Wild polio returns to Africa: How the GPEI is helping stop an outbreak from becoming an inferno
In February 2022, a year and a half after the continent was declared indigenous wild poliovirus-free, the virus resurfaced in south-eastern Africa. As the Global Polio Eradication Initiative kicks off pledging to fund the 2022-2026 strategy, VaccinesWork dives into what exactly happened in Malawi and Mozambique, where eight children have been paralysed by an infectious threat that really isn’t over until it’s over everywhere.
In mid-February 2022, Dr Modjirom Ndoutabe, then the Polio Rapid Response Team Coordinator at the WHO Regional Office for Africa, was on mission in Senegal when he received an email that made his head spin. “I can say it seemed like the sky was falling in on our heads,” Dr Ndoutabe says.
Bad news in Dr Ndoutabe’s line of work is frequently heart-breaking: when polio manages to break through a community’s immunity ramparts, the breach is typically signalled by the paralysis of a child. While the February email did concern a paralysed child – a three-year-old girl living with her grandparents in a township in Lilongwe, Malawi, who had first fallen sick in November – it constituted bad news on another scale altogether.
Polio experts have long warned that polio spreading in one country is a threat worldwide. Fires throw sparks. COVID-19 has shown the world just how difficult it is to make national borders act as a limit to transmissible pathogens, and the poliovirus still circulating in Pakistan and Afghanistan was always only a plane-ride away.
What Dr Ndoutabe was staring at on his laptop screen, was a lab report specifying precisely which variety of poliovirus it was that had invaded the child’s nervous system. “I said, ‘My God – it’s true? Can it really be WPV1?’” Dr Ndoutabe recalls.
WPV1 stands for "wild poliovirus type 1," the last wild strain still at large in the world. In early 2022, as far as Dr Ndoutabe knew, wild polio had no business being anywhere on the African continent. A year and a half earlier, in August 2020, the WHO African Region had been declared wild polio-free, an achievement decades in the making.
For the wider world, it was a signal that the end was in sight. The virus's once-global province had officially narrowed to just two countries where transmission was ongoing: Afghanistan and Pakistan. But now, here it was in Malawi, of all places – a country which had last had a case of wild polio in 1992, and had seen no polio of any sort for a decade.
"We are dealing with cVDPV2 [elsewhere] in our region," explains Dr Ndoutabe, who served as interim Polio Coordinator for WHO AFRO between March and October of this year. He is referring to circulating vaccine-derived polio virus type 2, a variant of polio that originates from the weakened strain of the virus contained in the oral polio vaccine (OPV).
In rare instances, the weakened, safe virus contained in the oral vaccine can change genetically in the gastrointestinal tract of a child. If that child happens to belong to a community that is incompletely vaccinated, the altered vaccine-derived virus can spread , continuing to change as it hops from child to child.
Rarely, that virus winds up capable, like the wild virus, of causing paralysis – an uncommon but still alarming complication of a global vaccination campaign that has managed to stamp out 99.9% of polio since the 1980s.
Every outbreak, no matter its provenance, is a worry – but cVDPV2, says Dr Ndoutabe, is a more predictable adversary than its wild-born cousin. “We’re a little bit confident that we can stop it very, very quickly. But if we’re dealing with WPV1 imported, that means the situation is really, really very much worse.”
Fire-fighting in Malawi
Within just 24 hours of receiving notice from WHO that wild polio had been confirmed in Lilongwe, Malawi declared a national health emergency. Support – in the form of a team of Global Polio Eradication Initiative (GPEI) experts – touched down in Lilongwe within a couple more days.
"What we faced at this time is that Malawi has spent 20 or 30 years without any cases. So it was a big issue to implement the campaign over there – we had to make the training – supervisors, national," Dr Ndoutabe says.
That was true on the vaccination frontlines too. With a decade and a half of service under her belt, Chikondi Nenani of Phalombe district is a veteran of Malawi's Health Surveillance Assistant (HSA) corps – a cadre of more than 11,000 grassroots health workers charged by the Ministry of Health with looking after basic healthcare in the community, giving health talks, and referring more complex cases to clinics and hospitals. But with polio, she found herself on unfamiliar ground.
"This was the most touching thing in the 15 years of my community health career," Nenani says. "Of concern is the fact that this is a dangerous, contagious and incurable disease. I thought about the health of my children too – this development meant a big risk to them."
Dr Mike Chisema, Expanded Programme on Immunisation (EPI) Programme Manager in Malawi’s Ministry of Health called the recurrence “shocking, disappointing and frustrating”. And yet, as surprising as it was, polio experts have long warned that polio spreading in one country is a threat worldwide. Fires throw sparks. COVID-19 has shown the world just how difficult it is to make national borders act as a limit to transmissible pathogens, and the poliovirus still circulating in Pakistan and Afghanistan was always only a plane-ride away. To a perfectly immunised country, that would present no risk at all. But more than one country’s public health programmes suffered during the pandemic lockdowns, widening cracks in coverage – invisible pathways for contagion.
“Mozambique, it’s a very diverse, it’s a very huge country,” Hellström says. “It’s not that people are hesitant about vaccines. On the contrary, the challenge is reaching every child."
Genetic analysis of the sample isolated in the Lilongwe toddler had showed the virus belonged to a Pakistani strain of WPV1 traceable to Sindh province in 2019. In technical terms, that made it an imported case. But neither the Lilongwe child nor her family had travelled to Pakistan, indicating the virus had found its way to her via somewhere else in her community. Only one in 200 cases of polio results in paralysis, which means a single case of paralysis is, logically and also by polio-fighting convention, the tip of the otherwise asymptomatic iceberg – an outbreak all on its own. WPV1 had, in other words, probably been circulating quietly for some time.
What was clear was that the responsive vaccination drive needed to be quick, massive and meticulous. Nenani’s first assignment was to hold community sensitisation sessions to prepare families for the kind of granular immunisation drive that is day-to-day in Pakistan, and alien in Malawi.
On March 21, a nationwide door-to-door campaign targeting millions of children aged under five kicked off. Doreen Ali, Deputy Director of Preventive Health Services (Community) in Malawi’s Ministry of Health, says, “We didn’t want to miss any child. This was a bit hectic in the first round, because Malawians were not used to such an approach.”
In Phalombe district, Nenani shouldered a blue vaccine carrier bag containing 166 doses of vaccine, and walked from household to household, trying to ensure she reached every single child with polio drops. Then she did it again, each day, for five days. “The traditional leaders cleared us, but some sections of the community didn’t welcome us,” she remembers. “Some insulted us, some told us in the face that they didn’t want their child vaccinated. Too many vaccines have come at the same time, so some thought we wanted to give COVID-19 vaccines to their children.”
By the third round in August, she reports, attitudes were shifting. "Some could even call me to have their children vaccinated." Lokesh Sharma, UNICEF Vaccine Management Specialist in Malawi, echoes her. "Each round we are learning something, and based on our past experience, we are improving," he says.
But if the distance between Pakistan and Malawi didn't halt the virus, then the porous land borders between Malawi and its neighbouring countries would present little obstacle, Nenani understood. "At Mpasa Health Centre, we receive many disease cases of unimmunised children from Mozambique. Measles is the most prevalent one. Most of such children have never received any vaccinations. This got me thinking: polio could be worse," she says.
Embers in Mozambique
“We started vaccinating in Mozambique because it’s standard operating procedure when you have a case – neighbouring countries should vaccinate as well,” explained Jan-Marcus Hellström, Polio Team Lead for UNICEF in Mozambique. The hope was to head off viral spread from Malawi.
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But in May, the first case of WPV1-induced acute flaccid paralysis (AFP) was discovered in a child in Mozambique’s northern Tete province, close to both Malawi and Zimbabwe. Since then, several more paralysed children have turned up in the same region. Lab analysis has shown that the virus in all the Mozambican cases in the current outbreak have been genetically linked to the same Pakistani “parent” WPV1. “We can definitely say that we have an outbreak that is of great concern,” says Hellström.
Unlike Malawi, Mozambique’s routine immunisation programme has historically struggled to achieve near-universal coverage. That has a lot to do with the country’s geography, a challenge the outbreak response campaign has also had to confront. “Mozambique, it’s a very diverse, it’s a very huge country,” Hellström says. “It’s not that people are hesitant about vaccines. On the contrary, the challenge is reaching every child.
“In Tete, where we have the five cases, I was part of the case investigation for four of those samples. The minimum distance for somebody to get to the nearest health centre was a good, six to seven hours. And that’s with a child on the back. So people live in very remote areas. And of course, we have had rains, cyclones, which have made things even worse. I’ve been with vaccination teams that have walked three to four hours to vaccinate three kids, right? And at the same time, these vaccination teams have a target that they have to vaccinate x amount of children per day.”
In these conditions, it was impressive that by the end of August, the vaccination campaign spearheaded by the Mozambican Ministry of Health had reached some 8.6 million children under five with protective polio drops. But was that enough? Is it over? Hellström fears not.
"I am afraid there's a big chance that we will find more [cases]," he says. "At the same time, we're seeing that our vaccination campaigns are getting better and better round by round – so hopefully we will have stopped it by the end of the year."
“This polio eradication initiative is the best programme I did ever see in my short life,” says Dr Ndoutabe, now 61 years old. “Because there is a kind of support – that dedication at the global level and on the national level. You are not alone. I can see that solidarity.”
And still, he underscores, the threat won't truly be over until polio is defeated everywhere. That means getting ahead of the risk; damping the potential for flying sparks to spread fires. "Routine immunisation is what needs to happen. It needs to be consistent and it needs to happen every day, in a sustainable way." He speaks urgently: "We need to come up with ways to reach those children that live far from health centres, and we need to keep it going."
Keeping it going
It's been a long road. In 1988, the World Health Assembly announced a plan to eradicate polio by the year 2000. Progress against the virus was rapid – the graph line of global cases tumbled towards the turn of the millennium. But 2000 came, and the virus wasn't done yet.
That year, a young Chadian physician and public health specialist at the University of Côte D’Ivoire joined the polio eradication struggle. “Me, I started hoping at this time that we’ll finish polio very quickly – 2010, or something like that. And then I’d focus on my career at the university,” Dr Ndoutabe says. “In 2020: Africa is polio free – I hope that okay, I focus now to my research… Unfortunately, until now, I am still running after polio.”
This last year has been hard. He chuckles, “Once I open my computer, I am ready to be scared. I’ll say: ‘Oh my God! Will I have news of new cVDPV2 or WPV1?’”
But there is comfort in the commitment of his fellow polio fighters – a vast, branching, diverse mesh of people. “This polio eradication initiative is the best programme I did ever see in my short life,” says Dr Ndoutabe, now 61 years old. “Because there is a kind of support – that dedication at the global level and on the national level. You are not alone. I can see that solidarity.”
As the next phase of the global mission to end polio kicks off at this year’s World Health Assembly, that global dedication looks set to be tested. Like the ongoing WPV1 outbreak in south-eastern Africa, the discovery of cVDPVs in New York, London and Israel this year represent cold reminders that victory against the paralysing virus is far from guaranteed. As Hellström says, “I don’t see why we couldn’t see cases from Tete or Malawi [cropping up] all over the world. Until all children are safe, no children are safe, regardless of where they are.”
The immediate goal in south-eastern Africa is to halt circulation by the end of the year, which would mean, according to Dr Ndoutabe, "that we've cleaned the situation". In addition to Mozambique and Malawi, Tanzania and Zambia have all conducted responsive immunisation campaigns, with Zimbabwe to join their number soon.
For now, Ndoutabe says that he is confident that Malawi – where no further cases have been found – will have done enough to stop the virus. He's less optimistic about Mozambique, which has now recorded seven cases. Outbreak response assessments in October will tell him if he's right about that, he says.
Surveillance is being strengthened across the region, which also means that it’s possible that more cases – more paralysed children – will be found. “Of course it’s horrible when we do find more cases, but at the same time, it’s better to find the cases that are out there now than not to find them at all,” says Hellström. There is some funding available through GPEI to make the lives of the unlucky children a little easier – to provide for physiotherapy, for wheelchairs. “But of course they’re not doing great,” Hellström says of the children found this year in Mozambique. “I mean, it’s polio. They are paralysed, and there is no cure.”
Hellström – who has worked in Pakistan and Afghanistan as well as in Mozambique – says he’s seen more than his fair share of children paralysed by the viral infection at this point. “Each one is a tragedy, because it’s so easy to prevent.”
"Kama ilivyoelezwa hapo juu, ""Kama GPEI inasaidia kuzuia mlipuko wa polio kutoka kuwa moto, Februari 2022, mwaka mmoja na nusu baada ya bara hilo kutangazwa kuwa huru kutoka kwa virusi vya polio vya asili, virusi vilionekana tena kusini mashariki mwa Afrika.""" Kwa mujibu wa Global Polio Eradication Initiative (GPEI), mpango wa kuondoa polio unaoendelea nchini humo, hatua ya kwanza ni kuondoa polio nchini Malawi na Mozambique, ambapo watoto wanane wameathiriwa na ugonjwa huo ambao bado haujakamilika. Mnamo Februari 2020, Dk Modjiro Ndoutabé, ambaye wakati huo alikuwa Mratibu wa Timu ya Majibu ya Polio katika Ofisi ya Mkoa wa WHO ya Afrika, alikuwa akifanya kazi nchini Senegal alipopokea barua pepe iliyomfanya apige pande zote. "Naweza kusema ilionekana kama anga lilikuwa likishuka juu ya vichwa vyetu", Daktari Ndoutabe anasema. Habari mbaya katika kazi ya Dk Ndoutabé ni mara nyingi ya kuvunja moyo: wakati polio inashinda kuvunja kuta za kinga za jamii, uvunjaji huo kwa kawaida huashiria kupooza kwa mtoto. Ingawa barua pepe ya Februari ilihusu mtoto aliyepooza - msichana wa miaka mitatu anayeishi na babu na nyanya zake katika mji wa Lilongwe, Malawi, ambaye alikuwa amekuwa mgonjwa kwa mara ya kwanza mnamo Novemba - ilikuwa habari mbaya kwa kiwango kingine kabisa. Wataalamu wa polio wamekuwa wakionya kwa muda mrefu kwamba kuenea kwa polio katika nchi moja ni tisho ulimwenguni pote. Moto hutokeza miali. COVID-19 imeonyesha ulimwengu jinsi ilivyo ngumu kufanya mipaka ya kitaifa iwe kikomo kwa vimelea vinavyosambazwa, na virusi vya polio ambavyo bado vinazunguka Pakistan na Afghanistan vilikuwa safari ya ndege tu. Ndoutabé alikuwa akitazama ripoti ya maabara iliyoonyesha ni aina gani ya virusi vya polio vilivyoingia kwenye mfumo wa neva wa mtoto huyo. Nilisema, Mungu wangu ni kweli? Je, kweli inaweza kuwa WPV1? <unk> Dr Ndoutabe anakumbuka. "WFPV1 ni kifupi cha ""Wild poliovirus type 1,"" aina ya mwisho ya polio duniani." Kwa mujibu wa Dk Ndoutabé, ugonjwa wa polio haukuwa na nafasi ya kuenea katika bara la Afrika. Mwaka mmoja na nusu kabla ya hapo, Agosti 2020, Mkoa wa Afrika wa WHO ulitangazwa kuwa hauna polio ya mwituni, mafanikio ambayo yalitarajiwa kwa miongo kadhaa. Kwa ulimwengu mzima, ilikuwa ishara kwamba mwisho ulikuwa karibu. Mkoa wa virusi uliokuwa wa kimataifa kwa wakati mmoja ulikuwa umepunguzwa rasmi hadi nchi mbili tu ambapo maambukizi yalikuwa yakiendelea: Afghanistan na Pakistan. Lakini sasa, hapa ilikuwa ni Malawi, ya maeneo yote - nchi ambayo mara ya mwisho alikuwa na kesi ya polio ya mwituni katika 1992, na hakuwa na kuona polio ya aina yoyote kwa muongo mmoja. "Tuna kushughulika na cVDPV2 [mahali pengine] katika mkoa wetu, ""anaeleza Dk Ndoutabé, ambaye alihudumu kama Mratibu wa Kipolio wa mpito kwa WHO AFRO kati ya Machi na Oktoba mwaka huu." "Hii ni kwa sababu ya kuenea kwa virusi vya polio vya aina ya 2 vinavyotokana na chanjo, aina ya virusi vya polio vinavyotokana na aina ya virusi vilivyopunguzwa nguvu vinavyopatikana katika chanjo ya polio ya mdomo (OPV).""" Katika visa vichache, virusi vilivyo dhaifu na salama vilivyo katika chanjo ya mdomo vinaweza kubadilika kwa maumbile katika mfumo wa tumbo la mtoto. Ikiwa mtoto huyo anafanyika kuwa wa jamii ambayo haija chanjo kabisa, virusi vilivyobadilishwa vinaweza kuenea, na kuendelea kubadilika wakati vinapopiga kutoka kwa mtoto hadi mtoto. Kwa mara nyingine, virusi hivyo vinaweza kusababisha kupooza, jambo lisilo la kawaida lakini linaloogopesha kutokana na kampeni ya chanjo ya kimataifa ambayo imefaulu kuondoa asilimia 99.9 ya polio tangu miaka ya 1980. Kila janga, bila kujali chanzo chake, ni wasiwasi, lakini cVDPV2 ni mpinzani unaotabirika zaidi kuliko binamu yake aliyezaliwa porini. "Tuna uhakika kidogo kwamba tunaweza kuizuia haraka sana. "Wakati huo huo, ""Wakili Mkuu wa WHO, Dr. Robert W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W. W Msaada - katika fomu ya timu ya wataalamu wa Global Polio Eradication Initiative (GPEI) - ulifika Lilongwe ndani ya siku chache zaidi. "Kama ilivyoelezwa hapo juu, Malawi imekuwa na miaka 20 ya ""kuendelea"" bila magonjwa." Kwa hiyo ilikuwa suala kubwa kutekeleza kampeni huko <unk> tulilazimika kufanya mafunzo <unk> wasimamizi, kitaifa, "Dr Ndoutabe anasema. Hilo lilikuwa kweli pia katika mstari wa mbele wa chanjo. Kwa miaka kumi na nusu ya huduma yake, Chikondi Nnenani wa wilaya ya Phalombe ni mkongwe wa Kikosi cha Msaidizi wa Uangalizi wa Afya (HSA) cha Malawi - kikosi cha wafanyikazi wa afya zaidi ya 11,000 waliowekwa na Wizara ya Afya kwa utunzaji wa msingi wa afya katika jamii, kutoa mazungumzo ya afya, na kuelekeza kesi ngumu zaidi kwa kliniki na hospitali. Lakini kwa sababu ya polio, alijikuta katika hali isiyojulikana. "Hii ndiyo iliyokuwa hatua ya kwanza katika miaka 15 ya kazi yangu ya afya ya jamii,"" anasema Nenani." "Kichocheo ni ukweli kwamba hii ni ugonjwa hatari, wenye kuambukiza na usioweza kuponywa. Nilifikiria pia afya ya watoto wangu - maendeleo haya yalimaanisha hatari kubwa kwao." Mike Chisema, Mkurugenzi wa Programu ya Kuongeza chanjo (EPI) katika Wizara ya Afya ya Malawi, aliita tukio hilo kuwa "la kushangaza, lenye kukatisha tamaa na lenye kukatisha tamaa". Hata hivyo, kwa kushangaza, wataalamu wa polio wamekuwa wakionya kwa muda mrefu kwamba kuenea kwa polio katika nchi moja ni tisho ulimwenguni pote. Moto hutokeza miali. COVID-19 imeonyesha ulimwengu jinsi ilivyo ngumu kufanya mipaka ya kitaifa iwe kikomo kwa vimelea vinavyosambazwa, na virusi vya polio ambavyo bado vinazunguka Pakistan na Afghanistan vilikuwa safari ya ndege tu. Kwa nchi iliyo na chanjo kamili, hiyo haingekuwa na hatari yoyote. Lakini programu za afya ya umma za nchi zaidi ya moja zilihitaji wakati wa kufungwa kwa janga hilo, kupanua nyufa katika chanjo - njia zisizoonekana za maambukizi. "Mozambique, ni nchi yenye utofauti mkubwa, ni nchi kubwa sana", Hellström anasema. Si kwamba watu wanashuku kuhusu chanjo. Kinyume chake, changamoto ni kufikia kila mtoto". Uchunguzi wa maumbile ya sampuli iliyopatikana katika mtoto huyo wa Lilongwe ulionyesha kuwa virusi hivyo ni vya aina ya virusi vya virusi vya corona vya Pakistan, aina ya WPV1 na vilitokana na jimbo la Sindh mwaka 2019. Kwa maneno ya kiufundi, hilo lilifanya iwe kesi iliyoletwa nje. Lakini mtoto huyo wa Lilongwe na familia yake hawakuwahi kusafiri kwenda Pakistan, ikionyesha kwamba virusi hivyo vimepata njia ya kumfikia kupitia sehemu nyingine katika jamii yake. "Kama matokeo, moja tu kati ya kesi 200 za polio husababisha kupooza, ambayo inamaanisha kesi moja ya kupooza ni, kwa mantiki na pia kwa mkataba wa kupambana na polio, ncha ya barafu isiyo na dalili - mlipuko peke yake. """ Kwa mfano, WPV1 ilikuwa imesambazwa kwa muda mrefu. "Kilikuwa wazi kwamba kampeni ya chanjo ya haraka inahitaji kuwa ya haraka, kubwa na ya uangalifu. """ Kazi ya kwanza ya Nenani ilikuwa kuandaa vikao vya uhamasishaji wa jamii ili kuandaa familia kwa aina ya kampeni ya chanjo ya granular ambayo ni ya kila siku nchini Pakistan, na mgeni nchini Malawi. Machi 21, kampeni ya nyumba kwa nyumba ya watoto chini ya umri wa miaka mitano ilianza. Doreen Ali, Naibu Mkurugenzi wa Huduma za Afya za Kuzuia (Jumuiya) katika Wizara ya Afya ya Malawi, anasema, "Hatukutaka kukosa mtoto yeyote. "Hii ilikuwa ni hatua ya kwanza ya kuanzisha kampeni ya kuondoa chanjo ya polio, ambapo mwanaharakati wa Malawi, Nenani, alibeba mfuko wa bluu wenye chanjo 166 na kutembea kutoka nyumba moja hadi nyingine, akijaribu kuhakikisha kuwa anafikia kila mtoto na matone ya chanjo ya polio. """ Kisha akafanya hivyo tena, kila siku, kwa siku tano. "Viongozi wa jadi walituachilia, lakini baadhi ya vikundi vya jamii havikutukaribisha", anakumbuka. <unk>Wengine walitukosea, wengine walituambia usoni kwamba hawataki mtoto wao apewe chanjo. """Vaccin nyingi sana zimekuja kwa wakati mmoja, kwa hivyo wengine walidhani tunataka kuwapa watoto wao chanjo za COVID-19,"" alisema, akiri kwamba kufikia raundi ya tatu mnamo Agosti, mitazamo ilikuwa ikibadilika." "Wengine wangeweza hata kuniita ili watoto wao wapate chanjo". Lokesh Sharma, Mtaalamu wa Usimamizi wa Chanjo wa UNICEF nchini Malawi, anaelezea jinsi alivyofanya hivyo. "Kila mzunguko tunajifunza jambo fulani, na kwa kutegemea uzoefu wetu wa zamani, tunaendelea kuboresha", asema. Lakini ikiwa umbali kati ya Pakistan na Malawi haukuzuia virusi, basi mipaka ya ardhi iliyo na vifusi kati ya Malawi na nchi jirani itakuwa kikwazo kidogo, Nenani alielewa. "Katika Kituo cha Afya cha Mpasa, tunapokea visa vingi vya magonjwa ya watoto wasio na chanjo kutoka Msumbiji. Ugonjwa wa surua ndio unaoenea zaidi. Wengi wa watoto hao hawajawahi kupatiwa chanjo yoyote. Jambo hilo lilinifanya nifikirie: polio yaweza kuwa mbaya zaidi", asema. "Tulianza chanjo nchini Msumbiji kwa sababu ni utaratibu wa kawaida wa uendeshaji wakati una kesi, nchi jirani zinapaswa chanjo pia, ""alieleza Jan-Marcus Hellström, kiongozi wa timu ya polio kwa UNICEF nchini Msumbiji." Tumaini lilikuwa kuzuia kuenea kwa virusi kutoka Malawi. Je, umesoma? Katika mwezi Mei, ugonjwa wa ugonjwa wa kupooza kwa sababu ya virusi vya corona (WFP1) uligunduliwa kwa mara ya kwanza katika mtoto mmoja katika jimbo la Tete kaskazini mwa Msumbiji, karibu na Malawi na Zimbabwe. Tangu wakati huo, watoto wengine kadhaa waliopooza wamepatikana katika eneo hilo. Uchunguzi wa maabara umeonyesha kuwa virusi katika visa vyote vya Msumbiji katika mlipuko wa sasa vimeunganishwa kwa maumbile na mzazi mmoja wa Pakistan, WPV1. "Tunaweza kusema kwa hakika kwamba tuna mlipuko ambao ni wa wasiwasi mkubwa", anasema Hellström. Tofauti na Malawi, mpango wa chanjo ya kawaida wa Msumbiji kwa historia umepambana kufikia chanjo ya karibu ya ulimwengu. Hii inahusiana sana na eneo la nchi, changamoto ambayo kampeni ya kukabiliana na mlipuko pia imepaswa kukabiliana nayo. "Mozambique, ni nchi yenye utofauti mkubwa, ni nchi kubwa sana", Hellström anasema. Si kwamba watu wanashuku kuhusu chanjo. Kinyume chake, changamoto ni kufikia kila mtoto. <unk> Katika Tete, ambapo tuna kesi tano, nilikuwa sehemu ya uchunguzi wa kesi kwa nne ya sampuli hizo. Kwa mfano, umbali wa mtu kwenda kituo cha afya cha karibu ni masaa sita hadi saba. Na hiyo ni na mtoto nyuma. Kwa hiyo watu huishi katika maeneo ya mbali sana. Na kwa kweli, tumekuwa na mvua, vimbunga, ambavyo vimefanya mambo yawe mabaya zaidi. """Nimekuwa na timu za chanjo ambazo zimetembea kwa masaa matatu hadi manne ili chanjo watoto watatu." "Tumekuwa tukifanya kazi kwa bidii sana na tumeweza kuwapa chanjo watoto wengi zaidi ya milioni moja kwa siku, lakini kwa mujibu wa ripoti ya Wizara ya Afya ya Msumbiji, ""mpaka mwisho wa Agosti, kampeni ya chanjo ilikuwa imewafikia watoto milioni 8.6 chini ya miaka mitano kwa matone ya polio.""" Lakini je, hilo lilitosha? Je, imekwisha? Hellström haogopi. "Ninaogopa kuna uwezekano mkubwa kwamba tutapata [kasusi] zaidi", asema. "Wakati huo huo, tunaona kwamba kampeni zetu za chanjo zinazidi kuwa bora na bora mzunguko kwa mzunguko <unk> kwa hivyo tunatumaini kuwa tutaizuia ifikapo mwisho wa mwaka.""" "Hatua hii ya kuondoa polio ni mpango bora zaidi ambao nimewahi kuona katika maisha yangu mafupi,"" anasema Dk Ndoutabe, ambaye sasa ana umri wa miaka 61. <unk>Kwa sababu kuna aina ya msaada <unk> kwamba kujitolea katika ngazi ya kimataifa na katika ngazi ya kitaifa. Wewe si peke yako. Ninaweza kuona mshikamano huo. <unk> Na bado, yeye anasisitiza, tishio halitakuwa kweli juu mpaka polio imeshindwa kila mahali. Hiyo inamaanisha kuepuka hatari; kupunguza uwezekano wa mienge kuruka kuenea moto. "Kujitahidi kuwa na chanjo ya kawaida ni jambo la lazima." Ni lazima iwe thabiti na inahitaji kutokea kila siku, kwa njia endelevu. " "Amesema: ""Tunahitaji kutafuta njia za kuwafikia watoto wanaoishi mbali na vituo vya afya, na tunahitaji kuendelea kufanya hivyo." Kuendelea na safari hii imekuwa ni safari ndefu. Mwaka 1988, Mkutano wa Afya Ulimwenguni ulitangaza mpango wa kuondoa polio kufikia mwaka 2000. Maendeleo dhidi ya virusi yalikuwa ya haraka <unk> mstari wa grafu ya kesi za kimataifa ulipungua kuelekea mwanzo wa milenia. Lakini mwaka 2000 ulipofika, virusi hivyo havikuwa vimekwisha. Mwaka huo, daktari mchanga wa Chad na mtaalamu wa afya ya umma katika Chuo Kikuu cha Côte d'Ivoire alijiunga na mapambano ya kuondoa polio. "Mimi, nilianza kutumaini wakati huu kwamba tutaimaliza polio haraka sana ""2010, au kitu kama hicho. Na kisha ningekazia fikira kazi yangu katika chuo kikuu, "Dakt. Ndoutabe anasema. """Ninaamini kwamba Afrika itakuwa huru kutoka kwa polio, lakini kwa sasa ninaendelea na utafiti wangu, lakini kwa bahati mbaya, bado ninaendelea na polio." Yeye hukata kelele, <unk>Mara ninapofungua kompyuta yangu, niko tayari kuogopa. Nitasema: 'Ee Mungu wangu! "Ameongeza kuwa ""hakuna habari za cVDPV2 au WPV1 mpya, lakini kuna faraja katika kujitolea kwa wapiganaji wenzake wa polio, mtandao mkubwa, wa matawi, wa watu tofauti.""" "Hatua hii ya kuondoa polio ni mpango bora zaidi ambao nimewahi kuona katika maisha yangu mafupi,"" anasema Dk Ndoutabe, ambaye sasa ana umri wa miaka 61. <unk>Kwa sababu kuna aina ya msaada <unk> kwamba kujitolea katika ngazi ya kimataifa na katika ngazi ya kitaifa. Wewe si peke yako. """Ninaona mshikamano huo, wakati awamu ijayo ya ujumbe wa kimataifa wa kukomesha polio ikianza katika Mkutano wa Afya Ulimwenguni mwaka huu, kujitolea kwa ulimwengu kunaonekana kuwa kumepimwa." Kama ilivyo na janga la sasa la virusi vya corona katika Afrika ya Kusini-Mashariki, uvumbuzi wa virusi vya corona huko New York, London na Israel mwaka huu unawakilisha ukumbusho wa baridi kwamba ushindi dhidi ya virusi vya ugonjwa huo haujahakikishwa. Kama Hellström anavyosema, "Sioni kwa nini hatuwezi kuona kesi kutoka Tete au Malawi [kujitokeza] ulimwenguni kote. "Hata watoto wote hawawezi kuwa salama, hakuna mtoto aliye salama, bila kujali yuko wapi.""Lengo la sasa katika kusini mashariki mwa Afrika ni kukomesha mzunguko wa damu kufikia mwisho wa mwaka, ambayo inamaanisha, kulingana na Dk Ndoutabé, ""tumeondoa hali hiyo.""" Kwa kuongezea Msumbiji na Malawi, Tanzania na Zambia zote zimefanya kampeni za chanjo, na Zimbabwe itajiunga nao hivi karibuni. Kwa sasa Ndoutabé anasema ana uhakika kwamba Malawi - ambapo hakuna kesi nyingine zilizopatikana - itafanya vya kutosha kuzuia virusi hivyo. Lakini, kwa upande wake, amesema kuwa hali ya afya nchini Msumbiji, ambayo imeripotiwa kuwa na visa saba vya maambukizi, haijabadilika. "Mapimio ya majibu ya milipuko ya ugonjwa wa corona ya Oktoba yatamwambia kama ana haki kuhusu hilo, ""alisema." Ufuatiliaji unaimarishwa katika eneo hilo, ambayo pia inamaanisha kuwa inawezekana kwamba kesi zaidi - watoto zaidi waliopooza - watapatikana. "Bila shaka ni jambo la kutisha tunapopata visa vingi, lakini wakati huohuo, ni bora kupata visa ambavyo viko nje sasa kuliko kutovipata kabisa", anasema Hellström. Kuna fedha zinazopatikana kupitia GPEI ili kufanya maisha ya watoto wasio na bahati kuwa rahisi <unk> kutoa matibabu ya mwili, kwa viti vya magurudumu. "Lakini bila shaka hawafanyi vizuri sana", Hellström anasema kuhusu watoto waliopatikana mwaka huu nchini Msumbiji. Namaanisha, ni polio. "Hali hiyo imesababisha kuharibika kwa maisha ya watoto wengi, na Hellström, ambaye amefanya kazi nchini Pakistan na Afghanistan na pia nchini Msumbiji, anasema amewahi kuona watoto wengi waliopooza kutokana na maambukizi ya virusi hivi.""" "Kila moja ni msiba, kwa sababu ni rahisi sana kuzuia".