Polio Program in SomaliaSomalia is one of the few countries remaining with a risk of poliovirus transmission. The polio program in Somalia was established as a way to eradicate the virus completely as part of the global immunization effort. However, with the arrival of SARS-CoV-2, the polio program in Somalia has been stifled. Somalia ranks 194 out of 195 on the Global Health Security Index. The international recommendation for healthcare workers is 25 per 100,000 people; however, Somalia only has two per 100,000 people. The country also has only 15 intensive care beds for a population of 15 million. It is considered to be among the least prepared countries in the world to detect and execute a quick response to COVID-19.

Effects of the Pandemic on the Polio Program in Somalia

Many of the workers that are part of the polio program in Somalia have suspended all door-to-door immunization due to the ongoing coronavirus pandemic. With travel kept to a minimum, polio samples cannot be flown abroad to external medical labs for testing. In addition to this, millions of polio vaccines will expire in a matter of months.

The global polio immunization program paused at the end of March 2020, leaving more than 20 million workers and medical practitioners without work. The World Health Organization (WHO) estimates that the number of unvaccinated children could reach 60 million by June in the Mediterranean region.

The Polio Program Fights COVID-19

Polio surveillance systems are developed disease surveillance systems. This network of disease surveillance has been able to track the poliovirus and deploy medical teams throughout the world. Now, the polio program in Somalia has shifted its efforts to combat the COVID-19 pandemic. The system’s infrastructure, its capacity and the experience of its medical staff make it prepared to deal with the novel coronavirus. As of July 2020, Somalia had approximately 3,000 confirmed cases of COVID-19 with 930 recovered cases and 90 deaths. The number of actual cases is likely significantly larger, but many cases go undetected due to a lack of testing.

Thousands of frontline workers for the polio program in Somalia started curbing the spread of the coronavirus. These workers form rapid response teams trained to detect COVID-19 cases as well as to educate and raise awareness about the ongoing pandemic in Somalia. WHO’s national staff and local community healthcare workers have joined theses polio response teams, utilizing their resources and skills to tackle the virus.

WHO Support

These teams have traveled to remote areas in Somalia, providing critical information regarding physical distancing, hand-washing, detection of symptoms and prevention. With WHO’s aid, the program has acquired testing kits and equipment to evaluate potential cases of the virus. The surveillance teams have adopted the same procedures that they used for the polio program in Somalia for COVID-19. After collecting potential COVID-19 samples from suspected cases, the rapid response teams transport the samples to external laboratories for testing. Outside humanitarian agencies use the same protocols and operations that they used for the poliovirus.

Furthermore, the response teams continue polio immunization simultaneously with the COVID-19 response. It is essential for the polio program to continue immunization, as Somalia experienced a polio outbreak earlier this year.

How Other Countries Have Adapted

Other countries in the same region have realized the practicality of the polio network. They have accordingly redeployed their own immunization programs to fight COVID-19. For example, South Sudan has converted approximately 80% of its polio workforce to track coronavirus cases in the country. It has trained polio contact tracers to evaluate people for symptoms of COVID-19. Mali has also been engaging its own polio program in response to the ongoing pandemic.

Even though polio and COVID-19 do not have much in common, the polio program is an important tool to fight the pandemic. The Bill and Melinda Gates Foundation, in partnership with the WHO, has been working to equip these polio networks to help countries deal with the pandemic. The suddenness of the pandemic has left no time for countries such as Somalia to prepare. As such, the global polio immunization campaign is a valuable resource for this unprecedented emergency.

Abbas Raza
Photo: Flickr

Africa Polio Resources
Africa is using its polio resources to find creative solutions to the new pandemic. COVID-19 halted employment for many Africans and placed strains on international polio laboratories. These laboratories are members of the Global Polio Laboratory Network. Therefore, health organizations are now using polio resources to tackle COVID-19 in African countries. Already facing many challenges, these groups must balance fighting COVID-19 with continued administration of polio vaccinations.

Polio Eradication in Africa

Vast amounts of global research aid polio eradication in Africa. It is appropriate to alter these successful strategies now to fight COVID-19. In fact, expectations determined that Nigeria would be officially void of the disease between March and June 2020. The World Health Organization (WHO) announced in July 2020 that Nigeria was the last African country where polio was endemic, but that polio is no longer in African countries.

WHO’s Method of COVID-19 Mitigation

WHO is fighting COVID-19 through 16 polio testing facilities across 15 countries. To do so, it reconfigured machines that it originally used to display polio symptoms with COVID-19 data. These cell phone devices have the contact information of outreach teams, making data tracking easier. Another example of Africa’s use of polio resources is an outreach center developed in Brazzaville (2017). The research center assists countries with data-keeping technology to fight COVID-19.

COVID-19 Eradication in Sudan and Somalia

The WHO Polio Eradication Program provides training across 14 states of The Republic of Sudan. This training allows citizens of all seven localities of The Republic of Sudan (Khartoum, Ombada, Omdurman, Karary, Bahri, Sharq Elnil and Jabal Awliya) to assist potential COVID-19 victims. Recipients of the training are front line essential workers trained in healthy behaviors, COVID surveillance and COVID data interpretation. The training sessions empowered over 300 rapid response individuals, all of whom tested satisfactorily while demonstrating their competency.

Current difficulties such as social distancing and the minimal availability of face masks and gasoline make it difficult to continue to serve patients who need polio vaccinations. The short supply of resources also makes it difficult to provide diagnoses to individuals potentially affected by COVID-19. With Africa using polio resources to control COVID-19, polio vaccinations themselves had to take a back seat. These programs will re-obtain regular importance when possible. Many children still need vaccinations regularly to maintain Africa’s ‘eradicated’ polio status or they could be susceptible to the disease.

WHO training in Somalia empowers workers and allows staff to educate the community. Polio teams train and educate Somalians on the techniques and importance of reporting suspected COVID-19 cases. Polio Eradication Program associates can then continue sending feces samples labs for testing. These same techniques used for polio eradication allowed teams to hit the ground running in April of 2020.

The Reason Africa Must Continue to Monitor Polio and COVID-19

While techniques for testing polio and COVID-19 are similar, the diseases are not. Africa, while recently declared free of polio, must continue to monitor both diseases and refocus its attention on polio following the pandemic. Polio has numerous dangers: it attacks children, is highly contagious and leaves individuals paralyzed, all with a high risk of death. Continued vaccinations are the only hope of keeping Africa polio-free.

Polio laboratories need to increase efforts against COVID-19 to regain a singular focus on polio vaccinations. Nigerian President Mohammadu Buhari increased polio funding in 2016. His efforts highlight how ending disease allows a country to continue leveraging those resources. The COVID-19 pandemic is a major obstacle to Africa’s safety from polio.

DeAndre’ Robinson
Photo: Flickr

Healthcare in TunisiaThe North African country of Tunisia is sandwiched by two relatively unstable nations, Algeria and Libya. However, Tunisia has had consistent development in human wellbeing for the past couple of decades, ranking among the best nations in Africa. In part, this success can be attributed to Tunisia’s relatively strong healthcare system. According to a World Health Organization report, Tunisia possesses a “national health strategic plan” as well as a relatively high life expectancy at 75 years. Healthcare in Tunisia is a promising sign that the country can adequately support its population and promote longer, healthier lives for its citizens. Here are six facts about healthcare in Tunisia.

6 Facts About Healthcare in Tunisia

  1. More than 90% of the population is covered by health insurance. While some citizens use private insurance, others are covered by programs in place to assist the most disadvantaged in society. However, Tunisia still lacks truly universal coverage. One of the top complaints about healthcare in Tunisia is gaps in payment for important medical procedures, which can burden families.
  2. Tunisia’s 2014 constitution granted healthcare as a human right. The government is still working to make this a reality and provide universal, effective healthcare in Tunisia. Specifically, the government is trying to improve the dilapidated health infrastructure in the south of the country. This manifested in a 9% increase in the healthcare budget in 2016, which went toward improving infrastructure in remote areas.
  3. Private healthcare in Tunisia is booming. In recent years, before the COVID-19 pandemic, the number of private clinics built in the country was expected to surge. Seventy-five new facilities are set to be completed by 2025, doubling the number of hospital beds in the country. These improvements should help make access to quality healthcare more readily accessible to the general population.
  4. Tunisia successfully combated many diseases in the past. Most importantly, Tunisia has been able to eradicate and control many deadly diseases that put a strain on its healthcare system. Malaria, polio and schistosomiasis are well under control. In addition, Tunisia’s healthcare system has worked to address HIV/AIDS.
  5. During the COVID-19 pandemic, Tunisia has done relatively well. Sitting at 1,327 confirmed cases and 50 deaths as of July 2020, the country is positioned to recover economically from the virus, which is devastating in other parts of the world. Though it is still early in the pandemic, it appears that the healthcare system in Tunisia was able to absorb the influx of cases in order to slow the death rate.
  6. Robust preventative measures enabled Tunisia’s positive response to COVID-19. Seeing the potential for a rise in cases early on, the government, as advised by healthcare experts, quickly went into a rigorous lockdown that lasted for months. This was especially difficult considering that tourism accounts for 10% of the country’s GDP. According to a WHO spokesman, a strong sense of community and respect for the lockdown measures eased the country’s caseload and death toll. Because the Tunisian population was willing to make sacrifices for the broader community, they are now in a comparatively better place than some other nations around the world.

Healthcare is a critical issue for any nation. While there is always room for improvement, Tunisia has succeeded in using its available resources to ensure medical coverage for its people.

Zak Schneider
Photo: Pixabay

Although there is a vaccine, Polio is still a global problem. Here are some facts on eradicating Polio in developing countries.
People often think of polio as a disease of the past; but for many in Pakistan, Afghanistan and Nigeria, it is still a very real threat. Poliomyelitis, more commonly known as Polio, is an infectious disease that can result in base level symptoms similar to the flu, or on the more extreme end, it can invade an individual’s spinal cord or brain causing paralysis. Paralysis is the symptom people most commonly associate with Polio because of how deadly it can be. As the disease progresses slowly, the individual eventually loses function across their body and requires outside assistance to do even the most basic task of breathing. Without medical assistance, the individual will asphyxiate. Here is some information about eradicating Polio in developing countries.

Eliminating Polio

Vaccination is the only way to eradicate Polio. Children’s bodies become prepared to fight the disease more effectively with vaccination. Almost all children or 99 out of 100 will have protection from Polio as long as they receive all recommended courses of the vaccination.

However, sanitation also plays a key role in preventing the spread of Polio in the interim. The virus lives in individuals’ throats and intestines, so open sewage systems can leave a community more vulnerable to the spreading virus. The virus can thrive in feces for weeks before dying, leaving plenty of opportunities for people to come into contact with the virus and spread it.

Eradicating Polio is highly dependent on herd immunization, so it is integral that mass vaccination initiatives go to all corners of a country. By immunizing everyone who can take the vaccine, the risk of the disease spreading and those unable to take the vaccine contracting it reduces.

The Reasons Polio Still Exists in Pakistan, Afghanistan and Nigeria

Though there have been major advancements in eradicating Polio in Pakistan, Afghanistan and Nigeria, they still remain vulnerable due to the fear that the vaccine may cause fainting spells and death in children, which are false claims. Additionally, open sewage systems in rural areas and the difficulty to dispense full courses of vaccination to individuals in rural areas play a role in the continued life of Polio.

There is also the issue of spreading. In Afghanistan and Pakistan, the majority of new cases of Polio are often in the tribal areas surrounding the shared border of the two countries. The unchecked border often has people traveling back and forth so they are hard to pin down to receive their full course of vaccinations. This also allows for the virus to spread faster and makes it more difficult to isolate the infected.

Nigeria is doing relatively well with the fight towards eradicating Polio. The country no longer has an active outbreak, but it is at high risk of having an outbreak. This is due to active initiatives within the country to assure widespread vaccination and hygiene education to prevent the spread of the virus.

Mutations

Another massive issue these countries and doctors are having with eradicating Polio is that the virus is mutating. In June 2017, there were 21 cases of vaccine-derived Polio in the world. This has been caused by remnants of the oral vaccine getting loose in the environment where it is regaining strength and infecting people. The oral vaccine is from a weak form of the Poliovirus that allows the recipient’s immune system to fight off the virus and become more adept at fighting the active virus if it ever enters their body.

Many also consider the mutated and strengthened strain of the vaccine-derived disease to be more deadly as it has a higher risk of causing paralysis in those infected.

Solutions

The organization, Global Polio Eradication Initiative, is a public-private partnership working in tandem with national governments and private partners including the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF) and the Bill & Melinda Gates Foundation. Together, they are attempting to roll out vaccines and education programs to aid in eradicating Polio internationally. The organization works with 200 countries and 20 million volunteers to ensure that everyone has the opportunity to live a life free of the pain Polio brings upon individuals and communities.

As of 2019, it has vaccinated over 2.5 billion children, and the number is only growing. This is an incredibly important program, as the alleviation of the threat of infection for every reduces the stress on government health programs. There is also a reduction in the personal and financial burden of contracting and surviving Polio from the shoulders of millions of families.

Through vigilant vaccination distribution and educational programs, the hope is that in the near future, people will be able to live in a world free from the crippling implications of the Poliovirus.

– Emma Hodge
Photo: Flickr

Nigeria Beat Polio
Like many countries in Africa, Nigeria has historically had to deal with serious diseases. One such disease that has been a prominent issue for the country is polio. Polio is an infectious disease that the poliovirus causes. The most common symptoms of polio are fevers, sore throats and nausea, among others. In more severe cases, polio can induce paralysis and meningitis, an infection that affects the spinal cord and brain. Recently, Nigeria beat polio by increasing vaccinations.

Polio Vaccines in Nigeria

The Nigerian government banned vaccinations for the poliovirus in 2003 amid fears they caused Muslim girls to become sterile and helped spread AIDS throughout the region. Around this time, reports stated an outbreak of polio cases throughout Nigeria, as well as many other parts of Africa. Afterward, United Nations officials convinced the then governor of Kano that the vaccinations were safe, although the virus continued to plague Nigeria.

In 2007, reports stated that many new cases of polio in Nigeria came as a result of a mutated vaccine. Normally the polio vaccine involves an injection with a more mild version of the poliovirus. Around this time, however, the vaccines appeared to have helped induce polio instead. This increased people’s concern over vaccinations and many did not perceive them to be a good idea, although it the United Nation’s World Health Organization (WHO) stressed the rarity of these mutations.

According to WHO, Nigeria accounted for more than half of all polio cases in 2012. However, WHO also reported that the country made great efforts since then to reduce the incidents of polio, including “increased community involvement and the establishment of Emergency Operations Centers at the national and state-level.” These efforts have allowed the Nigerian government to respond to outbreaks more efficiently and carry out vaccinations accordingly.

A Reduction in Polio Cases

According to WHO, Nigeria went two years from 2014 to 2016 without any cases of polio. WHO has attributed this to the Nigerian government’s efforts to combat the disease. However, this period quickly came to an end on August 2016, when reports indicated that polio paralyzed two children in the northern Borno state.

As of August 20, 2019, Nigeria achieved three years without any cases of polio. The liberation of the Borno State area in northeastern Nigeria from the Islamist military group, Boko Haram, may be a cause. This military group’s stated purpose was to forbid Muslim citizens in Nigeria from taking part in any activities associated with Western society. As a result of the liberation from Boko Haram, more children have been able to receive treatment for polio, including vaccinations.

Compared to the 600,000 children under the age of 5 who missed out on vaccinations in 2016, only 60,000 children under the age of 5 missed out on receiving vaccinations as of August 20, 2019. This is thanks to factors such as increased surveillance in various islands on Lake Chad, thus allowing them to see which ones people inhabit, thus allowing them to perform vaccinations on more people.

Nigeria Free of the Poliovirus

Nigeria is the last country in Africa to have had any records of the wild poliovirus, and WHO has announced that polio is no longer endemic on the African continent. In other words, thanks to the fact that vaccines have become more advanced and widespread, and the Nigerian government’s increased efforts to respond to these cases, many believe that not only has Nigeria beat polio, it is also virtually nonexistent in Africa as a whole.

While Nigeria beat polio and the virus’ presence in Africa may have faded, the disease has not completely disappeared. Several projects have formed to put an end to it once and for all, though. One such project is the Global Polio Eradication Initiative (GPEI). GPEI partners with organizations such as the World Health Organization and Rotary International. According to the GPEI website, it has helped ensure over 2.5 billion vaccinations for children all across the world in over 200 countries. This is a clear example of what the average person can do to help eliminate this disease.

– Adam Abuelheiga
Photo: Flickr

polio eradication in Nigeria
For the last three years, Nigeria has not had one case of polio. As the last country in Africa to still record the wild polio disease, this new health milestone of the eradication of polio in Nigeria has proven the success of public health campaigns for the entire continent of Africa.

The Decline of Polio

Back in 1988, polio paralyzed more than 350,000 children in over 125 countries around the world. Although the devastating disease infected children in almost every country, cases of wild polio decreased by 99 percent after 1988. While the wild polio disease exists in nature, several vaccine-derived outbreaks have occurred in six African countries. In 2012, the World Health Organization (WHO) reported that Nigeria held more than half of polio cases worldwide. Total immunization then became the primary goal for the eradication of polio in Nigeria to ensure that the population has protection from the vaccine-derived and wild virus. Persistent efforts of immunization have helped immunize over 45 million children under the age of 5 in Nigeria. An estimated 200,000 volunteers in Nigeria have aided in giving polio vaccines in the last five years.

Children and Polio

At the start of the polio epidemic in Nigeria, 600,000 children did not have the polio vaccine and an estimated 90 percent of polio cases were within northeast Nigeria. Due to this area encompassing largely scattered communities, satellite imaging has aided volunteers with finding unvaccinated children. Vaccinators will also frequently set up clinics within local markets to find all the unvaccinated children.

Dr. Pascal Mkanda, the leader of the eradication of polio in Nigeria for WHO, set out to eradicate the disease within three years by first vaccinating children under 5 years of age. The poliovirus remains highly infectious and mostly affects children. In the worst cases, polio causes irreversible paralysis. No cure for polio exists, but the eradication of the disease through immunization has prevented outbreaks. Estimates determine that the eradication of polio in Nigeria has saved 16 million children from paralysis.

Women and Vaccinations

Many Nigerian women are at the forefront of the battle against polio. UNICEF and the Bill & Melinda Gates Foundation hire mostly young Nigerian women as vaccinator volunteers because Islam is the most prominent religion in northern Nigeria, and it prohibits men that are not family members from entering a Muslim home. The women volunteers go door-to-door to educate families about the vaccine and receive clinical training to give vaccinations.

Today, more than 30 million Nigerian children have received the polio vaccine. The volunteers are also in a continuous battle with skeptical anti-vaccination parents and the militant group Boko Haram. Boko Haram intentionally spreads misinformation about the vaccine and violently targets volunteers in order to keep Islam pure in Northern Africa. Some Nigerian people still have doubts about the vaccine, but now only 1 percent of people refuse the vaccination.

Overall, the eradication of polio in Nigeria represents an achievement for global health. The commitment of global health organizations and neighboring communities to the eradication of polio proves that investing in foreign aid can have a worldwide benefit.

– Nia Coleman
Photo: Wikimedia Commons

Curing Polio in Pakistan and Afghanistan
In 1988, polio existed in more than 100 countries and infected close to 1,000 children daily. Due to advocacy efforts and the implementation of preventable vaccinations, cases of polio have significantly dropped at a rate of 99 percent. In 1988, about 350,000 children had polio while statistics indicated that in 2017, only 22 documented illnesses existed. However, children are still struggling as Pakistan and Afghanistan attempt to eliminate polio their countries.

Children are most vulnerable to contracting polio between birth and age five. One in 200 contagions result in irreparable paralysis, most commonly in the legs; five to 10 percent of those infected die from this disease due to the disabling of their breathing muscles.

Most children that are living with polio do not experience manifestations; however, polluted water and food can still spread the disease. Polio is preventable through several doses of vaccinations, but there is no treatment.

Modernized Vaccines to Prevent Polio

In 2013, all countries began to implement one dose of the new vaccines and terminate the use of the oral vaccines by 2018, which the Polio Eradication & Endgame Strategic Plan instructed.

In order to eliminate polio in Pakistan and Afghanistan, the Polio Eradication and Endgame Strategic Plan is terminating the administrations of oral vaccines which only protected against type 2 of the virus; instead, Afghanistan and Pakistan are implementing doses of the inactivated polio vaccine, which should be more effective in preventing the disease as it prevents all three types of polio. The modern vaccine can also enhance immunity and inhibit further epidemics of polio.

Efforts to Eliminate Polio in Pakistan and Afghanistan

In 2018, The Ministry of Public Health in Afghanistan partnered with UNICEF and The World Health Organization to initiate the country’s third nation-wide polio vaccination campaign. Nearly 9.9 million children below age five received the vaccination.

Regions such as Kandahar, Helmand, Uruzgan and Zabul contained nearly 1.2 million children who did not have access to the vaccine. However, this past program and future programs will ensure that these children can also receive the necessary dosages.

Vaccinated children also received Vitamin A capsules to strengthen their immunity and decrease diarrhea. This also strengthened their immune systems from respiratory infections. Immunity can increase their chances of survival by nearly 24 percent. Nearly 70,000 health workers visited every household to administer vaccinations. This was to ensure that other children received the preventable medication as well. Because polio is contagious, each family’s chances of surpassing the disease increases if every child receives a vaccination.

In Pakistan, the number of polio infections is at a low rate. Further, improved immunity has also begun to increase. While this country has made progress in battling polio, many children have not received the preventable vaccines in high-risk areas. Therefore, Pakistan has begun to implement various solutions such as customized vaccines. Additionally, the country has partnered with the Emergency Operations Centers to administer effective prevention techniques.

Polio is most common in Karachi as well as the federally administered tribal areas, the Quetta block and the Khyber-Peshawar corridor. While the disease is highly present in these areas, other areas nationwide are susceptible to contracting the virus due to travel and migration.

The Partnership Between Pakistan and Afghanistan

To eliminate polio in Pakistan and Afghanistan, the two nations plan on partnering to identify children who are vulnerable to the disease and provide vaccinations, while also administering health campaigns to promote advocacy about the prevention of polio. Environmental surveillance has discovered the presence of polio. This serves as evidence that children with weaker immune systems are present in these areas. Consequently, this enables the disease to grow and infect other children.

– Diana Dopheide

Photo: Flickr

vaccination rates in Papua New Guinea

Across the globe, access to adequate healthcare appears to be of paramount concern for both governmental and non-governmental organizations. Not only does providing health services to underserved and under-represented populations increase general wellbeing and happiness, it has also proven to be beneficial for the economy, per the U.S. Chamber of Commerce.

Pushing for Vaccinations

In February, the southeast Asian nation of Papua New Guinea declared 2019 as “The Year of Immunization,” in an effort to stave off preventable diseases and promote healthier lifestyles. This push to increase vaccination rates in Papua New Guinea was further intensified following several polio outbreaks across the country in Summer and late 2018 as well as in early 2019, and outbreaks of measles in 2014 and 2015 with 2,000 total confirmed cases and over 350 deaths. This recent resurgence in the near-eradicated virus can be attributed to sub-optimal living conditions and lack of wide-spread, generalized immunization.

Furthermore, the efforts to increase vaccination rates in Papua New Guinea would hopefully spur the economy, lifting more citizens out of poverty (as of 2002, 37 percent of New Guinea’s population lived below the global poverty line – approximately 2.5 million people), though this economic boost would act primarily as an added bonus to preventing polio, rubella and measles.

Widescale immunization quickly became a top priority for the government and National Department of Health of Papua New Guinea. While initially a daunting task, the southeast Asian nation partnered with the World Health Organization (WHO), UNICEF and other non-profit organizations, such as the Bill & Melinda Gates Foundation, in order to better coordinate these immunization campaigns.

According to UNICEF, one of the polio campaigns sought to immunize over three million children up to the age of 15-years-old. As of late July 2019, these campaigns have been deemed as successful by the government, significantly increasing vaccination rates in Papua New Guinea. Since February, Papua New Guinea’s National Department of Health, along with the WHO, and UNICEF have led eight successful immunization campaigns, vaccinating approximately 1.28 million children under the age of five for polio, in addition to just over one million children of the same age for rubella and measles.

Cooperation Among Organizations

The success of these campaigns can be traced to swift action and cooperation between the primarily players. The WHO estimates that over 12,000 workers (from vaccination specialists, mobilizers and surveillance officers) helped to orchestrate these movements across the country – movements, which according to The Papua New Guinea National Department of Health, have had a 95 percent success rate.

While these increased vaccination rates in Papua New Guinea are positive signs for the future of the country’s health promotion and disease prevention, it is important to note that Papua New Guinea was declared as polio free in 2000 and went 18 years without a confirmed case of polio. It is essential that Papua New Guinea continue these immunization campaigns in order to guarantee healthier lifestyles for the rest of 2019 and into the future.

– Colin Petersdorf
Photo: Flickr

Vaccine Hesitancy in Developing CountriesVaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, has been around since the invention of the vaccine. Recently, there has been an increase in vaccine hesitancy in developing countries due to safety concerns and long-term effects. With this skepticism, outbreaks of vaccine-preventable diseases that were once thought mostly eradicated such as measles, pertussis and diphtheria, have increased in frequency around the world.

This year, the World Health Organization named vaccine hesitancy one of the top 10 threats to global health. Vaccines remain the safest and most cost-effective ways of preventing diseases. Currently, vaccines save between two and three million lives a year.

Furthermore, if coverage improves, vaccines can save an additional 1.5 million lives per year. The reasons for vaccine hesitancy are complex, but a vaccine advisory group identified complacency, inconvenience in accessing vaccines and a lack of confidence as some of the root causes. With these factors identified, if now becomes a question of how to fight these causes of vaccine hesitancy in developing countries.

Complacency

Some health experts have theorized that vaccine skepticism stems from the fact that vaccines are so effective that parents no longer remember or fear vaccine-preventable diseases like measles and polio. Instead, they may focus their anxieties on the safety of vaccines, effects or the number and timing of injections.

Without a proper understanding of the devastating effects of these diseases, parents have less of a motivation to vaccinate. EU Health Commissioner Vytenis Andriukatis said at an international health conference, “We have become victims of our own success.”

Convenience

Vaccine hesitancy in developing countries is often bolstered by the need for medical infrastructure. Inadequacy and the inequities in health systems like poverty, the disparity in infant mortality and life expectancy and a need for trained providers damages community trust.

To combat this, many countries have implemented mandatory vaccinations in schools, with mixed results. In India, for example, during their measles and rubella vaccination campaign, parents objected to their children being vaccinated without their consent, stalling the campaign in court.

Rwanda, on the other hand, was successful in its HPV vaccination campaign by coupling it with an information campaign. The campaign targeted parents and explained the need for this vaccine.

Confidence

Much of the anti-vaxxer movement is built in misinformation. Vaccine hesitancy in developing countries often stems from rumors about vaccines. For instance, that the polio and HPV vaccines caused infertility and impotency. The movement stems from general concerns about the safety of vaccines.

Health workers, especially those operating in the communities, are the parents’ most trusted health advisors and act as the biggest influencer of vaccination decisions. Because of their position, they must be supported so that they may provide parents with credible information. The most effective campaigns to fight vaccine hesitancy in developing countries are the ones that tailor to the community. Healthcare workers in the community are vital for implementing these campaigns.

In Rwanda, for example, healthcare workers went door to door to explain the benefits of the HPV vaccine. They focused on the fact that the vaccination is meant to prevent cancer. The workers brought diagrams of the female reproductive system. They also dispelled rumors by explaining that cervical cancer is far more likely to cause infertility than vaccines. Because the campaigned was tailored to the community, it was met with a lot of success.

Overcoming Vaccine Hesitancy

While there is an increase in vaccine hesitancy in developing countries and around the world, immunization campaigns are experiencing successes. Transmission of wild poliovirus, for example, may stop in Afghanistan and Pakistan this year. Additionally, cervical cancer may be eliminated in 181 countries by the end of the century.

To keep this up, health officials have to be proactive in fighting vaccine hesitancy in developing countries by fighting complacency, making access to healthcare more convenient and building confidence by creating programs tailored to the community.

– Katharine Hanifen
Photo: Flickr

Polio in Somalia
After eradicating polio in 1997, Somalia has reported new cases since 2005 with a surge in outbreaks in 2018. The gradually increasing number of cases shows that the disease is far from gone and caused the World Health Organization (WHO) to call for immediate action in eliminating polio in Somalia in 2018.

Background

Somalia reported 228 cases of polio between 2005 and 2007. The country responded with an immunization campaign of four rounds of national immunization days conducted in 2008. Somalia maintained a polio-free status for six years following the campaign. And the country continues to require two national days of immunization per year following the end of the 2007 outbreak. Its National Child Health Day initiative has added a polio vaccination attempting to broaden the number reached. However, due to a number of challenges, National Child Health Day reaches less than one-half of eligible children.

Resurfacing of Disease

In 2013, polio in Somalia resurfaced with 194 cases. Polio outbreaks around the region were frequent in 2013, due to the influx of refugees fleeing Syria, a country which has had severe outbreaks since the start of the Syrian Civil War. Fourteen months after the first confirmed case, the outbreak was officially over. WHO commended the country for quickly containing the epidemic highlighting the importance of cooperation and commitment between government health officials and parents.

Polio rates in Somalia are highest in southern Somalia, which the WHO considers an inaccessible area. Only 3 percent of children in south Somalia have all three of their polio vaccinations, compared to the 17 percent of children that have all three doses in the northern region. The differing rates correlate with the national borders of Somalia and Somaliland. Northern Somalia declared independence in 1991 as the state of Somaliland, although no other nation recognizes it as independent. Somaliland has since flourished in comparison with democratic elections, working government institutions, a police force and its own currency. Many consider Somalia, by contrast, a failed state. It remains under the control of an Islamist armed group and fights instability and insecurity, causing it to remain in a constant humanitarian crisis. Due to the forces that govern, vaccination campaigns rarely occur, and many NGOs lack access to the region’s vaccination eligible children.

Fighting Back Against Outbreak

Following the 2013 outbreak, UNICEF funded the creation of Dhibcaha Nolosha or Drops for Life. Dhibcaha Nolosha is a weekly 15-minute radio segment attempting to combat the misinformation about polio and polio vaccinations. Of children vaccinated in 2019, less than half of their caretakers understood that children had to have multiple doses of vaccinations. The radio show has medical experts explain how polio transmits and how the vaccination works, including personal stories and space for listeners to ask questions about polio.

Somalia launched a nationwide three-day campaign in March 2019 to vaccinate 3.1 million children under the age of 5. The campaign, launched by the government and supported by the WHO and UNICEF, went door to door with 15,000 frontline polio health workers. The campaign sought to vaccinate all children under the age of 5 with at least the first round of the oral polio vaccine. The WHO plans to continue supporting the efforts with annual campaigns in Somalia along with monitoring any future outbreaks.

Polio in Somalia continues to be a problem with the most recent report in June 2019. Somalia currently has 15 confirmed and open cases but continues to promote vaccination campaigns, trying to regain polio-free status. However, with little cooperation with governing figures in the southern region, the WHO continues to monitor the situation closely.

– Carly Campbell
Photo: Wikimedia Commons