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At a glance: Indonesia

Public information and immunization go hand-in hand in massive Indonesia polio campaign

© UNICEF Indonesia/2005/ Hajaj
The massive immunization drive in Indonesia seeks to immunize every child under five – 24 million children – against polio.

By Claire Hajaj

JAKARTA, 30 August 2005 – A group of Indonesian mothers wearing brilliantly-coloured headscarves are gathered in the small meeting room of the local ‘Puskesmas’ (community health centre), where they come to learn about nutrition, immunization and the importance of exclusive breastfeeding. The children are outside, playing in the warm afternoon – unaware that just a few miles away, polio has struck eight of their peers and paralyzed them forever.

Today Indonesia is embarking on its largest-ever health campaign to counter a dangerous polio epidemic spreading across the country. Every child under five – 24 million children in total – is to be immunized with oral polio vaccine. Immunization is the only defence against this virus, which can cause paralysis within hours and has so far infected 225 children in the country.

But some of the women in Curug district, near the heart of the epidemic, have questions that need answering.

“Give us the facts!” cries Ibu Ina, a 27-year-old mother of two small children. She says her community has heard frightening stories, suggesting that the vaccine made children sick during a smaller immunization drive in May. “I immunized my children during the last campaigns, but many of my neighbours did not,” she tells us. “They are more afraid of the vaccine than they are of polio.”

UNICEF’s Ibu Nani, who works with the Indonesian community in the area, reassures her. “Didn’t you get the same vaccine when you were a child?” she asks. “This is why you are still healthy. The polio drops are safe and good for all our children.”

© UNICEF Indonesia/2005/ Hajaj
A group of mothers in Curug district learns about polio vaccine. Public information is an essential component of the immunization campaign; misconceptions about vaccine safety have contributed to the resurgence of polio.

Building trust

This meeting is one of many going on around the country – part of a mass communication effort supported by UNICEF, to clear up misconceptions about the polio vaccine during these anxious times. Since the global campaign to eradicate polio began in 1988, the vaccine has saved 5 million children from paralysis. It is essential protection for Indonesia’s children during the current epidemic. UNICEF is supplying 30 per cent of the vaccine for the coming mass campaign.

But with only days to go, fears like Ina’s threaten to cripple Indonesia’s efforts to stamp out polio. UNICEF staff say these fears are closely linked to a decline in the availability and quality of primary health care.

According to Dr. David Hipgrave, UNICEF Indonesia’s Chief of Health and Nutrition, the decentralization of national health services has left a large number of local health centres under-funded and under-staffed. Basic health awareness has suffered as a result.

“When families are routinely deprived of basic healthcare they can easily lose confidence in the health sector and in services like immunization,” Dr. Hipgrave says. “In situations like these, a child’s health depends as much on information and outreach as on doctors.”

Routine immunization rates have been falling in Indonesia for the last few years. With the rainy season just around the corner, UNICEF is concerned that the current polio epidemic might expand dramatically unless an immunity barrier can be built.

A nation and region at risk

Immunizing every Indonesian child under five against polio is an enormous challenge in this vast archipelago nation of 6,000 inhabited islands. Over 750,000 vaccinators will be working at 250,000 immunization posts, with more than 500 mobile teams at airports, harbours, bus and train stations. Determination to drive polio out of the country once more is high.

Polio was re-introduced into Indonesia as a result of an epidemic originating in northern Nigeria. The virus was then transmitted across Africa to Asia. The Nigerian epidemic, too, was sparked by groundless rumours which hampered polio immunization, resulting in susceptibility to the disease.

Health officials are hoping for a high turnout for this campaign. Otherwise, polio could spread through the densely populated Asia-Pacific area, which has been polio-free since 2000. Dr. Hipgrave says that large pockets of unimmunized children make this region highly vulnerable to re-infection. The stakes are very high.

“A regional polio outbreak could paralyze thousands of children and give a devastating blow to the global eradication initiative,” he said. “We just cannot let it happen.”

Ibu Nani is determined that polio will be beaten here. After two hours of questions from the local women at this particular health centre, she heads off to another district, to attend another meeting and try to resolve the anxieties of another group of mothers. Before she leaves, she asks Ibu Ina, “Do you understand now? Will you come to the Immunization Post?”

“Yes, it’s clear now,” says the young woman, and her neighbours agree, their smiles flashing as bright as their scarves.



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