that are about to embark on their own campaigns, real lessons can be learnt from Botswana in the value of having vigorous surveillance system in place and putting children’s health first. But political commitment aside, preventing the epidemic is likely to cost the world $100 million, $25 million of which is urgently needed by August if the first set of campaigns in the 22 countries are to stop the virus.