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Among polio-endemic countries in Africa, Ethiopia has probably made the most impressive strides toward implementing the World Health Organization (WHO) plan for the virus's eradication. The nation's government budgeted 40.35 million Birr (approximately US $5.8 million) for a vaccination and nutrition campaign in November and December of 1998 which involved some 90,000 health care workers at more than 30,000 vaccination posts.
The campaign, which took place at hospitals, health centers, local government offices, schools, churches, mosques and marketplaces across the east African country, involved vaccinating over nine million children against polio and distributing vitamin A capsules to 8.3 million children under the age of five and 300,000 lactating mothers. In addition, almost 350,000 children less than five years old in nine selected towns were vaccinated against measles, which the WHO has targeted for eradication after the completion of the polio campaign. The effort represents the kind of integrated healthcare program that many advocates of disease eradication have advocated.
As with other WHO polio vaccination efforts in less-developed countries, the Ethiopian campaign relied on National Immunization Days, in which vaccination of an entire population takes place on one or a few days, rather than trying to deliver vaccines throughout the year.
Hiwot Mengistu, an official from the Ethiopian health ministry announced on 8 April 1999 that the campaign, held on 6-8 November and 4-6 December 1998, was largely successful, with nearly 100 percent compliance registered in four of the country's states. In the Somali state, the effort reached less than 50 percent of the target population, a figure which will hopefully improve in future campaigns.
More serious problems face polio vaccination efforts in the Democratic Republic of Congo, formerly Zaire, where an ongoing civil war has kept vaccine supplies from being delivered to patients. The country experienced the largest modern outbreak of polio in 1995, when over 1,000 cases of paralytic poliomyelitis were recorded in the city of Kisangani, and war has complicated recent efforts to chase the disease from the central African country.
In 1997, Mobutu Sese Seko, the country's dictator for 32 years, was ousted by President Laurent Kabila and the country was renamed. The arrival of the Kabila government did not bring peace; in August of 1998, a rebel group took over the eastern portion of the country, separating it from the government-controlled west.
Working with UN negotiators, the WHO and UNICEF brought government and rebel leaders together to hammer out a plan for "days of tranquility" which would allow healthcare workers to vaccinate millions of children against polio in the war-torn country. Richard Franco, a spokesman for the WHO's Expanded Program on Immunization, was quoted by the Associated Press as saying "Our efforts have been hampered because of the prevailing war situation, but in spite of this situation, we cannot back down. We have to do our job to eradicate polio, and for this purpose the Democratic Republic of Congo is a critical country."
Under the negotiated deal, the WHO will implement a $13 million vaccination campaign during National Immunization Days in Congo during August, September, and October of 1999.
Bordering Congo to the Southwest, Angola is experiencing even more serious problems with a polio epidemic which is being exacerbated by civil war and the movement of millions of refugees within and out of the country. The epidemic, which was first reported on 23 March 1999, has now caused over 700 casualties, including more than 40 deaths, making it one of the largest polio epidemics in Africa since vaccination began there in the 1950s. On 8 April, the National Institute of Virology in South Africa confirmed that the epidemic is being caused by type 3 poliovirus.
While Angola has endured civil war for 25 years between the UNITA rebel movement and the government of President Jose Eduardo dos Santos, the fighting gained renewed intensity last December, displacing 1.5 million Angolans from their homes. The refugee crisis, along with the breakdown in healthcare from the fighting, have contributed to a precipitous drop in polio vaccination rates, from 90 percent nationwide in 1996 to less than 50 percent in some provinces 1998.
To combat the recent epidemic the WHO mounted a mass vaccination campaign on 17 and 18 April, inoculating 634,368 Angolan children in the capital of Luanda with the oral poliovirus vaccine. The organization plans three more rounds of vaccination in July, August, and September. Though a vaccine dose costs approximately 3 cents in US currency, the sheer scale of the necessary campaign and the logistical difficulties associated with delivering the vaccine to remote areas has strained WHO resources. On 5 May, the DeBeers corporation of South Africa, the world's largest diamond mining company, announced that it will provide additional funding for the polio eradication campaign in Angola, bringing hope that the War on Polio may be able to survive the country's internal conflict.
-Alan Dove, New York