Partner up to end polio - Feb. 2006
PolioPlus Partners offers a golden opportunity to make a difference.

When a health official in a green-and-white apron with a Rotary logo approaches an immunization site at a small village in western Nigeria, she is met with smiles. She retrieves a small vial of oral polio vaccine from an insulated cold box, then encourages a six-month-old baby to pucker up as the mother holds her son close against her chest. He grimaces at the taste of the drops, but the ordeal is over in an instant. The child is now safe from polio.
It sounds simple enough, but in some countries, villagers are wary of unfamiliar health officials or volunteers who claim to have medicine that will protect their children against disease. Some believe that the polio vaccine could be harmful or even sterilize their babies.

Marie-Irene Richmond-Ahoua, chair of the National PolioPlus Committee of Cote d'Ivoire, explains that people will not open their doors unless vaccinators are wearing familiar garb, like T-shirts or aprons, that identifies them as PolioPlus volunteers.

Funding for the garments is provided by the PolioPlus Partners program, established in 1995 by The Rotary Foundation to help polio-endemic and high-risk countries obtain tools and supplies necessary for polio eradication. The program targets two critical needs: social mobilization efforts led by Rotarians and assistance for polio medical officers and epidemiologists. In addition to providing recognizable clothing, the program funds insulated vaccine carriers called cold boxes; battery-operated megaphones to get the word out; and billboards and posters to announce vaccinations. Funds also help provide bicycles, boats, and four-wheel-drive vehicles to deliver vaccines.

Since its start, PolioPlus Partners has provided more than US$35 million to over 450 projects in 86 countries. Current projects are listed in an online catalog called the PolioPlus Partners Open Projects List, which is updated monthly. Rotarians can select a project that interests them or allow The Rotary Foundation to apply their contributions where they're needed most. (See page 45 of the February 2006 issue of The Rotarian.) The Rotary Foundation matches all cash contributions at the rate of 50 cents per dollar donated.

The program was suspended during the 2002-03 Rotary year so that Rotarians could focus on the Polio Eradication Fundraising Campaign, which raised $135 million to support immunization efforts. It was reinstituted in December 2003 when it became evident that more personal support was needed to finish the job. Charles C. Keller, chair of the PolioPlus Partners Task Force, says the PolioPlus Partners program remains "a golden opportunity for Rotarians to personally support polio eradication."

Protected by the Rotary logo
In countries racked by civil war or internal strife, wearing clothing bearing the Rotary gearwheel emblem is sometimes the only way that PolioPlus volunteers can gain access to certain areas. Some vaccinators have said they feel as though the logo acts like a bulletproof vest. In Nepal, for example, vaccinators have been threatened by Maoist rebels along the Indian border. Tehmas Manekshaw, chair of the Nepal National PolioPlus Committee, submitted a request to the PolioPlus Partners program for T-shirts, arm bands, and caps. "These are especially needed for identification of volunteers to save them from Maoist attack," he says, adding that the rebels even help volunteers they've identified.

Manekshaw has such faith in PolioPlus Partners that he has donated $10,000 annually for several years to support efforts in Nepal. He hopes this gesture will inspire other Rotarians to keep up the fight. Already U.S. districts 7510 (New Jersey and Pennsylvania) and 5450 (northern Colorado) bought motorcycles and bicycles through PolioPlus Partners to help surveillance efforts.

Perhaps the most important aspect of the PolioPlus Partners program is that it brings Rotary clubs together. "Participation in the PolioPlus Partners program has linked clubs and districts around the world," says Sylvia Nagy, chair of Angola's National PolioPlus Committee. "It makes people realize that polio is still a problem in the world."

While Rotarians can be proud of the fact that polio cases worldwide have been reduced by 99 percent, thousands of children are still afflicted by the disease. As of 16 November, WHO reported 1,499 polio cases. Six countries remain polio endemic and continue to infect previously polio-free countries. Eleven polio-free countries were re-infected in late 2004 and 2005.

"Polio will not be as easy as we thought to get rid of. It's that last one percent that will be most difficult to wipe out," says Bruce Alyward, coordinator of the WHO's Polio Eradication Initiative. "There are three strains of polio, and we have to contend with political and financial challenges. But we are on the brink of eradicating this disease. It appears that all countries, except perhaps Nigeria, will be able to stop the transmission of polio within the next six to eight months."

The equipment PolioPlus Partners provides will be used long after the disease is eliminated. "It will remain as Rotary's legacy to the world and will provide support to other public health needs for years to come," says Alyward.

"Our challenge is to keep Rotarians focused on the goal," adds Keller. "After 20 years of hard work and two fundraising campaigns, fatigue can easily set in. Our job is to keep Rotarians engaged. To do this, we must reach as many members as possible with the message of PolioPlus Partners."

Polio Network ready to respond to Avian Flu outbreak

Three cases of a deadly strain of avian influenza were confirmed in chickens in northern Nigeria last week, marking the first appearance of the H5N1 virus in Africa. The World Health Organization immediately responded with offers of aid that take advantage of the country's polio eradication infrastructure.

In a statement released 9 February, WHO Director-General Dr. Jong-wook Lee outlined ways the country's PolioPlus network can support the government of Nigeria during this crisis. Among his suggestions was an offer to make use of the 11-14 February National Immunization Days to distribute information to the public about avian flu. Publicizing the dangers of close contact with sick or dead birds infected with the virus is especially critical in Nigeria, where village households keep free-ranging flocks of poultry as a source for food and income.

Monitoring for human cases, assisting with the collection and transport of diagnostic specimens, and providing avian influenza technical staff with logistical support are some of the other ways the PolioPlus network is ready to help, says Linda Muller, external relations officer for the Global Polio Eradication Initiative.

The use of the polio eradication infrastructure of human and technical assistance is especially valuable in Africa where a weak health care system is already overtaxed from caring for patients with HIV/AIDS, tuberculosis, and malaria. If Nigeria's government decides to take advantage of the WHO offer, it will mark the first time the polio eradication network has been used in the early detection and response to cases of avian flu.

For the moment, however, Nigerian health officials have ruled out the direct involvement of vaccinators in the public information campaign over concerns that they may not be able to answer questions about avian flu. Instead, "field supervisors are giving the chicken-avoidance message to village leaders and having them decide the best way to disseminate it," the Washington Post reported on 13 February.

The highly pathogenic H5N1 virus was first discovered in Nigeria's Kaduna state on 8 February. The next day, the strain was confirmed in two other states: at two farms in Kano and on one farm in adjoining Plateau. Because of its ability to spread quickly among poultry flocks and result in severe disease and death in humans, this form of the virus is considered extremely dangerous.

The WHO's polio team has 449 staff in Nigeria, 57 of whom are non-Nigerian citizens. The greatest concentration of staff is located in the northern part of the country and primarily composed of officers for immunization, disease surveillance, and social mobilization. Muller noted that the team is working in full collaboration with the team from Epidemic and Pandemic Alert and Response, WHO's lead department on such responses.