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| A Milestone in Africa: No Polio Cases in a Year | |
| (35 minutes later) | |
| It has been one full year since polio was detected anywhere in Africa, a significant milestone in global health that has left health experts around the world quietly celebrating. | It has been one full year since polio was detected anywhere in Africa, a significant milestone in global health that has left health experts around the world quietly celebrating. |
| The goal had seemed tantalizingly close in recent years, but polio always managed to roar back, particularly in Nigeria. Then officials embraced a vigorous new approach to vaccination and surveillance in that country, hiring thousands of community “mobilizers” to track down the unvaccinated, opening operations centers nationwide to monitor progress and seeking out support from clerics and tribal chiefs. | The goal had seemed tantalizingly close in recent years, but polio always managed to roar back, particularly in Nigeria. Then officials embraced a vigorous new approach to vaccination and surveillance in that country, hiring thousands of community “mobilizers” to track down the unvaccinated, opening operations centers nationwide to monitor progress and seeking out support from clerics and tribal chiefs. |
| The result has been remarkable. | The result has been remarkable. |
| The last African case of polio was detected in Somalia on Aug. 11, 2014, the final sign of an outbreak with its roots in Nigeria — the one country where the virus had never been eradicated, even temporarily. But the last case in Nigeria was recorded on July 24, 2014. | The last African case of polio was detected in Somalia on Aug. 11, 2014, the final sign of an outbreak with its roots in Nigeria — the one country where the virus had never been eradicated, even temporarily. But the last case in Nigeria was recorded on July 24, 2014. |
| Africa has never gone so long without a case of polio. But in an indication of how nervous experts still are that the disease may resurge, even the announcement from the Global Polio Eradication Initiative was tentatively headlined “Is Africa Polio-Free?” | Africa has never gone so long without a case of polio. But in an indication of how nervous experts still are that the disease may resurge, even the announcement from the Global Polio Eradication Initiative was tentatively headlined “Is Africa Polio-Free?” |
| “This is a big success, but it’s still fragile,” said Dr. Hamid Jafari, the initiative’s World Health Organization director. “There’s always a worry that there could be an undetected case in a population you’re not reaching.” | “This is a big success, but it’s still fragile,” said Dr. Hamid Jafari, the initiative’s World Health Organization director. “There’s always a worry that there could be an undetected case in a population you’re not reaching.” |
| When the global polio eradication drive began in 1988, more than 350,000 children around the world were paralyzed by the virus each year. Last year, only 359 were. | When the global polio eradication drive began in 1988, more than 350,000 children around the world were paralyzed by the virus each year. Last year, only 359 were. |
| The case count has been below 2,000 annually since 2001, and eradication efforts now cost about $1 billion a year. But to the frustration of epidemiologists, the virus is a master of the cross-border jailbreak. Thirty-four cases have been found this year, all in Pakistan or Afghanistan, the last places in which the virus is known to persist. | The case count has been below 2,000 annually since 2001, and eradication efforts now cost about $1 billion a year. But to the frustration of epidemiologists, the virus is a master of the cross-border jailbreak. Thirty-four cases have been found this year, all in Pakistan or Afghanistan, the last places in which the virus is known to persist. |
| Many scientists now say a worldwide victory over polio is in sight. | Many scientists now say a worldwide victory over polio is in sight. |
| “This puts a lot of pressure on Pakistan to do better,” said Dr. Elias Durry, who leads the W.H.O.’s effort in that country and has fought polio in six others, including Somalia and Nigeria. | “This puts a lot of pressure on Pakistan to do better,” said Dr. Elias Durry, who leads the W.H.O.’s effort in that country and has fought polio in six others, including Somalia and Nigeria. |
| Usually, Africa is where diseases make their last stand. The last case of smallpox was found in Somalia in 1977, and the last case of rinderpest, a centuries-old cattle disease that may have killed millions of humans by causing famine, was recorded in Kenya in 2001. | Usually, Africa is where diseases make their last stand. The last case of smallpox was found in Somalia in 1977, and the last case of rinderpest, a centuries-old cattle disease that may have killed millions of humans by causing famine, was recorded in Kenya in 2001. |
| Even assuming there are no more cases, Africa will not be officially declared polio-free for two more years. The W.H.O. requires three case-free years because surveillance is difficult in a continent of isolated villages and nomadic herders. | Even assuming there are no more cases, Africa will not be officially declared polio-free for two more years. The W.H.O. requires three case-free years because surveillance is difficult in a continent of isolated villages and nomadic herders. |
| Since several other diseases can cause paralysis, stool samples from each suspect case must be analyzed to definitively exclude polio as the cause. | Since several other diseases can cause paralysis, stool samples from each suspect case must be analyzed to definitively exclude polio as the cause. |
| The Nigerian government was galvanized into action after a new monitoring board began singling out failures in its vaccination program in 2011 and after the W.H.O. declared polio a world health emergency last year. | The Nigerian government was galvanized into action after a new monitoring board began singling out failures in its vaccination program in 2011 and after the W.H.O. declared polio a world health emergency last year. |
| Nigeria marked its year without polio on July 25 with a modest tree-planting ceremony at which the new president, Muhammadu Buhari, was photographed putting vaccine drops into the mouth of his infant granddaughter. | Nigeria marked its year without polio on July 25 with a modest tree-planting ceremony at which the new president, Muhammadu Buhari, was photographed putting vaccine drops into the mouth of his infant granddaughter. |
| It was subdued because the campaign “did not want to send out the wrong message to political officeholders and donors that polio has been eradicated,” said Dr. Faisal Shuaib, a Health Ministry official who helped lead both the country’s polio eradication efforts and last year’s Ebola response. | It was subdued because the campaign “did not want to send out the wrong message to political officeholders and donors that polio has been eradicated,” said Dr. Faisal Shuaib, a Health Ministry official who helped lead both the country’s polio eradication efforts and last year’s Ebola response. |
| Vaccination and surveillance efforts need to continue, he and other experts emphasized. | Vaccination and surveillance efforts need to continue, he and other experts emphasized. |
| Reaching the milestone is a testament to the persistence, deep pockets and adaptability of the eradication initiative, which is led by the W.H.O., the Centers for Disease Control and Prevention, the United Nations Fund for Children, Rotary International, the Bill and Melinda Gates Foundation and the United Nations Foundation. | Reaching the milestone is a testament to the persistence, deep pockets and adaptability of the eradication initiative, which is led by the W.H.O., the Centers for Disease Control and Prevention, the United Nations Fund for Children, Rotary International, the Bill and Melinda Gates Foundation and the United Nations Foundation. |
| Northern Nigeria, homeland of the predominantly Muslim Hausa ethic group, became a polio hot spot in 2003 when waves of rumors began spreading about the vaccine: that it sterilized Muslim girls, that it contained pork products and that it contained the virus that causes AIDS. | Northern Nigeria, homeland of the predominantly Muslim Hausa ethic group, became a polio hot spot in 2003 when waves of rumors began spreading about the vaccine: that it sterilized Muslim girls, that it contained pork products and that it contained the virus that causes AIDS. |
| The governor of Kano, a northwestern state, stopped vaccinations for a year, and a local polio strain spread, first to 10 other African countries and then, through pilgrims, to Mecca in Saudi Arabia, and to Yemen and Indonesia. | The governor of Kano, a northwestern state, stopped vaccinations for a year, and a local polio strain spread, first to 10 other African countries and then, through pilgrims, to Mecca in Saudi Arabia, and to Yemen and Indonesia. |
| Since then, donors have poured billions of dollars into the eradication campaign, which pioneered many new tactics. W.H.O. scientists provided their Nigerian counterparts with evidence that the vaccine was safe, for instance, and imported more of it from Indonesia, the only Muslim country with a W.H.O.-approved vaccine factory. | Since then, donors have poured billions of dollars into the eradication campaign, which pioneered many new tactics. W.H.O. scientists provided their Nigerian counterparts with evidence that the vaccine was safe, for instance, and imported more of it from Indonesia, the only Muslim country with a W.H.O.-approved vaccine factory. |
| Islamic scholars were flown in from as far away as Saudi Arabia to endorse vaccination as halal — religiously acceptable. Bill Gates twice visited the Sultan of Sokoto, leader of Nigeria’s Muslims, asking for his support. Experts from India, which saw its last case of polio in 2011, traveled to Nigeria to share what they had learned. | Islamic scholars were flown in from as far away as Saudi Arabia to endorse vaccination as halal — religiously acceptable. Bill Gates twice visited the Sultan of Sokoto, leader of Nigeria’s Muslims, asking for his support. Experts from India, which saw its last case of polio in 2011, traveled to Nigeria to share what they had learned. |
| Unicef recruited and trained 16,000 “community mobilizers” to fight rumors by talking to their neighbors. Some were themselves polio victims, who displayed their withered limbs as a warning. | Unicef recruited and trained 16,000 “community mobilizers” to fight rumors by talking to their neighbors. Some were themselves polio victims, who displayed their withered limbs as a warning. |
| Because petty corruption was a major hindrance, seven operations centers were set up around Nigeria where each day’s vaccination progress was publicly tracked through cellphone reports. (The main one, in Abuja, became the headquarters of Nigeria’s successful fight against Ebola last year.) | Because petty corruption was a major hindrance, seven operations centers were set up around Nigeria where each day’s vaccination progress was publicly tracked through cellphone reports. (The main one, in Abuja, became the headquarters of Nigeria’s successful fight against Ebola last year.) |
| Surveying teams made detailed maps of villages, squatter camps and other hard-to-reach areas. Vaccination team leaders were handed cellphones that tracked their movements to prove that they had covered their assigned beats. More mothers were hired because they were better at persuading nervous young mothers to vaccinate and they showed up for work more regularly. | |
| There were further setbacks five years ago after Boko Haram extremists began their rampage. | There were further setbacks five years ago after Boko Haram extremists began their rampage. |
| In early 2013, they were blamed for the killing of nine vaccinators in one day, although such violence never became as common as in Pakistan. Boko Haram is centered in the northeast of Nigeria, while vaccine resistance began in the northwest. | In early 2013, they were blamed for the killing of nine vaccinators in one day, although such violence never became as common as in Pakistan. Boko Haram is centered in the northeast of Nigeria, while vaccine resistance began in the northwest. |
| Nonetheless, in response, “hit-and-run teams” were formed. On days considered safe, vaccinators would move quickly through marketplaces, taxi ranks and other gathering areas. | Nonetheless, in response, “hit-and-run teams” were formed. On days considered safe, vaccinators would move quickly through marketplaces, taxi ranks and other gathering areas. |
| Because of Boko Haram, more than one million people ended up in displaced persons camps, so vaccination drives moved there. | Because of Boko Haram, more than one million people ended up in displaced persons camps, so vaccination drives moved there. |
| To fight the common complaint that Westerners cared only about polio while rural Nigerians died of other ills, the campaign set up temporary “health camps” with many other medical enticements, including measles shots, deworming drugs, diarrhea treatment, blood pressure checks, ibuprofen, packets of Plumpy’Nut nutritional supplements for malnourished children, and packets of soap, tampons and other feminine hygiene items. | |
| Experts do not agree on which tactics worked best, but they are relieved that they have. | |
| Dr. Oyewale Tomori, president of the Nigerian Academy of Science, gave a speech in the mid-1990s expressing his fears that Nigeria would be the last country on earth with polio. | Dr. Oyewale Tomori, president of the Nigerian Academy of Science, gave a speech in the mid-1990s expressing his fears that Nigeria would be the last country on earth with polio. |
| “There was no hope then,” he said this week. “We were really messing up.” | “There was no hope then,” he said this week. “We were really messing up.” |
| The tide turned in the last few years, he said, “when we got sensible” and began slowly winning over traditional leaders — the emirs, tribal kings and local chiefs. | The tide turned in the last few years, he said, “when we got sensible” and began slowly winning over traditional leaders — the emirs, tribal kings and local chiefs. |
| “If the government calls a meeting, people ignore it,” he said. “But they listen to the Muslim leaders who address them every Friday.” | “If the government calls a meeting, people ignore it,” he said. “But they listen to the Muslim leaders who address them every Friday.” |