NIGERIA: THE FIGHT AGAINST POLIO SUFFERS SIGNIFICANT SETBACK

Worryingly, one has become rather immune to horror stories emanating from Africa’s most populous country such that news of the killing of nine health workers said to be administering polio vaccines in northern Nigeria has not come as a shock.

 

Boko Haram: The History

 

Regular visitors to the 1worldinternational weblog will be aware of the origins of Boko Haram, the terrorist group with Nigerian origins which has over the last few years masterminded attacks against the Nigerian government, public infrastructure, civilians and churches. In a previous article entitled “Boko Haram: The New Al-Qaeda?”, 1worldinternational highlighted the threat posed by the group. The article also covered fears raised by the U.S. about the Nigerian government’s inability to deal with the insurgency and the prospect that the national problem may spiral into an international concern.
 

As always, the Boko Haram Islamist sect which opposes polio vaccination programmes, for what many term the misguided reason that it is a Western-led ploy to inflict AIDS on Muslim children and cause infertility within that cross-section of the Nigerian society, have been blamed for the killings.  This week’s attack follows a similar attack against aid workers in Pakistan who had been administering polio medicine to those most prone to the disease. Police spokesman Magaji Musa explained: “Gunmen on bikes opened fire on a health centre in the Hotoro district killing seven, while an attack on the Zaria Road area of the city claimed two lives.” Musa continued: “They were working for the state government giving out polio vaccinations at the time of the attack.”

 

Blow to Worldwide Fight against Polio

 

The latest attacks on health personnel in Pakistan and Nigeria, allied with the continued threats to the lives of aid workers in these regions, is indeed a massive blow to worldwide efforts currently geared towards the eradication of the disease. In June of last year, 1worldinternational reported, in an article titled ‘Global Polio Eradication Initiative (GPEI) Declares Last Stand against Polio’, the Global Polio Eradication Initiative’s launch of an emergency action plan following fears of a resurgence of the disease in countries where the disease was thought to have been eradicated. By way of information, the GPEI was formed in 1988 and was spearheaded by the WHO, Rotary International, the United States Center for Disease Control and Prevention and UNICEF. It is also supported by polio-affected and donor governments, private foundations, development banks, humanitarian and non-governmental organizations, corporate partners and more than 20 million volunteers.
 

It is perhaps no coincidence that the countries in which the most stubborn and obdurate opposition to the administration of medicine emanates are those – Afghanistan, Pakistan and Nigeria -  in which polio remains endemic to levels needed to prevent the transmission of the disease. The December 2012 and January 2013 attacks by alleged Taliban-linked militants in Pakistan is indication of the continued lack of understanding which is required from leaders of these communities if the Ban Ki-moon led quest to “stamp out polio for good” is to be achieved in our lifetime.

 

Sound-off

 

In the circumstances, the GPEI and those leading the fight against the dissease are left with essentially three options. The first and least favoured is continuing with the same course of action, i.e. sending in aid workers against the background of the real and severe risks of attacks on their person. The second and middle of the road option entails praying and hoping that the military might of the North Atlantic Treaty Organisation (NATO), the International Security Assistance Force (ISAF) and the Nigerian government will prevail over those of the Taliban, its allies and the Boko Haram military sect. The third and most preferable option, and which in the writer’s view is most likely to yield the most dividends, is that of engaging and educating the opponents of the vaccination programme about the advantages of immunization to future generations of Muslim children. Perhaps this will, to some extent, assuage fears which manifests itself in the form of misguided views in respect of the aims and objectives of the programme.
 

In this regard, charity organisations who operate within the Islamic world such as the Red Crescent may act as mediators and/or negotiators owing to the fact that they may not face the same allegations levelled aganst Western-backed organisations and aid workers which is that they are acting as agents of the West and that they are essentially, propagating and cultivating a Western-backed agenda. Unfortunately, without the co-operation of the current opponents of the vaccination programme, who also wield such overarching power and influence over the regions in which it is most prevalent, the battle against the disease will be one with which future generations will be saddled.

WEST AFRICA: U.N. APPROVES MASS VACCINATION IN BID TO BEAT SEASONAL MENINGITIS IN WEST AFRICA

The U.N. has stepped up the fight against seasonal Meningitis in West Africa with the news that 50 million people in the region are set to be immunized within the next three months. The campaign is expected to reach inhabitants of the West African countries of Benin, Cameroon, Chad, Ghana, Nigeria, Senegal and Sudan.


The campaign is being led by the Geneva-based GAVI Alliance, a public-private partnership which is backed by the World Health Organisation (WHO), the United Nations International Children’s Emergency Fund (UNICEF), the Bill and Melinda Gates Foundation and the pharmaceutical industry amongst others. According to the GAVI Alliance, the region is said to have been targeted as a result of its vulnerability to ‘seasonal severe outbreaks of meningitis’ which places up to 430 million people at risk of the disease.


The Meningitis bacteria is transmitted between people through droplets of respiratory or throat secretions and affects the lining surrounding the brain and spinal cord. The disease can be spread by way of person-to-person contact such as through sharing, eating or drinking utensils, kissing, sneezing and coughing. The disease can lead to brain damage, hearing loss, learning disability which occurs in 10 to 20 per cent of survivors and in extreme cases, death.


“Meningitis takes a terrible toll on the people living in vulnerable parts of Africa every year. It is a painful disease which can kill quickly and often leaves victims with disabilities that will blight their lives,” said Seth Berkley, CEO of the GAVI Alliance. Dr. Berkley added: “Nobody really understands exactly why just in that region. But every five to seven years there would be an epidemic. There would be hundreds of thousands if not millions of cases. And it would completely drive the economies to a halt.”


Reports of the renewed campaign against the disease comes on the heels of last year’s development of a new vaccine MenAfriVac, the revolutionary meningococcal A conjugate vaccine developed through the Meningitis Vaccine Project (MVP) which aims to eliminate group A meningitis epidemics which has plagued the sub-Saharan African region for more than a century. MVP aims to eliminate meningitis as a public health concern through the development, testing, introduction, and widespread use of conjugate meningococcal vaccines. The Meningitis Vaccine Project is a partnership between the WHO, the global non-profit organisation PATH and the Bill and Melinda Gates Foundation.


News of the immunization campaign is certainly welcome not least because of the myriad effects including economic and social which the outbreak of the disease – outbreaks are said to occur every 7-14 years – brings along with it. It is widely known that people tend to avoid large or social gatherings when these outbreaks occur with associated consequences being that children often miss school and adults avoid the workplace. Following news that the West African country of Burkina Faso has reported no new cases of Meningitis since the introduction of the MenAfriVac vaccine, hopes abound that Meningitis will be eradicated by the turn of the present decade.

FIRST EVER DECLINE IN TB GLOBAL RATES, SAYS WHO

The number of people falling ill with tuberculosis (TB) each year is steadily declining, says the World Health Organisation (WHO). The WHO 2011 Global Tuberculosis Control Report reveals that the incidence of tuberculosis and tuberculosis related deaths are at its lowest levels for a decade.


The Report’s Findings

According to the Report, tuberculosis related illnesses fell to 8.8 million in 2010, having peaked at 9 million in 2005. Tuberculosis deaths also dropped to 1.4 million, after peaking at 1.8 million in 2003. In addition, 2009 saw 87% of patients treated cured, with 46 million successfully treated and 7 million lives saved since 1995. Margaret Chan, WHO Director-General, attributes these findings largely to increased domestic and international donor support. She states: “in many countries, strong leadership and domestic financing, with robust donor support, has started to make a difference in the fight against TB.”

Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected. In 2000, 189 countries which comprised the United Nations at the time recognised the scourge posed by the disease and made the eradication of the incidence, prevalence and deaths caused by tuberculosis as one of the eight Millennium Development Goals to be achieved by 2015. It is however unlikely that this component of the Millennium Development Goals will be achieved as the Report surmises that TB mortality rates are expected to drop by 50 percent in all parts of the world except for Africa.


Fears of TB Resurgence

Despite the huge progress being made in the fight against the disease, fears still remain that the gains made thus far could be easily reversed by the emergence of multidrug-resistant TB (MDR-TB). MDR-TB is a form of TB which is resistant to the most effective anti-TB drugs and does not respond to the standard six month treatment of the disease. It is also feared that a shortfall in funding could also hamper efforts to eradicate multidrug-resistant TB.

The United Nations Secretary-General, Ban Ki-moon, warns against taking the results of the Report for granted or resting on the significant laurels recently attained in the battle against the eradication of the disease. “Fewer people are dying of tuberculosis, and fewer are falling ill. This is cause for celebration,” said Ban Ki-moon. “But it is no cause for complacency. Too many millions develop TB each year, and too many die. I urge serious and sustained support for the Stop TB Partnership in the years to come.”


The Stop TB Partnership

The Stop TB Partnership was established in 2001 with the goal of eliminating TB as a public health problem and, ultimately, to ensure a world free of TB. It comprises a network of international organizations, countries, donors from the public and private sectors, governmental and non-governmental organizations (NGOs) that have expressed an interest in working together to eliminate TB.

Frighteningly, only 16% (about 46,000) of the estimated number of people infected with MDR-TB have received treatment worldwide. This alarming statistic may be attributed to the difficulty in obtaining an early diagnosis of MDR-TB. It is hoped that the new rapid test for MDR-TB endorsed by the WHO in December 2010 will modify the current method of diagnosis made redundant by the emergence of the MDR-TB, thereby ensuring that infected individuals are diagnosed quicker and can receive treatment as soon as they have been diagnosed. At present the new rapid test for MDR-TB is being used in 26 countries and this is expected to increase significantly in the coming months. Dr Mario Raviglione, Director of WHO’s Stop TB Department recognises the urgency in ensuring that all those infected are promptly diagnosed and offered treatment. Dr Raviglione states: “But the promise of testing more people must be matched with the commitment to treat all detected. It would be a scandal to leave diagnosed patients without treatment”.


Huge Achievements and Guarding against Complacency

Amongst the countries which have seen significant declines in cases of tuberculosis over the last decade are Kenya, Tanzania and Brazil. Notably, Kenya and Tanzania, countries which have seen a remarkable decrease in tuberculosis, have also seen a fall in the incidence rates of HIV/AIDS infections over the last ten years. Tuberculosis is a major killer of people infected with the HIV virus and the WHO state that a staggering 82% of people in Africa infected with HIV in 2010 developed TB. China has seen an even more marked decrease in tuberculosis prevalence and death rates. Tuberculosis death rates in China fell to 55,000 in 2010 from 216,000 in 1990 while prevalence rates tumbled to 108 per 100,000 population from 215 per 100,000 population.

Despite the huge successes achieved in the fight against the disease so far, the results of the Report should be considered with some caution. The authors of the Report admit that a third of estimated TB cases worldwide are not notified and as such it is unknown whether they have been diagnosed and properly treated. Arguably, this factor may have skewed the results of the Report somewhat. Drug-resistant TB strains and the drop in funding for TB-related global health programmes are undoubtedly the biggest challenges facing health experts worldwide and as such complacency should be guarded against in the far from won battle against tuberculosis.

MOSQUITOES RESISTANT TO INSECTICIDE-TREATED BED NETS, SCIENTISTS FEAR

Mosquitoes are rapidly developing resistance to insecticide-treated bed nets (ITNs), according to a group of 18 research scientists led by Jean-Francois Trape from the Institut de Researche pour le Developpment and the Pasteur Institute of Dakar.

The results of the study is an important development in the fight against the deadly disease malaria as insecticide-treated nets were previously thought to be the most effective method of reducing malaria morbidity, mortality and prevalence around the world. The researchers surmise in their study reported by the British Journal, The Lancet Infectious Diseases, that the “findings are of great concern” not least because “they support the idea that insecticide resistance might not permit a substantial decrease in malaria morbidity in many parts of Africa where Anopheles gambiae (the most common species of malaria spreading mosquito in Africa) is a vector.”

The results of the study conducted in Dielmo, Senegal between January 2007 and December 2010 aimed to assess the effect of the distribution of insecticide-treated bed nets and combination therapies on malaria morbidity, mosquito populations and infections. The scientists monitored inhabitants for the disease in the first year and a half of the programme. In July 2008, the scientists then offered long-lasting insecticide (Deltamethrin) treated nets to all the villagers.

The results of the study showed that the incidence of malaria was 13 times lower than before the nets were introduced. Further, the proportion of the Anopheles gambiae mosquitoes resistant to Deltamethrin, the chemical advocated by the WHO for use on the bed nets, was 37%. The study also found that the incidence of the disease rose to significant levels during the last few months of the study. In essence, the reports of malaria attacks were higher than recorded rates prior to the introduction of the ITNs. The researchers attributed this marked spike in disease incidence rates, especially in older children and adults, to the increasing resistance of A. gambiae mosquitoes to insecticides allied with loss of immunity or reduced immunity when the mosquito population declined.

Inevitably, the results of the study bears serious implications on the global fight against the spread of the disease especially if the Millennium Development Goals target of reversing the incidence of malaria by 2015 is to be achieved. ITNs were thought to be the most effective method of preventing the disease which is prevalent in sub-Saharan Africa, Asia, Latin America and to a lesser extent the Middle East and parts of Europe. The disease is also said to infect between 400 and 500 million people a year and also kills nearly two million people yearly; 90% of these deaths occur in sub-Saharan Africa.

The use of ITNs has resulted in a reduction of malaria incidence, morbidity and prevalence rates. UNICEF states that between 2004 and 2010, more than 400 million nets were delivered to malaria-endemic countries, with 290 million delivered since 2008 alone. It also states that this has led to the reduction in global malaria deaths by 20 per cent between 2000 and 2009.

However, John Keating and Thomas P. Eisele; both of the Department of Global Health Systems & Development at Tulane University, New Orleans aver that the results of the survey should be assimilated with caution. The researchers point to the relatively short duration of the research (3 – 4 years) which inhibits the assessment of long-term shifts and transmission of malaria epidemiology. An additional unanswered question they state regards how quickly a person previously exposed to malaria (before use of ITNs) loses their acquired immunity. The researchers add that this becomes an even more important issue especially in the case of adults who have experienced decades of exposure in endemic areas. Also, the fact that the study was conducted in a single village and further over a short period of time is said to be a limitation of the study, not least because it may thus be impossible to generalise its findings across Africa.

Despite these criticisms, the resurgence in malaria mortality in Rwanda, Sao Tome and Zambia since 2009 perhaps lends credence to the researchers’ fears. Worryingly, the prevalence of malaria in Kenya has increased in the last 3 years, according to a government survey. The survey indicates an overall malaria prevalence rate of 11% at present, with the disease affecting about 8% of all children under 5 years, compared with 3% in 2007. Interestingly, these countries have all implemented programmes aimed at distributing the WHO endorsed ITNs to their population.

Against this background it is perhaps now, and more than ever before necessary for scientists and researchers to develop effective malaria prevention and control strategies which protect individuals in endemic areas and which also reduces the speed of transmission of the disease. Therefore recent news that the PATH Malaria Vaccine Initiative is to collaborate with Glaxosmithkline (GSK) & Crucell in development of second-generation malaria vaccine is heart warming. At the time of writing, the RTS,S vaccine candidate is in the midst of a large-scale phase 3 clinical efficacy trial. The WHO anticipates that a policy recommendation for RTS,S may be possible by early as 2015. Dr Christian Loucq, director of PATH Malaria Vaccine Initiative, states that: “for the first time, we have a malaria vaccine in late phase development.” He adds that the new approach has the potential to “move us closer to the internationally agreed upon goal of an 80% effective second-generation vaccine by 2025.” It is no doubt hoped that development of a vaccine can be accelerated and made available and accessible to the developing world in the near future. Without this, the air of victory over malaria which currently pervades is just as likely to revert back into the sense of helplessness which previously abounded.