As the war in Syria approaches its fourth year, public health concerns are rising, especially after the outbreak of several infectious diseases perhaps the most worrying of which is Polio. Wafa Dakwar, MAP Programme Officer, writes about how the threat of Polio is being handled in Lebanon.
Polio is a highly infectious disease that has killed and crippled hundreds of thousands in the past decades across the world. Polio usually affects children under the age of 5 attacking the nervous system and causing paralysis or death in a matter of hours. The disease was once feared by every parent worldwide. It is incurable and the damage it causes is irreversible. Affected children were left for a lifetime in a cast, wheelchair bound, completely immobile or even in an iron lung box. The Polio causing virus is transmitted from person to person mainly through the oral-fecal route and, less frequently, by contaminated food and water. Hygiene is an important precaution, but it has been proved not sufficient; prevention is only guaranteed through the revolutionary vaccine discovered and developed in the mid-twentieth century.
In 1988, a global determination to eradicate Polio worldwide was agreed in the forty-first World Health Assemblies’ resolution that marked the launch of the Global Polio Eradication Initiative. Since then, the initiative has succeeded in reducing the yearly incidence of the disease by 99%. In 2014, only 3 countries (Nigeria, Afghanistan, and Pakistan) remained polio-endemic. Unfortunately in 2013 Polio forced its way back to war-torn Syria, which had been Polio-free since 1999, with 36 cases reported in the past 2 years. The outbreak was mainly triggered by a combination of conflict-related factors: large scale displacement, unsanitary living conditions, water contamination, poor access to primary health services in some areas and gaps in vaccination coverage- according to the UN the polio vaccination coverage dropped from an average of 99% to 52% since the start of the conflict.
With the influx of more than 3 million refugees fleeing the conflict in Syria to neighboring countries, the region has become susceptible to an outbreak of this highly infectious disease. The World Health Organization (WHO) has declared a state of emergency in seven countries, including Lebanon, concerning a possible polio outbreak. Lebanon hosts more than 1.5 million Syrian refugees, 44,000 Palestinian refugees from Syria, and thousands of Iraqi refugees, mostly living in dire and unsanitary conditions- an environment that is suitable for Polio to thrive and spread if cases were found and immunization coverage was less than ideal.
Lebanon is determined to maintain its record in being polio-free for almost 14 years; thus, collaboration between the Lebanese ministry of public health, WHO and UNICEF culminated in the launch of a massive nation-wide vaccination campaign as a preventative measure. The campaign, planned to be finished before the end of the year, aims to orally vaccinate more than 600,000 children under the age of 5 all over Lebanon regardless of their nationality and the previous polio vaccinations they took. Polio vaccines have been made available for free in various locations including public and private hospitals, primary health centers, clinics, mobile clinics, and for various organizations participating in administering the Polio vaccination.
“A mother that protects her child can protect a country”, “Every child has the right to live in a polio free world”, “Waiting is dangerous, give the drops” are slogans used by the campaign aiming to persuade parents to take responsibility and vaccinate their children. Genuinely, parents would not want to expose their child to the risk of Polio; however, a vaccination dose might have been missed due to a failure in the vaccination system or to the poor access to primary health services in areas of conflict, or because parents are traumatized by the war in Syria and overwhelmed by the difficult condition faced in the host country. Thus, a mix of methods was used to ensure that all families are reached and that every child within the target group is vaccinated, as “the presence of the disease anywhere is a threat to children everywhere” said Anna Maria Laurini, UNICEF’s Head of Mission in Lebanon. The two drops of polio vaccine were given to children in schools, children at community centers, children visiting health centers, newborns at the hospital, and through community health workers visiting homes and neighborhoods (door-to-door vaccination).
The Awareness messages concerning the disease and the polio vaccination campaign were disseminated using various methods including, television promos by celebrities such as Nancy Ajram, radio shows, facebook page , a hotline, SMS messages sent to all mobile phones in Lebanon, health education materials showing explaining the campaign messages in simple cartoon drawings, and awareness sessions by civil society organizations and NGOs.
The campaign was implemented in the Palestinian camps in collaboration with UNRWA, who took the responsibility of administering the polio vaccination to Palestinian camps’ residents regardless of their nationality. MAP considers child’s rights and welfare a priority; hence was eager to participate in the Polio vaccination campaign through the dissemination of the campaign’s messages. MAP is doing its best to make sure that the wellbeing of a child is not compromised due to lack of knowledge, particularly concerning a preventable disease. Two midwives from MAP’s outreach Maternal and child Health project (MCH) attended a two-day training organized by UNICEF, and then rolled out the training to the other midwives/nurses working in the framework of the MCH project.
Key polio awareness messages have been incorporated in the routine of the home visits, and disseminated to more than 3000 families. The families reached include those who are most vulnerable, marginalized, and the few who, for one reason or another, do not attend health centers. The midwives also rolled out the training to community workers of MAP’s partner organizations (Naba’a, Solidarity Association/Tadamon, NISCVT/Beit Atfal Assomoud, and Association Najdeh). The community workers, in turn, organized community-based awareness sessions on World Polio day (24th October), focusing on Polio awareness messages.
The awareness sessions were well attended; and most parents participating in the sessions, came out well informed about polio and well aware of the importance of vaccination. Some of the session’s participants responds when asked about the new information they learned through the session were: “it is safe and recommended to give the oral Polio vaccination to a child who was previously vaccinated”, “it is okay to give the polio drops to a child if he has a cold or fever”, “I didn’t know that polio can cause that much harm to a child”, “I always took my children to vaccination appointments according to UNRWA’s nurse request. I am very happy I did that, now that I know how dangerous this disease is”.
Finally, keeping the world Polio-free for future generations, is the responsibility of all. Thus, this unprecedented collaboration between various actors worldwide should continue to ensure that every last child is reached and vaccinated.