By Marwaan Macan-Markar
BANGKOK, Apr 22, 2011 (IPS) - A small army of volunteers from local non-governmental organisations has fanned out across Burma to inoculate 3.4 million children from a rare strain of the polio virus that has re-emerged three years after the country was declared polio free.
Some 12,000 volunteers are racing against time to reach close to 115 of the 325 townships in the South-east Asian nation also called Myanmar. Local health authorities and United Nations officials want the vulnerable children under five years to receive the oral polio vaccine before the monsoon breaks in late May.
But health volunteers face other odds: Many of the communities are inaccessible, and health is not a priority of the Burmese government.
"To reach scattered and mobile populations and difficult-to-reach areas will be challenging," said Dr. Tin Htut, health specialist for child immunisation at the Burma office of the United Nations Children’s Fund (UNICEF). "Best efforts will be made to reach every child through house-to-house visits to find any child missed in the days after the campaign."
Polio, which is transmitted in human excrement, attacks the nervous system and "can cause irreversible paralysis within hours," said the World Health Organisation (WHO). "Young children are the most vulnerable."
The on-going mass vaccination campaign in Burma comes as a new government replaces a succession of oppressive military regimes that have been in power for nearly 50 years. The new government that took over after last November’s general election - the first in 20 years - is still largely military driven, although in civilian garb.
Critics of Burma’s military leaders do not expect the new government to stand in the way of the inoculation drive, but they ask whether the administration of President Thein Sein will inject more funds into the ailing public health system.
The country’s latest budget, announced in January, had allocated nearly 25 percent for the country’s 450,000-strong military and only 1.3 percent for health.
Concern about the re-emergence of vaccine-driven polio virus (VDPV) surfaced after a seven-month old infant was infected with the crippling virus in December in the Yamethin Township in the Mandalay Division in central Burma.
The case prompted the Department of Health to immediately immunise 10,000 children living in the vicinity. It also brought to an end the three-year period from 2007 till 2010 when U.N. agencies declared Burma "polio free".
"The occurrence of even one case of polio in a previously polio free area is considered a public health emergency that requires rapid and high quality health responses as an utmost priority," Ramesh Shreshta, head of the UNICEF office in Burma, said before the current immunisation campaign was launched. "This must involve a house-to-house campaign to ensure no child is missed."
The brief outbreak of polio in Burma in 2007 came after a lapse of seven years, since the country had previously been declared polio free in 2000, marking another success at the time for a worldwide polio eradication effort.
The Global Polio Eradication Initiative (GPEI), led by the World Health Organisation (WHO), UNICEF and Rotary International among others, is on the cusp of finally defeating this debilitating virus.
"Since 1988 (when GPEI was launched), the incidence of polio has been reduced by more than 99 percent," said Dr. Patrick O’Connor, advisor for vaccine preventable diseases surveillance and polio at the WHO’s South East-Asia regional office, based in New Delhi.
From more than 350,000 children paralysed in 125 endemic countries each year in 1988, the incidence rate dropped to 974 children in 2010, O’Connor revealed in an interview.
"Only four countries remain endemic: Afghanistan, India, Nigeria and Pakistan," he added.
But the reappearance of the rare strain of virus in a community where some people have been immunized and others have not serves as a cautionary tale for public health experts.
"On occasion, when the polio vaccine is replicating in the human gut, it can genetically change and may spread and cause paralysis in communities that are not fully immunized, especially in areas with poor sanitation and over crowding," WHO said.
"All countries in the region with poorly immunized communities remain susceptible to all forms of polio virus and are potentially at risk," O’Connor explained. "Most recently Nepal, Indonesia and Bangladesh all had importations after a period of being polio free."
Local authorities and U.N. agencies are now deep into the anti-polio campaign. "The first round was planned for the first week of April and the second round (will begin) in the first week of May," said UNICEF’s Tin Htut.
"If this new government is sincere, they should spend money to improve the health system," a Rangoon-based doctor told IPS on condition of anonymity. "It is more foreign aid than local funds going to pay for campaigns like the polio eradication effort."