Low vaccination rate causes polio outbreaks in Sudan and Yemen

A UN employee vaccinates against polio at a clinic in Gaza's Bureij refugee camp on September 9.MOHAMMED ABED / AFP

After the official eradication of wild poliovirus from Africa on August 25, only two countries remain in the world, Afghanistan and Pakistan, where it continues to circulate.

However, two new outbreaks of polio derived from the vaccine virus, in Sudan and Yemen, remind us that the long battle against this disease is not over yet and that the difficulties of movement of health workers and, therefore, the casualties Vaccination rates due to armed conflicts and now due to the covid-19 pandemic pose a risk against the outbreak of other diseases.

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The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have warned this Friday, through a statement, that these two outbreaks, "the first of polio in the era of covid-19 in this region ”, are directly related to the difficulties in providing healthcare in conflict and unstable areas.

"The pandemic has caused a serious decline in vaccination rates and has increased interruptions in health care, which were already occurring due to instability and armed conflict," they say.

The oral polio vaccine, which is given to children under the age of five, contains an attenuated form of the virus that activates the immune system.

This pathogen is excreted by minors and, in places with poor sanitation, helps it reach other children through faeces and further strengthens their immunity.

However, in those areas where there is a low vaccination rate, the virus does not end up disappearing but circulates for a long time and, on occasions, can mutate and re-develop the capacity to produce paralysis.

This is the vaccine-derived polio that is now affecting Sudan and Yemen.

The two outbreaks have similar contexts.

In the Sudanese case, which experienced the last case of wild polio in 2009, vaccination efforts face challenges such as population displacement, both those that are the result of nomadism and those that have their origin in armed conflicts, and the existence of areas that health workers cannot reach due to violence.

In Yemen, the new cases are concentrated in a single area, Sa'adah governorate in the north-west of the country, which has been inaccessible to the polio vaccination program for two years due to the war.

"The covid-19 has come to worsen the situation, but the problems of access to children were there since before and have worsened in the last two years," says Juliette Touma, spokesperson for UNICEF in the Middle East and North Africa.

“Whether it is wild polio or polio derived from the vaccine, the only option we have to end it is through immunization and for that we have to reach all corners, all children.

We are launching a warning message: if humanitarians who have the knowledge and experience to vaccinate cannot arrive, polio knows no borders and will continue to resist ”, he adds.

The Government of Sudan has just signed a peace agreement with five rebel groups with which it was fighting in various regions, such as Darfur, the Blue Nile and South Kordofan, and the UNICEF spokesperson hopes that this pact will make things easier.

“Any peace treaty is welcome if it allows us to access children and improve their health.

We are hopeful, ”says Touma, for whom the polio outbreaks in Sudan and Yemen are an example of how other diseases cannot be neglected in the COVID-19 period.

“It is also water, sanitation, healthcare.

The parties in conflict must let us do our work and this is critical in times of pandemic ”, he concludes.