The Death of a Disease: A History of the Eradication of Poliomyelitis

12. The End Game

The End Game 123 123 12 The End Game Kenya and Sudan, November 2000 and India, January 2001 Lokichoggio, Kenya, Saturday, November 18, 2000. The UNICEF cold room is buzzing with activity. It has been set up in a tent at the camp the United Nations uses as its base for the Lifeline Sudan operation. From here, UNICEF and nongovernmental organizations provide assistance to some 5.4 million inhabitants of southern Sudan, amid the ravages of the African continent’s oldest civil war. UNICEF employees load large ice boxes filled with oral polio vaccines into trucks. The containers will be transferred to five airplanes, not far from the camp, which fly the United Nations colors. The planes are scheduled to leave the next morning for over eighty landing strips in southern Sudan. Sudan, a country of 23 million inhabitants, is about onequarter the size of the United States. It was the arena of armed conflicts from its independence in 1955 until 1972. Civil war broke out in 1983 and has not abated since. The southern part of the country is in conflict with the ruling powers in Khartoum, where a military dictatorship promulgating an Islamic government took over after a coup d’état 124 The Death of a Disease in 1989. Nearly two million people have lost their lives, and more than twice as many have been displaced. The situation is complicated by the fact that the rebel zone is shared by many rival groups of militia. Southern Sudan is one of the ten priority target areas identified by the WHO to bring the number of cases of poliomyelitis to zero. Five of these target areas are in countries where war has kept children from being immunized: Sudan, Angola, the Democratic Republic of the Congo, Somalia, and Afghanistan. The five other countries are considered “reservoirs” because they are characterized by a combination of high population density, poor sanitation, and very low immunization coverage: India, where over one half of all cases worldwide occur, Bangladesh, Ethiopia, Nigeria, and Pakistan. It is in these ten countries that the “end game,” as the WHO calls it, is being played out—the home stretch in the race to eradicate polio. If the virus continues to circulate in just one outlying village, or just one overpopulated slum in just one of these countries, it can be spread by travelers to the entire world. In the last decade of the twentieth century, polio epidemics broke out in many war-torn parts of the globe: in Chechnya in 1995 (150 cases); in Iraq after the Gulf War and then again in 1999 in the northern part of the country; in Albania in 1996, whence it spread to Kosovo and Greece; in Sudan; and, most seriously, in Angola in 1999. From March 1 to May 28, 1999, Angola suffered the worst polio epidemic ever seen in Africa. In and around the capital, Luanda, 1,093 cases were reported. More than 80 of them were fatal. On November 19 and 20, 2000, new National Immunization Days were organized in southern Sudan. The dates were negotiated with the secessionist leaders and the authorities in Khartoum. Bombing ceased and the United Nations planes carrying vaccines were able to take off. The End Game 125 The vaccines airlifted from Lokichoggio were part of Aventis Pasteur’s donation of 50 million doses of oral vaccine presented to the WHO on October 11, 1999. These vaccines are being supplied over a three-year period for the National Immunization Days in five war-torn African countries : Sudan, Angola, Liberia, Sierra Leone, and Somalia. This is an example of the effectiveness of partnerships that are forged within the framework of the Global Polio Eradication Initiative. According to Michel Gréco, deputy CEO of sanofiaventis , “This is how Aventis Pasteur is expressing its solidarity with the WHO in its fight to eradicate polio from the globe. We hope that our contribution will encourage all those involved in eradication to continue their efforts. If industry can make a donation, there is no reason why others can’t do the same. For our donation to have a more dramatic impact , we have targeted five African countries who are in dire need of foreign help because they are being completely destroyed by war.” The partnership with the vaccine industry goes well beyond donations. The polio eradication campaign was launched in a context where a new kind of relationship...