The resurgence of polio last week in Congo-Brazzaville illustrates the long over-hang consequences of civil war and political instability. Pointe Noire, the epicenter of the current outbreak, is a port city largely isolated from the rest of the country, and the surrounding region has long been plagued by poverty and insecurity. The new polio cases are concentrated among those between fifteen and seventy years of age, rather than small children, as is more common in similar outbreaks. The strain of the disease in Pointe Noire appears to be especially virulent, and the mortality rate is high. As of November 9, there were 184 new cases, and 85 deaths.
International polio vaccination efforts likely missed the current victims when they were children because of insecurity and population movements in Congo-Brazzaville and in adjacent Angola and Congo-Kinshasa. When local conditions allowed vaccination to resume, the focus most likely was on small children, the usual protocol. Identifying all or most of those missed by the vaccination campaign is a major challenge, and inevitably, some are missed.
In contrast, one may recall the resurgence of polio Nigeria in 2003-2004, where it was the actual suspension of polio vaccination that led to the spread of the disease to other parts of the country and to other countries as far away as Indonesia . Popular political and Muslim religious opposition to the campaign resulted in the state governments suspending the campaign against a backdrop of deep suspicion of President Olusegun Obasanjo’s government in Abuja, which was closely associated with the polio eradication campaign. Only with difficulty did the Nigeria vaccination program resume, and pressure from international Islamic organizations played a crucial role. While polio remains in Nigeria, the WHO estimates that the number of new cases in only ten.
The outbreak of polio in Pointe Noire, like its earlier resurgence in northern Nigeria, highlights the importance of the WHO’s effort to eradicate polio from the face of the earth, as it has small pox. Otherwise, so long as there is political instability and internal conflict, there is the risk that polio will reassert itself.
(Photo: Afolabi Sotunde/courtesy Reuters)