Polio eradication in Eastern and Southern Africa

© UNICEF/NYHQ2011-0137/Williams
During his recent visit to Angola, UNICEF Executive Director Anthony Lake chats with children on the outskirts of Luanda. Mr. Lake was accompanied by Dr. Tachi Yamada of the Bill & Melinda Gates Foundation to promote polio eradication in Angola.

The issue

Polio eradication remains a top priority with the region. Although there are no polio endemic countries within Eastern and Southern Africa, children throughout the region continue to be affected by importations of virus from other countries, reiterating that while there is poliovirus anywhere, children everywhere remain at risk.

The biggest priority country and challenge in the region is Angola, which experienced an importation from India in 2005. The outbreak was never brought under control and since then the virus has continued to circulate and affect people across Angola, spreading into neighbouring Congo and Democratic Republic of Congo. In 2010 Angola reported a total of 32 cases of polio and is considered to be one of the highest risk areas on the continent and is a risk to polio eradication efforts globally. With too many children continue to be missed during polio campaigns and through routine immunizations, Angola is off track in meeting the global eradication milestones.

Countries in the region with polio cases:



Routine immunization together with strong disease surveillance are the foundation of polio eradication efforts. In many countries in the region, there continue to be gaps in routine immunization coverage, meaning many children remain un-immunized and therefore un-protected against diseases such as polio and measles. In late September 2010, two children in Uganda were also affected by poliovirus. To bring the outbreak under control, UNICEF country offices in the region have been supporting Ministries of Health and partners to conduct campaigns in response. As a result, supplemental immunization campaigns against polio are held to boost the immunization status of all children under the age of five in countries where routine coverage remains low.

Response in the region

In Angola, UNICEF, together with other partners, is supporting the Government to implement an emergency plan to stop polio and to improve routine immunization. UNICEF will also soon support the Government to implement a focused home-based water treatment and hand washing campaign targeting nearly 1 million people in the three polio affected municipalities in Luanda Province. The focus remains on improving the quality of the campaigns to ensure all children under five are reached. Given the upsurge in cases, now more than ever, ownership of immunization campaigns at all levels and the involvement of all stakeholders will be the only way to achieve success.

© UNICEF/NYHQ2011-0140/Williams
A boy looks at a gully filled with polluted water and garbage on the outskirts of Luanda, the capital of Angola. Poor sanitation, a lack of safe water, and other unsanitary conditions promote the spread of illness and disease, including polio.

Many countries, including Rwanda, Ethiopia, Kenya and Burundi have included oral polio vaccine together with other health interventions during the Child Health Days, and with measles campaigns. A total of 14 countries in the region included oral polio vaccine in their Child Health Days in an effort to prevent polio outbreaks.

When a polio outbreak occurs anywhere in the world, three rounds of high quality campaigns are recommended to bring the outbreak to a halt. Uganda has conducted rapid response polio campaigns in response to the two cases reported near the border with Kenya. Although Kenya has not reported any cases since July of 2009, the Government has also undertaken preventive campaigns to enhance polio immunization coverage in 22 districts near the border with Uganda.

In addtion to procure oral polio vaccine for the Governments, UNICEF provides important support in the area of communications and mobilization, which is fundamental to reaching every child with routine and supplementary immunization. In countries throughout the region, including Angola, Uganda, Kenya and Ethiopia, communications efforts focus on engaging religious leaders, traditional elders, civil society, schools, the media and others have been utilized to enhance immunization coverage.

It is important to highlight that polio eradication efforts go far beyond just the eradication of a disease. The polio programme is reaching out to more children in more districts, and areas more often than most other programmes, with particular emphasis on reaching the hard to reach. Local-level planning for polio activities, which identifies all health facilities and key institutions across the country will enhance the ability to strengthen routine immunization and potentially other primary health care services. It is also important to note that polio eradication efforts are providing a basis for other public health efforts - including the surveillance of diseases, improvement in vitamin A status, and response to disease outbreaks. This focus on the health of all people contributes to equity and national development.

Background on polio eradication efforts globally

In 1988, UNICEF joined forces with the World Health Organization, Rotary International and the US Centers for Disease Control and Prevention to put an end to polio. As a result of the Global Polio Eradication Initiative, the largest public health initiative of all time, millions of children world-wide have been protected from life-long paralysis. Since the initiative was first launched, the number of polio-endemic countries has been reduced from 125, down to just 4 in 2010 (Afghanistan, India, Nigeria and Pakistan). As well the number of children crippled by polio has been reduced from more than 350,000 down to just over 1600 cases in 2009, reinforcing the possibility of achieving the goal of complete eradication. Through national and sub-national immunization campaigns which target all children under the age of five, thousands of children across Eastern and Southern Africa have been saved from the devastating effects of polio.

Trend in routine DTP3 & masles WHO/UNICEF coverage estimates in ESAR (2007-2009) & number of unvaccinated children

 Country  DTP3 2007  DTP3 2008  DTP3 2009  Measles 2007  Measles 2008  Measles 2009 Unvaccinated DTP3 2009   Unvaccinated Measles 2009
 Angola  83  81  73  88  79  77  229258  195294
 Botswana  96 96  96 94 94  94  1775  2662 
 Burundi 99  92  92  88  84  91  26072  29332 
 Comoros 75  81  83  65  76  79  3120  3854 
 Eritrea 96 99 99  95  95  95  1278  6389 
 Ethiopia  73 81 79 65   74 75 552990 658321 
 Kenya  81 72  75  80  76  74  375475  390493 
 Losotho  84 83  83  85  85  85  7697  6791 
 Madagascar  84 77 78  81  70  64  154395  252646 
 Malawi  87 91  93  83  88  92  47022  53740 
 Mozambique  76 76  76 77 77 77 204960  196420 
 Namibia  86 83  83  69  73  76  11978  16910 
 Rwanda  97 97  97  94  92  92  10326  27537 
 Somalia  39 31 31   34  24  24  231058 254499
 South Africa  69 69  69  62  62  62  311045  381281 
 Swaziland  95 95  85 90 88 91 246377 147826 
 Tanzania  83 86 85  90  88  91  246377  147826 
 Uganda 64 64  64  68  68  68  470296  418041 
 Zambia  81 81  81  85  85  85  111530  88050 
 Zimbabwe  72 75  73 69 70 76 98518 87571
 Weighted average  76 77 77 76 78 76 3,096,949 3,219,437



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