Ethiopian Campaign Raises Hope of Eradicating Polio Worldwide

As children gathered for polio vaccinations beneath cough-drop fragrant eucalyptus trees, a grim drama was underway at a nearby clinic.

A 17-year-old girl, her skin burnished by sweat, struggled to strengthen legs withered by polio. Mahuba Shifa pulled herself along the clinic’s parallel bars, dragging heavily braced, child-size legs.

“Had I been vaccinated, I would not be crippled,” said Shifa, who was stricken before she learned to walk. “I am very happy that the children are being vaccinated because they won’t end up like me.”

Her cousins were among 8.5 million small children across mountainous Ethiopia who swallowed drops of oral polio vaccine as part of a crash campaign to bring down the country’s incidence of polio.

After years of neglect that left this impoverished country with one of the world’s highest rates of polio, Ethiopian officials accepted a new approach to eradication that has worked in 105 other countries.

Over five days in November, 75,000 health workers and volunteers traveled by pickup truck, bicycle or foot to 25,000 posts in almost every village and urban neighborhood to vaccinate every child under age 5. The operation was repeated over three days in mid-December because several doses are needed for full protection.

The $4.6-million effort was financed by the U.S. Centers for Disease Control and Prevention, the World Health Organization, the U.S. Agency for International Development, the U.N. Children’s Fund and Rotary International.

It is another important step toward a polio-free world by 2000, a goal advanced in 1981 by Rotary, the Chicago-based service club for business and professional people, and adopted by the 166-nation World Health Assembly a decade ago.

“If progress continues at the present pace, wild polio viruses could be eradicated from the world by the year 2000,” said Dr. Harry Hull, the Geneva-based chief of WHO’s polio program.

There is a precedent. After a 12-year eradication program, the last case of smallpox was recorded in Somalia in 1977--23-year-old Ali Maow Maalin developed the disease and lived. Two years later, after intense verification, the world was declared free of the disease.

Success in beating polio would help Ethiopians overcome other chronic health problems, including deadly outbreaks of measles, pneumonia, diarrhea, malaria and tuberculosis, experts say.

WHO estimates that once polio is eradicated and immunization halted, the global savings in immunization, treatment and rehabilitation costs will amount to more than $1.5 billion a year.

In the last decade, more than 1 billion children have been immunized against polio. The number of cases has been slashed by 90%--down from about 350,000 cases to 35,000 to 40,000 today. An estimated 2 million to 3 million children who would have been disabled by polio are now able to run, walk and play normally.

But for Shifa--in Butajira, 85 miles south of Ethiopia’s capital, Addis Ababa--and up to 20 million people worldwide living with polio paralysis, the eradication program has come too late.

Shifa doesn’t remember walking before polio struck.

Her family, typical of many Ethiopians, believed her illness was a punishment from God. Ashamed, they kept their daughter hidden inside their mud-walled hut.

Because Shifa was confined to a reed mat, crawling just occasionally, her leg and buttock muscles atrophied. Finally, just months ago, she was brought the few miles to Acacia House to get the help she needs.

Her body is well sculpted from the waist up and topped by a brilliant smile with a Lauren Hutton gap between her front teeth.

Below the waist, her spine is twisted. Her torso juts perpendicular to the linoleum floor. But she has been fitted with braces, and for the first time she says her legs are not entirely useless to her.

Shifa’s case influenced people in her village like Zemzen Ferja, who brought her 2-year-old twin daughters to be vaccinated. “I don’t want them to end up like my neighbor,” she said. “She can’t walk or work or help her family. She is a burden.”

Swiftly, a health worker moved down a line of toddlers, squeezing two drops of bitter, reddish vaccine into tiny mouths.

When the first child screamed, the others clamped hands over their mouths and flailed their legs.

Three adults struggled to administer two drops to one child. When coaxing failed, the child’s nose was plugged. When he gasped for air--drop, drop, medicine went in too.

A WHO medical epidemiologist, Bernard Moriniere, estimates Ethiopia has 500 to 1,000 new cases of polio every year, making it one of the largest reservoirs of wild polio virus in the world.

The poliomyelitis virus, also called infantile paralysis, can spread from the intestines and attack the brain and spinal cord. One of 200 nonimmunized children is paralyzed, and 10% of those die.

In the 1940s and 1950s, iron lungs were used to regulate breathing and keep paralyzed polio patients alive. Today, the body-encasing cylinder largely has been replaced by a ventilator that forces air in and out of lungs through a hole cut in the trachea. Neither is available in developing countries like Ethiopia, however.

Two vaccines against polio have been available in Ethiopia since before Shifa was born--Dr. Jonas Salk developed an injectable vaccine in 1955, and Dr. Albert Sabin’s oral vaccine, developed in 1961, made it possible to wipe out one of humanity’s most disabling diseases.

But the vaccines failed to reach most children in Ethiopia, especially those who were poor and lived outside the capital. Shifa said she hadn’t heard until November that a few drops of medicine would have spared her a life of misery.

“It’s just a totally preventable tragedy. We know how to do it; we’ve got a vaccine. It’s cheap,” Hull, the WHO official, said. A full course costs about $1 for each child.

Polio remains endemic in 116 countries. WHO has targeted trouble spots mainly in Africa, among them Congo, Sierra Leone, Liberia, Nigeria and Ethiopia, and in Asia, including Afghanistan, Pakistan, India, Cambodia, Laos and Vietnam.

The disease has been wiped out in 155 nations, including all of North and South America and western Europe, as well as China and Australia.

The last case in the Americas was in Peru in 1991. Three-year-old Luis Fermin Tenorio caught polio because he was unable to complete his polio immunizations after rebels destroyed the local health center.

Poor sanitation fuels the spread of the virus, which is shed in the feces of infected people. A lack of toilets in developing countries forces people to defecate on open ground, often near drinking-water supplies, homes and crops.

Toddlers are particularly vulnerable because they haven’t learned to take precautions against a virus that attacks through the mouth, and they lack immunities acquired by adults.

Until the virus is eradicated everywhere, no child will be safe because cross-border transmissions are common, Hull said.

Political turmoil and civil war are the most serious challenges to defeating polio. War-related outbreaks of polio occurred in Chechnya in 1995, Sudan in 1993 and Iraq in 1992-93.

Negotiators have worked to ensure that children’s health does not become another casualty of war.

In 1985, the number of children dying in El Salvador from vaccine-preventable diseases surpassed the number of people killed in the Central American nation’s civil war. The government and rebels agreed to a series of one-day truces to permit immunizations that rid the country of polio.

Every year since 1995, the Sri Lankan army and Tamil separatists have suspended hostilities for a few days and passed vaccine across the front line so children on both sides can be treated.

In campaigns around the world, children have been immunized in fast-food outlets, gas stations, company clinics, shopping malls, radio and television stations, bus and railway stations, government offices and schools.

Vaccine has been carried on the backs of camels, horses, donkeys and bicyclists and in rickshaws and army helicopters.

India accounted for more than half the world’s polio cases in 1996, but immunized 127 million children last January.

In Vietnam, little girls in party dresses opened lipstick-reddened mouths for their drops.

Much of the credit goes to Rotarians, who have raised more than $400 million to eradicate polio, WHO says. They are spending nearly $1 million in Ethiopia.

What’s more important, Rotary has mobilized its 1.2 million members around the world to help. Some were in Ethiopia giving oral drops, while others worked to set up a lab that will be important for determining the success of the immunization campaign.

In the mountains above Addis Ababa, a dozen small children wearing leg braces played a wobbly game of soccer at Cheshire House, a haven for polio victims.

“Parents take their children to holy water, witch doctors, to hospitals, then they finally come to us. They think we are miracle workers because we can help their children walk again,” said Fasil Ayele, the center’s administrator.

“But the real miracle would be in eradicating this disease.”