DAKAR, 23 March 2012 (IRIN) - Health volunteers, aid agency and health authority staff are trying to immunize 111.1 million children under five across 20 countries in West and Central Africa against polio. The four-day campaign started today, but instability in some of the target countries could hamper the effort.
 
Parts of Nigeria are highly unstable due to ongoing attacks by Boko Haram; a rebellion is currently under way in northern Mali, while security in the capital Bamako is also precarious with a military junta having ousted the president.

Over half of the children targeted - some 57.7 million, are in Nigeria, which is West Africa's only polio-endemic country.
 
Meanwhile parts of Niger (for instance Tillabéri in the northwest) are difficult to access, as are parts of eastern Chad, with some aid agencies working only with armed escorts.
 
"Access to children [in some of these places] can be a serious problem," said UN Children's Fund (UNICEF) regional health specialist Halima Dao.

"Vaccinators' safety can be compromised, or insecurity means the whole population of a village may flee at a moment's notice, or there may be far more people than we expected in an area, due to displacement," she told IRIN.

The conflict in northern Mali has, for instance, led to about 195,000 people being displaced either within the country or when they fled to Algeria, Mauritania, Niger, Burkina Faso and Senegal, according to the UN Refugee Agency (UNHCR), but these numbers are constantly changing as people return or move from camps to host villages, meaning reaching them could be complicated.
 
Dao admits some children in the Tombouctou  and Kidal regions of northern Mali may not be reached, though they are discussing with NGOs working there, including Médecins Sans Frontières and the Malian Red Cross, to see how to reach as many as they can. "We have to work with authorities and NGOs who are used to accessing these insecure areas," she said
For a polio immunization campaign to be effective, 100 percent of the children must be reached, says the World Health Organization (WHO), while the long-term fight against polio will only work if routine immunizations are consistently kept up, for at least 90 percent of children under five, for several years running.
 
Last year, election-related in violence in Côte d'Ivoire hampered efforts to quash a polio outbreak affecting 36 children, according to aid agencies.

Thus far, only Ghana, Cape Verde, Burkina Faso, Gambia and Togo have achieved the required 90 percent coverage, according to UNICEF.
 
Children in the hardest-to-reach areas are often the most vulnerable, said Dao, as they do not have access to regular health services. Agencies will try to give Vitamin A and de-worming medicine to these children where possible.

Weak health systems
 
Human error and weak health systems also play an important role in sub-optimal immunization reach: In Chad, for instance, where the health system is broken, just 60 percent of children have been covered, according to UNICEF.

The campaign involves hundreds of thousands of health workers, though it will not lead to eradication in one fell swoop, said Dao. "We hope the exercise will bring us closer to reaching our goal of interrupting wild polio virus transmission in our region in 2012," said Luis Sambo, West Africa director of WHO in a 22 March communiqué.

Despite a resurgence of the virus in West Africa, the global fight against polio has made progress: since 1988, when the Global Polio Eradication Initiative was launched, polio has reduced by over 99 percent. At the time some, 350,000 children were paralysed by polio each year but in 2011 the reported caseload was 650, according to UNICEF.
 
An intense effort to stamp out polio in India led to no new cases being reported in 2011. India alongside Pakistan, Afghanistan and Nigeria is one of the world's four polio-endemic countries. "If India can do it, then so can these African countries," said Dao. "We've reached 99 percent of the world - we need to reach that final 1 percent; the whole programme is at risk," she said.
 
Source:  Integrated Regional Information Networks (http://www.irinnews.org )