Sierra Leone makes inroads over Polio but challenges remain

By Kemo Cham

Official figures are yet to come out but health authorities are hopeful that the latest mass polio immunisation campaign in Sierra Leone will break new grounds in terms of coverage.

The exercise which lasted from 24 to 27 March is this year’s second mass vaccination against the virus that causes poliomyelitis [Polio], a debilitating disease that leads to paralysis and deaths.

Children from zero to 59 months were administered orally with the vaccine by volunteers who moved door to door nationwide. A total of 1.5m children were targeted.

Polio mostly affects children. The virus spreads through contacts from person to person, and is contracted mainly via faecal route or orally. In less common ways it is transmitted through food and water. The virus can invade an infected person’s brain and spinal cord, in which case it causes paralysis within hours.

According to WHO, 1 in 200 Polio infections leads to irreversible paralysis, and among those paralysed, 5 percent to 10 percent die when their breathing muscles become disabled. Symptoms include fever, headache, vomiting, and pain in the limbs.

Once a person is infected with Polio, it is not curable. Therefore, the best way out is prevention through vaccination.

When a child is infected with the virus, it enters the body through the mouth and multiplies in the intestine. It is then shed into the environment through their faeces where it can spread rapidly, especially in situations of poor hygiene and sanitation.

About 90 percent of infected people show no symptoms or very mild symptoms and this makes it even easier for the virus to spread. But if enough people in a community are immunised, the virus will be
deprived of vulnerable hosts and it will die out. High levels of vaccination coverage must therefore be maintained to ensure this. And the vaccine, given multiple times, can protect a child for life.

Global efforts

The vaccine is available via routine vaccination. In addition, every year the Ministry of Health and its partners conduct several rounds of mass vaccination, in line with the global Polio Eradication and Endgame Strategic Plan 2013-2018.

There exist two main category of Polio virus – Wild Polio Virus (WPV) and Vaccine-derived polioviruses. The latter is contracted from Oral Polio Vaccines, which rarely happens. The WPV, which is the most common, is reclassified into types 1, 2 and 3.

WPV type 2 was declared eradicated in 1999. Type 3 hasn’t been detected since November 2012, with WHO concluding that the world may only have been dealing with type 1.

Nonetheless, the Bivalent oral polio vaccine, which protects against both types 1 and 3, is recommended for use.

Global efforts to eradicate polio have been missed twice in the past - 2005, and 2010. Nonetheless, huge progress has been made in terms of the reduction of cases by over 99 percent since 1988, from an estimated 350, 000 cases to 74 reported cases in 2015.

The WHO regions of the Americas, Western Pacific, Europe, and South-East Asia have all been declared free of polio. This means 80 percent of the world’s population now lives in certified polio-free regions.

Nigeria, Afganistan, and Pakistan are the three countries where Polio remains persistent. A total of 36 cases were recorded in 2016 between these three countries. In Nigeria, last month alone, three cases were recorded.

These countries, dubbed the ‘Wild Polio Reservoir’, have one thing in common – instability, fueled by religious and cultural factors.

Experts say because of its highly infectious nature, as long as a single child remains infected with the virus anywhere in the world, children in all countries are at risk of contracting it. And WHO predicts that failure to stop polio in these last remaining areas could result in as many as 200, 000 new cases every year, within 10 years, all over the world.

The Nigerian situation has held back the chance of Africa being declared Polio free. In the meantime, the rest of the continent has the task of ensuring no new cases are recorded, and that means high levels of consistent vaccination.

But even in Sierra Leone cultural and religious factors are a concern.

Stumbling block

The Western Area District Health Management Team (DHMT) had a coverage target of 95 percent, same as national target, ahead of this vaccination exercise. Thomas K. Harding, District Social Mobilization coordinator, said figures obtained administratively showed an impressive performance. But he noted that figures from independent monitors, headed by WHO, will serve as official.

Harding told Kombra Media Network (KMN) that feedback from this and previous exercises indicate persistent resistance from the Lebanese and Fullah communities posing threat to the national anti-Polio efforts.

“Over the years these are the two people who have actually been the stumbling block to our interventions,” he said, noting that refusal doesn’t only happen at household level, but also at institutional level.

In order to avoid any chance of a child missing out, the health ministry usually deploys teams to schools and other institutions dealing with children. But school authorities, under instruction from distrustful parents, deny access to the volunteers.

Harding says political intervention might be needed to address this culture of refusal.

A spokesman for the Lebanese community denied knowledge of the campaign. Joseph Kudame, Public Relations Officer of the body that represents the community in the country, told KMN they were never involved and therefore were never aware of the campaign. He however said they would be open to discuss with the authorities.

Social mobilization

Another obstacle to the mass immunization campaign is that many settlements in the Western Area are located in hard-to-reach areas, so that volunteers are reluctant to explore them.

New England Ville, a mountainous settlement in the west end of Freetown, is a perfect example of this. The largely deprived settlement shares borders with another community with similar difficult geographical terrain – Dwarzak.

Melvin Tejan Mansaray, journalist and community mobiliser in New England, says many of the residents reported not seeing any volunteers during the last exercise, and he blamed that on the apparent lack of involvement of community stakeholders.

Tejan’s group, the New England Ville Community Development Organisation, uses town criers to pass on information to people in areas only those who know the community can reach. They were very useful during the Ebola epidemic. He says they could have been useful to getting more people in their community immunized.

With support from organizations like Unicef, a few local organizations have helped a great deal in the social mobilization effort. One such group is Focus 1000, which operates as an umbrella body of several grassroots national organizations, from market women to religious leaders to traditional healers, and even journalists.

During this campaign, representatives of these groups were deployed on the ground to help in mobilisation and monitoring of the process.

Sheikh Hafiz Sesay, National Chairman of the Traditional Healers Association of Sierra Leone, was deployed in the Kalaba Town area in the east end of Freetown. He observed that sensitisation wasn’t sufficient as people didn’t appear to know about it exercise.

However, through the Focus 1000 coalition, there has been a lot of improvement on social mobilization, notably in the area of refusal on the basis of cultural and religious grounds.

The Islamic Action Group (ISLAG) has been notably instrumental in countering negative views from within the mainly Muslim Fullah ethnic group. ISLAG, alongside the Christian Action Group (CRISTAG), make up the influential religious arm of the Focus 1000 family. Imams and Pastors use their pulpits in the mobilization efforts.

Sheikh Alhassan Kargbo, a senior member of ISLAG, said with their group being headed by an influential Fullah scholar, Dr Ahmad Ramadan Jalloh, they have been able to change a lot of the “wrong perceptions” among skeptics, using verses from the vary Quran they use to justify their refusal.

“Islam doesn’t allow a Muslim to speculate about things we have no knowledge about because they result to sin,” he says.

[First published on www.politicosl.com]