1.0 Introduction
According to the Global Polio Eradication Initiative (GPEI), the Republic of Congo is referred to as an importation country as far as Polio is concerned. As a matter of fact, Congo is categorized by the same organization, GPEI, as being in the “wild polio virus importation belt.” This belt refers to a strip of countries which stretch from the Western part of Africa, through Central Africa all the way to the horn of Africa, which has been re-infected with the polio virus. Other countries in this importation belt include Liberia, Mali, Kenya, Uganda and Niger among other. In the case of Congo, the poliovirus strain in the country is similar to the transmission that has been reestablished in Angola, which is one of the countries under the “infected” category.
The focus of this research paper is the eradication of the poliovirus in Congo. This represents the evaluation of an urban response to an outbreak of the poliovirus. Core to the response is multipronged approach that is composed of mop-up campaigns. These campaigns include quashing of all active and passive poliovirus outbreaks in Congo and a series of supplementary immunization activities strategically targeting the importation countries within the earlier mentioned belt. This research thesis shall include a detailed analysis of a poliovirus outbreak in Congo and a detailed description of the emergency response strategies implemented as a result of such a pandemic. Based on this premise, the scope of the research paper shall be limited to the October 2010 poliovirus outbreak in Republic of Congo, in the port city of Pointe Noire.
2.0 Analysis of the Pointe Noire 2010 Poliovirus Outbreak
2.1 Initial Government Press Statement
There was an acute outbreak of the poliovirus in the port city of Pointe Noire, Congo in the year 2010. On the 4th of November 2010, the date the government made public this outbreak, the virus had claimed at least 58lives, and caused flaccid paralysis to a further 120people. It must be mentioned all the above figures were reported within the first 10days of the outbreak an indication of the severity pandemic. The press statement also indicated that preliminaries testing had revealed that two of the reported cases were as a result of the wild poliovirus type1 that’s synonymous with Angola.
Most of the reported deaths were those of young adults. Specifically, 33 of the aforementioned deaths were of young Congolese aged between 15 and 24 years, one was under 5 years while the rest were aged between 7 and 13 years. The press statement also indicated that the virus was as a result of importation. This was because the last incident of indigenous poliovirus in Congo was witnessed in the year 2000. A good percent of the reported cases were limited to Pointe Noire. However, some isolated cases were also reported in other major urban centers in the country. These included two cases in Dolisie, while as of November 4th 2010, the towns of Bouenza, Brazzaville and Mvouiti each had one case.
2.2 Subsequent Independent Press Statement
Slightly over a month after the initial report, the situation in Central African nation had quickly worsened. The death toll had trebled to 179 and the number of people suffering from acute flaccid paralysis (AFP) had quadrupled from 120 to 476. This was as of the 8th of December 2010. In fact, the World Health Organization (WHO), United Nations Children’s Fund (UNICEF) and the Rotary International had a US$22million emergency response appeal. By then, independent investigations had ascertained that six of the reported cased had been caused by wild poliovirus type1 and further tests were still being conducted. In addition to this, it was then clear that the reestablished transmission of the virus was associative with the indigenous poliovirus strain common in the neighboring Angola. Further reports indicated that the number of isolated cases of the outbreak of the virus had increased to encompass the towns of Niari and Kouilou as new cases trickled in by the day.
2.2 Reaction from the Media
The international media especially the BBC, CNN, and ABC to mention but a few were awash with blow by blow coverage of the outbreak of the poliovirus in Congo. This outbreak was also featured on the renowned New York Times also featured the state of emergency that was declared in the neighboring Angola as a result of the outbreak. Preliminary reports from all the international media houses were indicative of the fact that as long as poverty still existed in the world, eradication of the poliovirus shall never be achieved. The media also went ahead to assert that the presence of Polio in the developing world was not new. This is because according to the media, the isolated cases of the virus are often ignored by the international community. Further reports indicated that the presence of polio in the developing world was a result of the pockets of the unimmunized population that encouraged the reestablishment of the transmission of the virus in countries where the indigenous strains had long been eradicated. Basically, the media played a crucial role in the emergency response especially as far as the dissemination of information to the international community was concerned.
2.3 Involved Parties
In response to the polio outbreak in Congo, an emergency response was mounted through the collaborative efforts that were mounted by the government of Congo which sought the assistance of international agencies such as the World Health Organization, United Nations Children and Education Fund, Rotary Club and the United States Centers for Disease Control and Prevention. The government of Congo played a critical role in determining the extent of the outbreak, the number of people who had been affected hence providing the aid agencies as to who was to be targeted during the vaccination program which was part of the emergency response plan.
During the launch of the first round of vaccination, the first Lady and the Minister of Health were present. The first round of vaccination was done using mono valent oral polio vaccine type 1 and was carried out in Pointe Noire and Kouilou in addition to 16 districts in Congo and Cabinda in Angola. The first round of vaccination targeted 1.3 million people of all ages in the aforementioned regions. On 3rd December, a second round of vaccination was carried out followed by a third round that was carried out in January. An analysis of the rounds of vaccination revealed that the first round of vaccination was highly successful with 105% of the set targets being attained.
The WHO , Rotary and CDC played a critical role in ensuring that the vaccination programme was successful by providing the funds, the vaccines and the experts who were needed to execute the program. It is estimated that about US $ 6.2 million was sourced and availed for the campaign in addition to about 1.7 million doses of polio vaccines. Denmark also contributed to the vaccination program through the provision of 5 million polio vaccines.
2.4 Political response to the outbreak
The government immediately launched an emergency response plan after results from laboratory samples collected from patients indicated that there was an outbreak of wild polio virus type 1. The social response entailed launching a round of national supplementary immunization activities that targeted the entire population of the republic of Congo. The first two rounds of immunization were carried out using mono valent type 1 oral polio vaccine and were carried out in November and December 2010 respectively. The third round was carried out in the period between January 11 and 15 of 2011 using bivalent oral polio vaccine type 1 and 3. The fourth round of immunization took place on 22-26 February 2011 using bivalent oral polio vaccine. International travelers were also advised to get a series of polio vaccination before travelling to the democratic republic of Congo. In addition to this, the countries neighbouring republic of Congo such as Angola were also included in the immunization programme.
2.5 Economic response to the outbreak
In order to successfully carry out immunization, it was necessary for the government of Congo to seek additional funding. The country has been marred by civil war for years hence lack proper economic frameworks to implement a programme of such magnitude. The international donor agencies contributed to a large extent in ensuring that the immunization programme was carried out successfully. The World Health Organization, the Rotary international, UNICEF and the US Center for Disease Control were some of the key financial supporters of the immunization programme and the emergency response plan. The vaccines were procured by UNICEF which ensured that the quality of vaccines was in accordance with the recommended standards.
2.6 Social response to outbreak
The success of any emergency health plan is dependent on the mobilization of the community and the implementation of the strong effective communication plans. The government of Congo mobilized community and religious leaders in order to ensure that news about the importance of immunization trickled down to all its citizens. This ensured that the targeted age groups were vaccinated and that news about any cases was conveyed to the relevant authorities in good time. It also ensured that the communities were more receptive of the immunization programme.
2.7 Factors affecting the implementation of the emergency response plan to the polio outbreak
The instability in the republic of Congo has to a large extent caused disruption of education. Therefore there is a shortage of qualified health personnel who are required to successfully implement such a programme. The international aid agencies therefore had to come with their own personnel in order to ensure that the immunization programme was carried out successfully which escalated the cost of the immunization programme. After the immunization, it is important to have regular screenings and surveillance activities in order to determine whether the spread of polio is contained. The lack of adequate numbers of local trained personnel hinders such activities from taking place as would be necessary.
The democratic republic of Congo has a poor health framework therefore lacks proper health facilities. Given that the vaccines often had to be transported to remote parts of the country, it was often a challenge to preserve the vaccination due to lack of refrigerators and electricity. It was also a challenge to transport them at times as a result of the breakdown of the vehicles that were available due to the poor infrastructure.
In the past 15 years, immunization programmes against polio have not taken place in the republic of Congo due to political instability. The country has a large number of refugees who often travel from one place to another therefore contributing to the spread of the wild type virus 1. This is one of the factors that contributed to the outbreak of wild type polio virus 1. There are no proper mechanisms for monitoring and predicting the occurrence of such outbreaks hence making it difficult to prepare and mount a response in advance.
3.0 Swot analysis of the outbreak
3.1 Strengths
The use of the oral polio vaccine was highly effective in curbing further spread of the wild type virus 1 in the democratic republic of Congo. It has been observed that in other parts of the world, the immunization efforts have led to a 90% reduction in the occurrence of polio cases. The intensified social mobilization efforts also bore fruit in the attainment of the set targets during the immunization programme. These efforts aided in the acceptance of the vaccination at community level since those who understood the importance of the immunization conveyed this information to those who did not fully understand the importance of the programme.
The mobilized community was also critical in keeping track of new infections therefore assisting the experts in mapping the vaccination efforts. The intensified efforts and participation of the government in the emergency response plan were key elements of the success of the programme. This was evident in the involvement of the Ministry of Health in releasing timely results of the laboratory findings and co-operation in the drafting of the emergency response plan to curb the polio outbreak. The ministry of health also provided the relevant support to the aid agencies in terms of the regions that were most affected and personnel who were required to make the immunization programme a reality. The strategic plans have not only been implemented in Congo but have also been implemented in Asia where they have been found to be highly effective in the reduction of the incidences of polio if mounted in a timely, well co-ordinated fashion.
3.2 Weaknesses
Security challenges were a hindrance in the implementation of the emergency response plan. The democratic republic of Congo has been at war for more than a decade with guerrillas taking over most parts of the country. Most parts of the country remain inaccessible due to the fact that health personnel fear for their lives hence do not venture into zones that are known to be the hub of guerrilla groups. In addition to this, the guerrillas have also been known to take the vaccines and restrict the access of the rest of the citizens in order to stay in control.
The instability in Congo has also hampered efforts to adequately manage the resources that were meant to be part of the response efforts. This is because there are no proper health facilities that can be used to store the vaccines hence carry out regular immunization. This would particularly be important in the democratic republic of Congo because the country experience a polio outbreak since there had been no immunization programme in the country for 15 years prior to occurrence of the outbreak.
3.3 Opportunities
There are lessons that can be learnt from the outbreak in Pointe Noire which occurred in 2010. These lessons are opportunities for mounting better, timely and well coordinated efforts elsewhere in the future. Funds need to be raised in order to ensure that efforts to eradicate polio run smoothly.
3.4 Threats
The gains that were made as a result of the immunization programme that was carried out in response to the outbreak in 2010 in Porte Noire may be reversed as a result of the following threats:
In order to successfully eradicate polio out a nation, an extensive surveillance network is required. The political instability in the nation makes it necessary for the citizens to migrate in search of more peaceful and habitable abodes. This threatens the efforts that have been put in place in order to report and curb the recurrence of polio in the country. It is also difficult to keep track of the patients health histories reflected in hospital records since the patients may have moved by the time the reports reach the relevant authorities. The technical assistance necessary for the implementation of the emergency response plan is also threatened by the insecurity. Technical assistance is a necessary aspect of curbing the spread of polio since they are required to monitor and survey their respective communities, raise awareness on the importance of immunization, plan and implement awareness campaigns in addition to managing supplies. Being in a central location for long periods of time is therefore necessary for any person who is part of a technical team responsible for mounting a response against person; which is made difficult by sporadic violence.
On rare occasion, the oral polio vaccine can mutate and take up the wild virus form. The viruses derived from the oral polio vaccine can be transmitted to other people. Cases of such viruses have been reported; in 2010, about 55 cases were reported. In future, it will be necessary to come up with other forms of vaccination in order to eliminate the occurrence of such cases. Oral polio vaccine has also been found ineffective in some instances hence the need for the several doses of immunization for an individual to be protected from polio infection. This has particularly been observed in northern India. This could prove to be a threat in the eradication of polio in the future. Paralysis is not often the end result of polio infection; about one out of 200 cases results in paralysis. Therefore there are many other cases that are asymptomatic. The disease can therefore be passed on from one individual to the next one without being detected.
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