Ethiopia remains susceptible to imported polio virus

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Though Ethiopia has remained polio free since April 2008, the country’s susceptibility to polio importation, particularly in border regions, remains a point of concern.

The Minister of Health, Tedros Adhanom (PhD), called upon Rotractors to reaffirm  their commitment to build a better image of Ethiopia, in a speech he made at the debriefing ceremony of Supplementary Immunization Activities held at the National Palace on October 21, 2012. 
“I am moved and delighted by the quality of work and support of Rotarians who have been deployed to Gambela and Assosa. Most of them have been coming back every year for the past 15 years. It  takes a lot of commitment. As Ethiopians, are we really contributing to our nation like Rotarians? I call upon all Rotractors to reaffirm  their commitment to our country in order to change its image,” said the Minister, visibly cheerful.      
Led by District Governor-Elect Ezra Teshome from Seattle, USA, every year for the past 15 years Rotarians from the US, Canada and Hawaii have been coming to Ethiopia benevolently, on their own initiative, covering their full expenses to help launch the national polio immunization campaign and raise money.
Ezra vowed to keep coming back to Ethiopia until polio is wiped out, and this year once again he came with his long friend Ralph Monroe who served as Secretary of State for the State of Washington on their 16th trip to Ethiopia.
This year 32 Rotarians from the US and Canada came along and were deployed to Gambela and Assosa to demonstrate the efforts of Rotarians to end polio worldwide.  Ezra Teshome, District 5030 Rotarian and District Governor-Elect 2013-2014, was recently awarded World Citizen and Polio Warrior, and is a leading member of Rotary International, which has relentlessly worked to eradicate polio from the earth than any organization.
Ezra and his group not only work on the immunization campaigns, but always involve in many other projects aimed at improving health and welfare in Ethiopia.
Polio is a crippling and potentially fatal disease that still threatens children in some parts of Africa and Asia. It can strike and cause physical damage at any age but mainly affects children under the age of five.
“Though Ethiopia has remained polio free since April 2008, achieved and maintained certification level surveillance performance indicators, and achieved steady improvement in immunization coverage, the immunity and surveillance gaps at the sub national level increases the country’s susceptibility to polio importation particularly in the bordering region of Somali, Afar, Benishangul Gumuz, and Gambela. The population immunity gaps along the neighboring boarder areas in countries such as Somalia, South Sudan, and Sudan, due to access, security, and seasonal challenges, coupled with frequent cross boarder movements pose further threats of potential epidemic diseases such as polio,” noted Khaled Bessaoud (Dr.), World Health Organization’s (WHO) representative in Ethiopia.
The last indigenous case of a wild polio virus in Ethiopia was reported 11 years ago. However, from 2004 to 2008, the country experienced five separate importations of the virus. The outbreaks were successfully interrupted and a polio free status has been maintained for more than four year now.
“The World Health Organization commends the Ethiopian Government’s commitment and efforts to achieve and maintain a polio free status over the past four years. The recent government effort to intensify cross border collaborative activities are highly acknowledged,” added the WHO representative. 
Four cross border meetings were held in August 2012 with Somalia, Sudan, South Sudan, Kenya, Djibouti and Somalia to strengthen collaborative efforts in surveillance, routine immunization, and synchronization of campaigns along the borders. Ethiopia shares a 6,000 kilometer long border with these five countries. These targeted cross border areas are noted to have relatively poor routine immunization coverage and poor surveillance indicators.
Dr. Tedros shares the fear of Ethiopia’s vulnerability to imported polio virus.   
“In addition to the lifestyle of the community, the population movement along these borders is so complex. The movement extends from Indian Ocean ports to the hinterlands of Ethiopia, from the African Great Rift Valley to the Kenyan central land escarpment. All these factors make the areas vulnerable to polio importation risk,” said the minister.
Furthermore, the Polio Technical Advisory Group for the Horn of Africa noted that the region is at a significant risk for polio outbreak. The high risk is attributed to a number of factors including the circulation of undetected wild polio virus and suboptimal routine immunization coverage, according to UNICEF.
In response to this threat, the World Health Assembly passed a resolution that declares polio eradication an emergency for global public health. The resolution calls for increased commitment and accountability by all member states and partners in the fight to end polio.
Although good progress had been made, Ethiopia ranks fifth on the list of countries in the world with large numbers of unvaccinated children.
To maintain polio free status and avert possible risks of importation, Ethiopia has planned to conduct supplementary sub national polio immunization activities from October to November 2012 in 23 high risk border regions of the country. This is expected to increase the countries immunity profile against the virus. The polio sub national immunization activity launched last week aims to reach 2.8 million children under the age of five.             
“It is our hope that these efforts will be closely monitored and momentum maintained to achieve the desired result,” concluded Bessaoud. 
Prior to the annual National Palace debriefing ceremony, the 32 visiting Rotarians from the US and Canada had immunized some 200 children, door to door in Gambela and Assosa.           
“There are many needs in our communities in terms of water, sanitation and literacy at all levels. Our mothers and children die every day of diseases that can be prevented… Rotarians are an amazing bunch of people who know that we cannot address all these challenges alone.
This is where the magic of Rotary is so enormous, that our brothers and sisters come to our assistance. In Rotary, we are one big family, that is why our friends from the US and Canada have come to help us, so that we can help our people,” stated Geeta Manek, Governor of Rotary District D9200, which is comprised of Kenya, Uganda, Ethiopia, Eritrea and South Sudan, in her speech at the palace.
Endemic wild polio has been eliminated from all but three countries in the world; Afghanistan, Nigeria, and Pakistan. Less than 170 cases were reported worldwide in 2012. The polio eradication effort is estimated to cost 40 to 50 billion USD.
“Only two countries in Africa have reported active polio viruses in 2012. This is a significant achievement compared to 2011, when 14 countries recorded active polio virus outbreaks mostly following importation from endemic countries,” said Khaled Bessaoud (Dr.).
In February 2012, the WHO removed India from the list of countries with active wild endemic polio virus, leaving only three countries with endemic polio virus; Nigeria, Pakistan, Afghanistan.
As of October 10, 2012, only 162 wild polio virus cases have been reported globally. Out of the total reported cases, 60 percent of them are in Nigeria and Chad.
Since the launch of the Global Polio Eradication Initiative in 1988, nearly six million potential disabilities due to polio have been averted. Through the tremendous efforts and investments of the initiative, the number of wild polio cases was reduced from 350 thousand in 125 countries to 650 cases in four endemic countries by the end of 2011, accounting for a 99 percent reduction in global incidences of polio according to the World Health Organization (WHO).
In 1985, Rotary International created PolioPlus, a program to immunize the world’s children against polio. Rotary has contributed more than 1.2 billion USD and countless volunteer hours to the protection of more than two billion children in 122 countries to date. It has recently raised an additional 200 million USD toward a 355 million USD challenge grant from the Bill and Melinda Gates Foundation. These efforts are providing much needed operational support, medical personnel, laboratory equipment, and educational materials for health workers and parents. In addition, Rotary has played a major role in decisions by donor governments to contribute over 8 billion USD to the effort.
“Though great progress has been made challenges remain. The overall quality of immunization campaigns must be improved and more funding is critically needed,” noted Past District Governor Tadesse Alemu (Dr.), National PolioPlus Committee Member presenting a speech on behalf of Past District Governor Nahusenaye Araya, Chairman of the National Polio+ Committee.