UN calls for immediate ceasefire in Congo to allow for much-needed polio vaccinations, as epidemic grows

From The Guardian in the UK:

United Nations officials have called for an immediate ceasefire in the Democratic Republic of Congo (DRC) to allow vaccinations to reach millions of children who are threatened by a sudden epidemic of polio.

The aggressive return of the contagious paralysing virus comes just five years after it was declared eradicated in most of the world. It marks a major setback in the race to make polio only the third disease, after smallpox and the cattle virus rinderpest, to be eradicated.

In the wake of an outbreak earlier this year of so-called wild poliovirus, the first round of an unprecedented vaccination campaign aimed at 72 million children under five was launched in 15 African countries in November.

But vaccination teams have struggled to reach children in war zones, such as eastern DRC, where government forces, the Rwandan army and militias are fighting. "We are calling on all parties to the conflict to respect the vaccination days and cease fighting," said Pierrette Vu Thi, who represents Unicef, the United Nations children's fund, in the DRC. "All children have the same right to health."

According to the charitable organisation Rotary International, one of the main supporters of the African vaccination effort, up to 800 suspected cases of polio have been found in the past six months in 12 African countries. "As soon as we have one case of polio, we consider that we are dealing with an epidemic," said André Kasogo, a Unicef immunisation officer in the DRC. "Polio is highly contagious. One person can pass the virus to 200 others and each of those can infect 200 people."

The World Health Organisation puts the number of confirmed cases of polio in Africa this year at only 139, but spokesman Rod Curtis said: "Determining numbers is complex. Multiple factors, such as the Republic of Congo not having seen polio for 10 years, or adults dying before being able to provide stool samples, mean that a significant number of early cases in the outbreak did not provide diagnostic specimens."

Poliomyelitis, which is incurable and is spread through faeces, reached pandemic proportions in Europe and the United States in the early 20th century. President Franklin D Roosevelt was among the most famous of its victims. British pop star Ian Dury was another.

It appears via a fever which kills some victims and subsides of its own accord in others. Days or weeks later some survivors wake up paralysed, often in one leg and in the arm on the opposite side of the body.

But mass childhood vaccination campaigns begun in the 1960s made polio eradication one of the success stories of western public health systems and the WHO declared war on polio worldwide. By 2001, fewer than 500 cases were recorded in the world and in 2005 the WHO said polio remained endemic only in four countries: Nigeria, Pakistan, Afghanistan and India.

Hopes that it would soon be declared eradicated have, however, been dashed by the emergence of wild poliovirus in countries with weak public health systems that fail to carry out routine vaccination of babies and toddlers.

The vast DRC has not had a functioning national civil service or health service since independence in 1960. The majority of its doctors have not been paid a salary since they qualified, and they in effect privatise their services while handing out drugs given by international donors.

Kasogo worked for the health ministry for a decade before moving to Unicef. He said: "If polio has returned, it is firstly because of the failure of our health system. While I was at the ministry we managed to set up a line of credit for childhood vaccination but because of fears of corruption and inefficiency we never succeeded in getting the civil servants to disburse the money."

He also blamed the polio epidemic on the DRC's neighbour, Angola, which had been polio-free for several years until its own public health failures led to an outbreak in 2007 that was traced to India. "There have been recent, large-scale population movements from our neighbour Angola, which is infected," he said.

Relations between the DRC and Angola have recently soured due to a conflict over oil extraction. As a result of a series of tit-for-tat expulsions, thousands of people have crossed the border between the two countries. Had routine vaccinations taken place in the past few years in the DRC, the virus might not have crossed over.

But the lack of routine vaccination programmes is not limited to the DRC. Apart from endemic Nigeria, 11 other African countries – from Uganda in the east to Mali in the west – have recorded cases this year. The DRC, which has experienced 73 cases, is in the grip of its worst outbreak for 10 years. Its capital, Kinshasa, is threatened by a massive epidemic in neighbouring Congo-Brazzaville, where 169 people have died from more than 400 suspected cases. Unusually, most of the victims in the Congo-Brazzaville have been teenagers and adults, pointing to failings in routine childhood vaccinations over a number of years.