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E-Note
# 29: Polio Eradication Initiative in Africa Yeilds Results, but Polio
and Routine Immunization Programs Face Significant Challenges
African countries
made substantial progress during 1998 in implementing the World Health
Organization's (WHO's) Polio Eradication Initiative that aims to eradicate
polio and achieve 90 percent vaccination coverage with 3 doses of Oral
Polio Vaccine (OPV) by 2000. In 1998, 33 out of 36 countries conducted
two rounds of National Immunization Days (NIDs) and most reported vaccinating
over 80 percent of children under five years of age. The Bureau for Africa
of USAID and its Missions provided support for surveillance and operational
costs to 17 of the 36 countries.
The strategy
for global eradication of polio, developed in 1988 by WHO and other partner
agencies, is four-pronged:
- High levels
of routine immunization of children under one year of age with OPV to
reduce the incidence of polio and prevent reintroduction of the virus
in areas where it has been eradicated;
- National
Immunization Days (NIDs) to provide supplemental doses of OPV to all
children under age 5, in order to vaccinate children who have no immunity
or only partial immunity and to boost the immunity of others;
- Acute
Flaccid Paralysis (AFP) surveillance systems in all countries (including
where polio has been eradicated) to identify every case of AFP and exclude
the possibility of polio through laboratory testing;
- "Mopping
up" with door-to-door vaccination in areas where polio may still be
circulating to interrupt further transmission of the virus.
POLIO
AND EPI PROGRESS IN AFRICA
The countries
of WHO's Africa Region made significant progress toward both polio eradication
and expanded program on immunization (EPI) over the past year, according
to reports presented at the 6th meeting of the Task Force on Immunization
in Africa (TFI), held in December 1998, in Harare, Zimbabwe. Among the
achievements applauded at the meeting were:
- Development
of a three-year action plan for polio eradication;
- Acceleration
of AFP surveillance, including laboratory investigations in 33 of the
47 WHO/AFRO countries (compared to 19 in 1996);
- Highly
successful NIDs in nearly all countries in the region;
- An in-depth,
independent review of the Regional EPI, which identified opportunities
for improving both vaccination coverage and the quality of vaccination
services;
- Expansion
of the technical and financial resources available for EPI - for example,
funding has increased more than ten-fold over the past several years,
from US$7 million in 1995 to US$73 million in 1998 and US$199 million
(projected) for 1999;
- Preparation
of guidelines for the work of the African Region Inter-Agency Coordination
Committee (ARICC), which comprises the donor agencies, non-profits,
and other partners that provide funding for the TFI (including USAID
and the USAID-funded BASICS Project).
MEETING
THE CHALLENGES AHEAD
The TFI adopted
over 30 specific recommendations to address the significant challenges
ahead. Highlights of these recommendations include:
- Development
of a comprehensive policy and strategic plan for immunization and disease-control
programs in the region: This will provide WHO/AFRO an opportunity to
revisit current strategies in light of recent health sector reforms,
stagnation and decline of vaccination coverage rates in the region,
and the need for new management structures and administrative procedures
in the wake of the program's rapid expansion.
- Collaboration
among all EPI partners to prevent civil unrest and war from disrupting
EPI supplies and services: War in the Democratic Republic of Congo,
Liberia, and Sierra Leone is increasing the risk of disease within transient
populations, reducing the effectiveness of NIDs, and delaying AFP surveillance.
EPI partners must work together to address these obstacles.
- Improved
strategic planning to better integrate programs, to enhance quality,
and target priority needs: Even with recent increases in government
financing for EPI, there is insufficient funding to implement key activities.
For example, ARICC estimates that the shortfall in 1999 for carrying
out the three-year plan of action for polio eradication will be almost
40 percent ($40 million out of the $103.5 million required).
- Development
of clear national policies on injection safety and better planning,
management, and budgetary systems to improve injection technology: The
high prevalence of hepatitis B and HIV/AIDS in Africa makes the safety
of injections a high priority.
- Establishment
of centralized logistics teams and inclusion in national plans and budgets
of all costs associated with cold chain and logistics rehabilitation:
The current state of equipment and logistics impairs overall vaccine
quality, and this problem will worsen in the near term. For example,
more than half the existing cold chain equipment in the region is old,
obsolete, or environmentally unsound and will need to be replaced during
the next five years.
CONCLUSIONS
Polio Eradication
can be achieved in Africa by the end of year 2000, but requires:
- Implementation
of extra-rounds of supplemental vaccination particularly in West and
Central Africa , Angola and the Democratic Republic of the Congo;
- Commitment
of nationals and all partners at the regional and country level; > Availability
of sufficient financial and human resources on a timely basis.
Routine immunization
programs can benefit from the Polio Eradication Initiative only if the
planning done for NIDs and the development of surveillance for polio includes
a focus on strengthening the planning and improved surveillance for routine
immunization services.
To this end,
in FY 99, USAID/AFR intends to provide a small grant to WHO/AFRO and UNICEF
to enable them to work jointly together with MOH/Immunization staff in
four countries to try to address the challenges which may cause stagnating
routine immunization coverage. In addition, it is expected that improved
tools and strategies will be developed to plan and implement various disease
control strategies supported by other immunization partners, complimenting
and strengthening routine delivery of immunization services.
For more
information, contact:
AFR/SD, Mary Harvey
Senior Child Survival Advisor
Ph: (202) 712-5483
E-Mail: Maharvey@usaid.gov
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