History Has Been Made. Female Genital Mutilation Banned In Nigeria.


“More than 130 million girls and women have experienced female genital mutilation or cutting …”

 

Nigeria made history by outlawing female genital mutilation. The ban falls under the Violence Against Persons (Prohibition) Act 2015 that was passed in Senate on May 5 and recently enacted into law.

This was one of the last acts by the outgoing president, Goodluck Jonathan. His successor, Muhammadu Buhari, was sworn into office this past Friday, May 29.

 Female genital mutilation or cutting (FGM/C) is the act of either partially or totally removing the external female genitalia or causing injury to the female genital organs for non-medical purposes.

According to UNICEF:

“More than 130 million girls and women have experienced FGM/C in 29 countries in Africa and the Middle East where the practice is most common.”

With the help of community activism, campaigns and numbers of organizational efforts to end this practice, UNICEF reported that teenage girls were now one-third less likely to undergo FGM/C today than 30 years ago.

Now with the new law criminalizing this procedure, the hope is the ban will fully eliminate this practice and be strongly enforced to combat any existing societal pressures.

The World Health Organization cites immediate harmful effects of FCM/C that include hemorrhage (bleeding), bacterial infection, open sores, and long-term consequences that include infertility, childbirth complications and recurring bladder infections.

In another UNICEF report, communities who practice FGM often do so to reduce sexual desire in women and to initiate girls to womanhood, among other purposes.

According to “The Guardian‘s” analysis of 2014 UN data, a quarter of the women in Nigeria have undergone FGM.

Stella Mukasa, director of Gender, Violence and Rights at the International Center for Research on Women, explains the complexity of the implementation of the new law banning FGM/C.

“It is crucial that we scale up efforts to change traditional cultural views that underpin violence against women,” she wrote in an article for “The Guardian.” “Only then will this harmful practice be eliminated.”

Under hashtag #VAPPBIll, Twitter users celebrated the bill’s passing.

 

 

 

 

 

 

The Violence Against Persons (Prohibition) Act serves to protect women and violence in multiple aspects. BuzzFeed News cited a 2013 version of the bill that highlights its purpose to eliminate violence both in private and public, and end physical, sexual, domestic and psychological violence.

Ebola – This Is What You Are NOT Being Told.


There is something very, very important that the corporate media and public health officials are not telling you regarding the Ebola outbreak in west Africa.

The information I’m about to present here is frightening. There’s really no way around that. However, I request that you do your very best to maintain a calm state of mind. Right now in West Africa the worst Ebola outbreak in history is in full swing and is jumping borders at an alarming rate. Already it has spread to four countries, Guinea, Liberia, Sierra Leone and now Nigeria.

This latest jump into Nigeria is particularly serious since the infected individual carried the virus by plane to Lagos Nigeria, a city with a population of over 21 million. Doctors without borders has referred to the outbreak as “out of control”.

To make matters worse, there is something very, very important that the corporate media and public health officials are not telling you regarding this crisis. You’ll notice if you read virtually any mainstream article on the topic that they make a point of insisting that Ebola is only transferred by physical contact with bodily fluids.

This is not true, at all. A study conducted in 2012 showed that Ebola was able to travel between pigs and monkeys that were in separate cages and were never placed in direct contact. Though the method of transmission in the study was not officially determined, one of the scientists involved, Dr. Gary Kobinger, from the National Microbiology Laboratory at the Public Health Agency of Canada, told BBC News that he believed that the infection was spread through large droplets that were suspended in the air.

“What we suspect is happening is large droplets; they can stay in the air, but not long; they don’t go far,” he explained. “But they can be absorbed in the airway, and this is how the infection starts, and this is what we think, because we saw a lot of evidence in the lungs of the non-human primates that the virus got in that way.”

Someone pointed out that in medical terms, if the virus is transferred through tiny droplets in the air this would technically not be called an “airborne virus”. Airborne, in medical terms would mean that the virus has the ability to stay alive without a liquid carrier. On one hand this is a question of semantics, and the point is well taken, but keep in mind that the study did not officially determine how the virus traveled through the air, it merely established that it does travel through the air. Doctor Kobinger’s hypothesis regarding droplets of liquid is just that, a hypothesis. For the average person however what needs to be understood is very simple: if you are in a room with someone infected with Ebola, you are not safe, even if you never touch them or their bodily fluids, and this is not what you are being told by the mainstream media. Essentially I am using the word “airborne” as a layman term.

Now I’m not going to speculate as to whether these so called “journalist” and public health agencies who keep repeating the official line regarding the means of transmission are lying, or are just participating in some massive display of synchronized incompetence, but what I will say, is that this shoddy reporting is most likely getting people killed right now, and may in fact put all of humanity in danger.

How so? By convincing people that the virus cannot travel through air, important precautions that could reduce the spread of the virus are not being taken. For example the other passengers on the plane that traveled to Lagos, Nigeria were not quarantined.

According to the AP and the BBC, Patrick Sawyer, the Ebola infected man who traveled to Lagos Nigeria by plane, passed the disease on to eight health workers before being properly isolated. Nigerian health authorities acknowledged Tuesday that they did not immediately quarantine a sick airline passenger who later died of Ebola, announcing that eight health workers who had direct contact with him were now in isolation with symptoms of the disease. In spite of the seriousness of this disease, and in spite of the fact the fact that the BBC itself covered a study in 2012 that demonstrated that Ebola can spread through the air, no one in the corporate media has budged from the official line regarding transmission.

The AP’s spin on it: Experts say people infected with Ebola can spread the disease only through their bodily fluids and after they show symptoms. From CNN: Ebola spreads through contact with organs and bodily fluids such as blood, saliva, urine and other secretions of infected people. And from the BBC itself in their article describing the second confirmed case in Nigeria: The virus spreads by contact with infected blood and bodily fluids – and touching the body of someone who has died of Ebola is particularly dangerous. To put this into context, Ebola kills between 50% and 90% of its victims, so the stakes are very, very high here.

We have reported on the fact that Ebola can spread through the air in three separate articles since March of 2014, here, here and here, however the corporate media has continued to misrepresent the vectors of transmission.

IMPORTANT UPDATE: August 13th: The CDC has admitted that the Ebola virus can travel through air, but they made that admission in a very sneaky and hard to find manner. The following statement is added as a footnote at the very bottom of the page: Casual contact is defined as a) being within approximately 3 feet or within the room or care area for a prolonged period of time while not wearing recommended personal protective equipment or having direct brief contact (e.g., shaking hands) with an EVD case while not wearing recommended personal protective equipment. The implication of this statement is very, very clear: Ebola DOES in fact travel through the air. This is critical information and it should be highlighted in large letters on every page, but instead it is tucked away in fine print where many won’t look. Given the fact that the CDC previously was running infographic campaigns claiming that Ebola does not travel through the air (see image below) this is highly irresponsible on their part. Hat tip to the Pontiac Tribune for making us aware of this information in their article on the topic. Note we saved a cached version of the CDC page just in case they decide to alter the text in the future. Furthermore, if the official vectors of transmission are accurate, please have them explain how 170 of their aid workers have been infected in spite of being covered from head to foot with protective gear? This particular strain of Ebola is not Ebola Zaire. This is a new strain, and it may in fact be more dangerous than the Zaire variety. Not because of any difference in the symptoms (the symptoms are identical), but because this new virus seems to be harder to contain. Whether this is due to some characteristic of the virus itself or merely dumb luck is uncertain at this time, but the rate at which this outbreak has extended its range is unprecedented. According to the CDC this virus is genetically 97% similar to the Zaire strain. However if you are interested in this virus’ phylogenetic relationship (genetic lineage) to the Zaire strain you should look read “Phylogenetic Analysis of Guinea 2014 EBOV Ebolavirus Outbreak” on plos.org. Another study by the New England Journal of medicine (this was the one referenced by the CDC) specifically names the parts of the genetic code which differ: The three sequences, each 18,959 nucleotides in length, were identical with the exception of a few polymorphisms at positions 2124 (G→A, synonymous), 2185 (A→G, NP552 glycine→glutamic acid), 2931 (A→G, synonymous), 4340 (C→T, synonymous), 6909 (A→T, sGP291 arginine→tryptophan), and 9923 (T→C, synonymous). Note that there doesn’t yet seem to be a consensus as to what this new strain is called. One study referred to it as “Guinean EBOV”, another as “Guinea 2014 EBOV Ebolavirus” and others are still referring to it as Zaire. Given that we can specifically name the points where the virus has mutated, using the old name is misleading. Right now the question on everyone’s minds is whether this virus will spread outside of Africa. Considering the fact that Ebola has a three week incubation period, can travel through the air, and has already hitchhiked onto an international flight, this is a very real possibility. There are some that are downplaying the probability of this outcome, and to be honest, I hope that they are right, but the simple fact of the matter is that these people are basing their assessment on the faulty premise that Ebola is not an airborne virus. Now the first thing you might be feeling when looking at this situation is a sense of fear and helplessness, and while that’s a perfectly normal reaction it’s really not helpful. Instead we should be thinking in terms of practical steps we can take to influence the outcome. One thing we can all do is to start confronting journalists and public officials who keep making false statements regarding the way Ebola spreads. Use the links to the original study, the BBC report from 2012 and this video to put them in their place. We also need to confront the fact that there isn’t a full out, coordinated, international effort to contain this. This is being treated like a sideshow but it has the very real potential to become a main event. The doctors on the ground in West Africa don’t have enough staff or resources to deal with this situation. It is absolutely inexcusable for the U.S. and the E.U. to be investing billions of tax payer dollars into their little power games in Ukraine and Syria (which are both in the process of escalating right now by the way) while Ebola is getting a foothold in Africa. Every available resource should be shifted to West Africa in order to contain and extinguish this epidemic right now. This is serious. Call them, write them, heckle them in the streets if you have to, but don’t allow them to ignore this issue. Make it impossible for them to pretend later that they didn’t know. Now whether or not official policy towards the Ebola crisis changes there are some precautions that you should take right now for yourself and your family. 1. Know where you would go if you needed to leave your home on short notice. If Ebola escapes Africa the last place you want to be is in a densely populated metropolitan area. It may be that the most practical destination for your family would be a rural area near your current home, but if you already have concerns about the government you are living under, and how they may handle a crisis like this, then you might want to start looking at alternatives. Finding an alternative location that suits your family’s needs is something that requires a lot of time and research, so don’t put this off. The primary characteristics you should be examining in an alternative destination are geography , political environment, climate, population density and visa terms and requirements. Ideally you would want to end up somewhere that is geographically isolated to some degree. 2. If you don’t have passports for yourself and each of your dependents, get them now. This is not to say that you should leave your country, but you should have the means to do so. In countries where the Ebola outbreak is underway it is getting harder and harder to exit. Borders are being closed down. Flights are being cut off. This didn’t happen right away, but you definitely don’t want to be waiting for your passport to show up if Ebola arrives in your city. 3. Know what you would carry with you if you had to leave on short notice. Have those items ready, and have the luggage to carry them. It would be wise to consider buying a pack of surgical masks as part of this. Now if you think about it, these preparations are wise steps to take regardless of whether the Ebola situation deteriorates or not. Knowing where you would go in an emergency, and having the means to get there on short notice is important for a wide variety of situations. The civilian population of Iraq, Syria, east Ukraine, and Gaza can attest to that. Whatever you do don’t let fear take control of your mind. Take the steps you can take now, monitor the situation calmly, and be prepared to adapt if necessary. [UPDATE July 31st]: A number of people have requested that I comment on the fact that the Americans infected by Ebola are right now being flown into the U.S. My personal opinion is that this particular move will not lead to the virus getting out. This event is going to be highly scrutinized, and the isolation security should be at max. The real danger isn’t in these highly controlled transfers and quarantines, but rather in the ongoing flow of air travel from these regions. Thirty five countries are merely one flight away from an Ebola zone right now. Why is this random air travel more dangerous? Because if it gets in when people aren’t looking, it can spread before containment measures are put into place.

[Update September 30th] The U.S. just had its first confirmed case of Ebola in Dallas today. You should definitely keep an eye on the situation. Ebola is spreading exponentially at this point in west Africa. The number of cases are doubling every three weeks. As the number of infected increases in the hot zone the odds of new cases arriving in the U.S. or Europe increase as well. |

Watch the video. URL: https://youtu.be/JnQVUf775VE

‘Mystery disease’ claims 18 in Nigeria


At least 18 people have been killed in a southeastern Nigerian town due to a “mysterious” disease which kills in less than 24 hours, government says.

 

A Nigerian health official wearing a protective mask waits to screen passengers at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria, August. 4, 2014. (AP Photo)

A Nigerian health official wearing a protective mask waits to screen passengers at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria, August. 4, 2014. (AP Photo)

At least 18 people have been killed in a southeastern Nigerian town due to a “mysterious” disease which kills in less than 24 hours, government says.

“Twenty-three people (were affected) and 18 deaths were recorded,” AFP quoted the Ondo state health commissioner, Dayo Adeyanju, as saying on Saturday.

Earlier in the day a government spokesman, Kayode Akinmade, had put the number of casualties at 17, saying that the mysterious disease broke out early this week in Ode-Irele town.

Akinmad added that all the victims perished within a day of falling ill and that Ebola or any other known virus has so far been ruled out as the cause by Laboratory tests, noting, “There is no patient of the disease in any hospital and the disease has not spread beyond the town.”

He added that apart from government experts and health officials, World Health Organization (WHO) epidemiologists had also arrived in the town for further investigation.

WHO has confirmed having information on 14 cases and 12 deaths.

“Common symptoms were sudden blurred vision, headache, loss of consciousness followed by death, occurring within 24 hours,” said WHO spokesman Tarik Jasarevic, adding that an investigation was currently underway.

Urine, blood and cerebrospinal fluid samples had been taken from victims, he added. “All samples have been sent to Lagos University Teaching Hospital this morning, and results are still pending. Investigations are still ongoing”

“Twenty-three people (were affected) and 18 deaths were recorded,” AFP quoted the Ondo state health commissioner, Dayo Adeyanju, as saying on Saturday.

Earlier in the day a government spokesman, Kayode Akinmade, had put the number of casualties at 17, saying that the mysterious disease broke out early this week in Ode-Irele town.

Akinmad added that all the victims perished within a day of falling ill and that Ebola or any other known virus has so far been ruled out as the cause by Laboratory tests, noting, “There is no patient of the disease in any hospital and the disease has not spread beyond the town.”

He added that apart from government experts and health officials, World Health Organization (WHO) epidemiologists had also arrived in the town for further investigation.

WHO has confirmed having information on 14 cases and 12 deaths.

“Common symptoms were sudden blurred vision, headache, loss of consciousness followed by death, occurring within 24 hours,” said WHO spokesman Tarik Jasarevic, adding that an investigation was currently underway.

Urine, blood and cerebrospinal fluid samples had been taken from victims, he added. “All samples have been sent to Lagos University Teaching Hospital this morning, and results are still pending. Investigations are still ongoing”

FDA eases restrictions on experimental Ebola drug as CDC warns of ‘inevitable’ spread to US.


While Ebola, the deadly disease spreading through parts of West Africa, has no cure, specific treatment or vaccine, there are several experimental drugs being tested in US labs. Now the FDA has lifted its hold on one of those drugs.

The US Food and Drug Administration gave Tekmira Pharmaceuticals verbal confirmation that they modified the full clinical hold the regulatory agency had placed on the company’s experimental TKM-Ebola drug, enabling the potential use on Ebola patients, Tekmira said in a statement.

“We are pleased that the FDA has considered the risk-reward of TKM-Ebola for infected patients. We have been closely watching the Ebola virus outbreak and its consequences, and we are willing to assist with any responsible use of TKM-Ebola. The foresight shown by the FDA removes one potential roadblock to doing so,” said Dr. Mark Murray, CEO and president of Tekmira.

“This current outbreak underscores the critical need for effective therapeutic agents to treat the Ebola virus. We recognize the heightened urgency of this situation, and are carefully evaluating options for use of our investigational drug within accepted clinical and regulatory protocols.”

The company, in collaboration with infectious disease researchers from Boston University and the United States Army Medical Research Institute for Infectious Diseases, showed the drug’s ability to protect non-human primates from Ebola in preclinical trials in May 2010, Tekmira said.

A Phase I clinical trial ‒ the first step towards FDA approval ‒ began on humans in January. The agency then approved a fast-track designation for the drug in March, around the same time the Ebola outbreak began in Guinea, Liberia and Sierra Leone. It has since spread to Nigeria. According to World Health Organization figures published on Wednesday, there are over 1,700 suspected and confirmed cases of Ebola in the four countries, and 932 of those patients have died from the disease.

A different drug, ZMapp by Mapp Biopharmaceutical Inc., was used to treat two American aid workers who had contracted Ebola in Liberia. ZMapp, previously only known as “a secret serum,” has not been given the go-ahead to begin human trials yet, Forbes reported. It works by boosting the immune system to battle against Ebola. The treatment consists of antibodies from lab animals exposed to the virus.

After receiving a dose of the serum, both Nancy Writebol and Dr. Kent Brantly were transferred to Atlanta’s Emory University Hospital, near the US Centers for Disease Control and Prevention. Brantly, 33, who is an employee of the international group Samaritan’s Purse, also received a blood transfusion from a 14-year-old Ebola survivor, who had been under his care before. Both American patients appear to be improving, officials have said.

With the arrival of Ebola in the US via the two aid workers ‒ who remain in isolation in Atlanta ‒ CDC Director Tom Frieden told Congress that the disease will “inevitably” spread around the world due to global air travel, but that any outbreak in the US would not be large.

Frieden testified on the epidemic in front of the House Subcommittee on Africa, Global Health, Global Human Rights and International Organizations on Thursday. “It is certainly possible that we could have ill people in the US who develop Ebola after having been exposed elsewhere,” he said in his testimony. “But we are confident that there will not be a large Ebola outbreak in the US.”

As people who have traveled to West Africa and then return to or continue on to other destinations develop Ebola-like symptoms, such as fever and gastrointestinal distress, other nations have begun testing for the disease. On Tuesday, Great Britain announced a person in Wales was being monitored by health officials following a potential exposure to the virus.

On Monday, the US experienced its first scare. Mount Sinai Hospital in Manhattan performed tests on a male patient with high fever and gastrointestinal symptoms, the hospital said in a statement. He arrived in the emergency room Monday morning, and had previously traveled to one of the West African countries where Ebola has been reported. However, by the end of the day, officials confirmed the patient had not contracted the deadly disease.

“We are all connected and inevitably there will be travelers, American citizens and others who go from these three countries ‒ or from Lagos if it doesn’t get it under control ‒ and are here with symptoms,” Frieden said.

But that does not mean that the US will become the next battlefront against the disease, a CDC spokesman clarified after Frieden’s testimony.

“It is inevitable that people are going to show up with symptoms. It is possible that some of them are going to have Ebola,” CDC spokesman Tom Skinner said, according to AFP.

Polio Eradication by the Numbers.


http://www.ozy.com/acumen/polio-eradication-by-the-numbers/3274.article#b10g24f20b13

Syria: Polio outbreak fears


Polio
Polio can be prevented but not cured

Experts are concerned that polio may have made a return to war-torn Syria.

The World Health Organization says it has received reports of the first suspected outbreak in the country in 14 years.

Syrian’s Ministry of Public Health is launching an urgent response, but experts fear the disease will be hard to control amid civil unrest.

Immunisation is almost impossible to carry out in regions under intense shellfire.

As a result, vaccination rates have been waning – from 95% in 2010 to an estimated 45% in 2013.

At least a third of the country’s public hospitals are out of service, and in some areas, up to 70% of the health workforce has fled.

Outbreak risks have also increased due to overcrowding, poor sanitation and deterioration in water supply.

Polio

  • Caused by a highly-infectious virus
  • Mainly affects children under five years
  • Can lead to irreversible muscle paralysis
  • A course of vaccines against polio can protect a child for life
  • Global eradication efforts continue
  • The disease remains endemic in only a few countries – Afghanistan, Nigeria and Pakistan
  • Mass vaccination is needed to eradicate polio

More than four million Syrians who have relocated to less volatile areas of the country are mostly living in overcrowded, unsanitary conditions.

The WHO says it is already seeing increased cases of measles, typhoid and hepatitis A in Syria.

Dr Jaouad Mahjour, director of the department for communicable diseases at WHO’s regional office for the Eastern Mediterranean, said: “Given the scale of population movement both inside Syria and across borders, together with deteriorating environmental health conditions, outbreaks are inevitable.”

The cluster of suspected polio cases was detected in early October 2013 in Deir al-Zour province.

Initial results from a laboratory in Damascus indicate that at least two of the cases could indeed be polio.

A surveillance alert has been issued for the region to actively search for additional potential cases. Supplementary immunisation activities in neighbouring countries are currently being planned.

WHO’s International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.

Most people infected with the poliovirus have no signs of illness and are never aware they have been infected. These symptomless people carry the virus in their intestines and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges.

Polio is spread by eating food or drink contaminated with faeces or, more rarely, directly from person-to-person via saliva.

Global Burden of Sickle Cell Anaemia in Children under Five, 2010–2050: Modelling Based on Demographics, Excess Mortality, and Interventions.


Abstract

Background

The global burden of sickle cell anaemia (SCA) is set to rise as a consequence of improved survival in high-prevalence low- and middle-income countries and population migration to higher-income countries. The host of quantitative evidence documenting these changes has not been assembled at the global level. The purpose of this study is to estimate trends in the future number of newborns with SCA and the number of lives that could be saved in under-five children with SCA by the implementation of different levels of health interventions.

Methods and Findings

First, we calculated projected numbers of newborns with SCA for each 5-y interval between 2010 and 2050 by combining estimates of national SCA frequencies with projected demographic data. We then accounted for under-five mortality (U5m) projections and tested different levels of excess mortality for children with SCA, reflecting the benefits of implementing specific health interventions for under-five patients in 2015, to assess the number of lives that could be saved with appropriate health care services. The estimated number of newborns with SCA globally will increase from 305,800 (confidence interval [CI]: 238,400–398,800) in 2010 to 404,200 (CI: 242,500–657,600) in 2050. It is likely that Nigeria (2010: 91,000 newborns with SCA [CI: 77,900–106,100]; 2050: 140,800 [CI: 95,500–200,600]) and the Democratic Republic of the Congo (2010: 39,700 [CI: 32,600–48,800]; 2050: 44,700 [CI: 27,100–70,500]) will remain the countries most in need of policies for the prevention and management of SCA. We predict a decrease in the annual number of newborns with SCA in India (2010: 44,400 [CI: 33,700–59,100]; 2050: 33,900 [CI: 15,900–64,700]). The implementation of basic health interventions (e.g., prenatal diagnosis, penicillin prophylaxis, and vaccination) for SCA in 2015, leading to significant reductions in excess mortality among under-five children with SCA, could, by 2050, prolong the lives of 5,302,900 [CI: 3,174,800–6,699,100] newborns with SCA. Similarly, large-scale universal screening could save the lives of up to 9,806,000 (CI: 6,745,800–14,232,700) newborns with SCA globally, 85% (CI: 81%–88%) of whom will be born in sub-Saharan Africa. The study findings are limited by the uncertainty in the estimates and the assumptions around mortality reductions associated with interventions.

Conclusions

Our quantitative approach confirms that the global burden of SCA is increasing, and highlights the need to develop specific national policies for appropriate public health planning, particularly in low- and middle-income countries. Further empirical collaborative epidemiological studies are vital to assess current and future health care needs, especially in Nigeria, the Democratic Republic of the Congo, and India.

Multiple warnings regarding the effect of epidemiological and demographic transitions in low-income countries and their consequences for SCA burden have been published . By quantifying this increase from 2010 to 2050 using evidence-based data and identifying potential changes in the distribution of areas the most affected, we hope (i) to highlight further the need for greater awareness of SCA, appropriate public health policies, and funding; (ii) to guide the implementation of appropriate policies; and (iii) to provide a framework that could be applied to other birth defects. In most countries, the burden of SCA has so far not been recognised. Its long-term toll is nevertheless significant. These results highlight once more the need for further epidemiological collaborative studies, particularly in Nigeria, the DRC, and India, to define more accurately the current and future health burden of SCA.

Source: PLOS

2018 must be the final target for polio eradication.


Since the eradication of smallpox in the late 1970s, no other diseases have followed suit; the goal that has come closest so far is eradication of polio. The development of vaccines in the 1950s led to cases of polio plummeting: whereas hundreds of thousands were affected annually in the middle of last century, in 2012 around 250 people were paralysed by the disease. But the final stages of eradication are proving more difficult than the early phases. The disease remains entrenched in three countries—Afghanistan, Nigeria, and Pakistan—where social, political, and logistical factors prevent effective vaccination campaigns and lead to export of virus to countries that have previously been free of the disease.

As Haris Riaz and Anis Rehman reported in the journal last month, the global polio eradication programme suffered a grave setback in December last year when seven vaccination workers were shot dead by terrorists as they took part in a 3 day campaign to deliver vaccine in Karachi and Peshawar. At the end of January, two more vaccine workers were killed in a landmine explosion in the Kurrum tribal region. These two latest casualties are not thought to have been directly targeted, but unwitting victims of sectarian violence.

Such events are not only tragic losses—people dedicating their time to a global health effort senselessly killed—but also they leave children who would have received vaccine unprotected and allow the virus to continue to circulate. The consequences of which can be extremely far reaching: in January, poliovirus related to strains circulating in Pakistan was detected in sewage samples in Cairo, Egypt, more than 3000 km away (the last case of polio in Egypt was recorded in 2004). No new cases of polio have been recorded in Cairo, but health authorities are surveying the impoverished districts of Al Salam and Al Haggana where the virus was found for recent cases of paralysis, and vaccination campaigns have been initiated.

In the middle of the 20th century, children in developed countries of Europe and North America would return to school at the end of the summer break and look around to see empty chairs of classmates who had not returned because they had been crippled or killed by polio. When the global polio eradication initiative (GPEI) was launched in 1988, the disease was endemic in 125 countries and caused paralysis in around 350 000 people every year. Recent events highlight how a threat that for many is thankfully a distant memory—or for younger generations in some developed countries unknown—remains a real and present danger.

The Bill & Melinda Gates Foundation is one of the major contributors of financial aid to the polio eradication effort, and speaking recently in London at the Richard Dimbleby lecture, Bill Gates reiterated his commitment to wiping out the diseases, highlighting the new eradication target of 2018. On January 23, the GPEI published a draft Polio Eradication and Endgame Strategic Plan (2013—18). The plan has four main objectives and four milestones for eradication. The four objectives are, detection and interruption of wild poliovirus, strengthening of routine immunisation and withdrawal of the oral polio vaccine, containment and certification (enabling some facilities to store poliovirus and outlining the processes for certification of eradication), and legacy planning to ensure that resources put aside for polio eradication are repurposed when the goal is achieved. The milestones for the new strategic plan are for the last case of wild polio by 2014, withdrawal of type 2 oral polio vaccine by 2015—16, worldwide certification of polio eradication by the end of 2018, and cessation of bivalent oral polio vaccination during 2019.

This is not the first deadline for polio eradication. When the GPEI was set up, the planned date for eradication was 2000. As the cases become fewer, the problems become knottier, and hindrances to final eradication become ever more dependent on localised factors and characteristics of the virus’s remaining toeholds. As the saying goes, the devil is in the detail.

The new plan encouragingly contains intricate analyses of recent outbreaks in the three remaining countries, reasons for programmatic declines, and reflection on the lessons learned from success in India, which has not recorded a case in more than 2 years. It is an excellent example of how data, local knowledge, and experience can be synthesised to provide clear goals and realistic targets. 2018 seems soon, but for some children it will not be soon enough. And for the vaccination workers who have lost their lives, eradication of polio within 5 years would be a tribute to their efforts.

Source: lancet

 

Poliomyelitis in Pakistan: time for the Muslim world to step in.


polio

Global poliomyelitis eradication is almost within reach—this disease persists only in Nigeria, Afghanistan, and Pakistan, which are countries with substantial Muslim populations.1 Today this ambitious goal is threatened, partly by misinformed and politicised religious views that not only seed suspicion about polio vaccination but recently led to murder of polio workers. In Pakistan, 16 workers engaged in a polio vaccination campaign have been killed since December, 2012, halting vaccination in many parts of the country and placing Pakistan’s 2012 gains in poliomyelitis eradication at risk.2 Copycat attacks followed in Kano, Nigeria, and were thought to be the work of extremist group Boko Haram.3 Although Pakistan’s Government, civil society, and religious factions have condemned the killings, action is urgently needed to dispel public misperceptions and deter ongoing violence.

Saudi Arabia and its health authorities are uniquely placed to bring about change in Pakistan for two reasons. First, as the site of Mecca and Medina and host to the Hajj, Saudi Arabia wields enormous influence in Muslim Pakistan. Second, Saudi Arabia has experience of introducing new public health recommendations and strengthening public health outreach by legitimising new public health measures with both formal Islamic authority, in the form of fatwas, and informally, through public opinion.4

Saudi theocrats and public health officials are experienced in effective public health messaging in the diverse Muslim public space. Despite a widely held perception of narrow interpretations of Islamic tradition, Saudi Arabia’s advanced medical academe and traditional religious theocracy have forged imaginative partnerships to solve public health challenges so that advanced therapies—whether living or cadaveric organ harvesting, genetic counselling, care of terminally ill patients, or therapeutic abortion—are available in Saudi society.5 A nexus of science, medicine, and religion has enabled a smooth introduction of advances in every aspect of health care into Saudi Arabia’s medical system, which successfully operates in a conservative Muslim society. This collaborative approach is one Pakistan must emulate to the benefit of its imperilled polio programme.

Pakistan’s Taliban views vaccination programmes as not being Islamic and a western innovation to be repudiated, at the peril of the murder of health workers and the inexorable rise of poliomyelitis.6 Saudi Arabia’s clerics have shown the opposite view through their willing and engaged acceptance of diverse forms of advanced medicine—eg, the use of alcohol-based hand hygiene agents, and use of porcine medicinal products if no alternative is available.

Pakistan could benefit from such a collaborative approach, and Saudi public health officials are ready to engage international Islamic organisations to issue religious edicts lending vital legitimacy to Pakistan’s programme for eradication of poliomyelitis. Similar partnerships have been deployed between local religious clerics and public health officials in Nigeria,7where polio vaccination campaigns were once boycotted, and Indonesia,8 which has also legitimised health programmes with the help of religious theocracy.

Saudi Arabia has a strong national interest in controlling the spread of the poliovirus in Pakistan. Every year, over the past decade, more than 10% of all pilgrims, nearly 200 000 Muslims, travelling to Hajj were Pakistanis (figure). Only Indonesia sent more pilgrims to the Hajj, and Pakistan is predicted to surpass Indonesia in population size by 2020.9 Host to pilgrims from more than 187 nations10 arriving in Saudi Arabia, the massive influx of Pakistan’s pilgrims can be a risk for new polio outbreaks in the Hajj cohort, the domestic population, and, through returning pilgrims, globally. Such an outcome could set the global polio eradication programme back by decades. The existence of poliomyelitis in Pakistan already poses a regional risk, as recently described in Afghanistan and China.

Saudi Arabia has enforced strict public health interventions for the millions of people who travel to Mecca each year, linking the issue of a visa to documented vaccinations, deploying thermal cameras to quarantine pilgrims with fever, and denying entry to people who might pose public health risks.12 Currently, Saudi Arabia recommends the administration of two doses of oral polio vaccine to all pilgrims coming from countries with active circulation of poliovirus. Saudi Arabia requires one dose 6 weeks before arrival (tied to Hajj visa issue) and a second dose on arrival. During Hajj 2012, nearly 500 000 doses of oral polio vaccine were administered at Saudi Arabia’s expense to pilgrims coming from countries with poliovirus circulation.13

Saudi authorities have a lead time of about 9 months before the Hajj season begins, allowing swift and specific planning for each Hajj. Saudi Arabia’s legitimacy in managing Hajj-related health is demonstrable. During Hajj 2012, the Saudi Ministry of Health banned all Muslim pilgrims from Uganda and the Democratic Republic of Congo, because of reports of Ebola outbreaks, to safeguard pilgrims. Although this decision could have been contested as not Islamic if not sanctioned by religious authorities, and Saudi authorities vilified for denying the divine rights of African Muslims, the ban was peacefully enforced and accepted because of the religious legitimacy afforded by clerics.12 Similarly, Saudi clerics have supported public health rulings deterring certain Muslims from Hajj during the recent influenza A H1N1 pandemic, which was a particular threat for pregnant women, elderly people, and those with comorbidities—a sensitive matter because all Muslims should attend the Hajj while they are able bodied.1314

Saudi Arabia’s experience has benefited from the Mecca-based World Muslim League’s ratification of medical recommendations, facilitating their wider adoption in Saudi Arabia and beyond. This unified approach avoids the opposition seen by extremist groups claiming to act in the name of Islam, despite motives clearly anathema to Islam. Saudi Arabia’s experience can inform the debate about eradication of poliomyelitis in Pakistan with similar approaches to management of public opinion through officially sanctioned public health and religious messaging, supported by the international religious theocracy and by the Saudi monarch, the apical authority for Islam in Saudi Arabia.

Although counteraction of the Taliban with a fundamentally Islamic position might seem inflammatory, this approach is rooted in Islamic teachings guaranteeing the sanctity of human life above all religious rites. Enlisting local mosques and community centres to promote polio vaccination as sanctioned by Islam to preserve life could lend Pakistan’s polio programme immeasurable authority. These measures, if ratified by national and international Muslim organisations, when supported by the world’s health agencies and leading public health academics of Muslim heritage, provide the authority needed.

Pakistan’s demoralised public health workers must be supported by a robust international approach that combines both traditional diplomatic and imaginative political responses to draw on the powerful authority of the international Muslim community, including the Organization of the Islamic Conference, the International Fatwa Body in Mecca, and Al Azhar in Egypt. Only then can we relegitimise infection control authorities and engender confidence in both public health officials and the vulnerable Pakistani population.

The Muslim world is responding emphatically. Sheikh Mohammed bin Zayed Bin Sultan Al Nahyan of Abu Dhabi is partnering with the Bill & Melinda Gates Foundation in a US$100 million commitment to the Global Polio Eradication Initiatives and Endgame Strategic Plan 2013—18 to be announced at the Global Vaccine Summit, Abu Dhabi, during World Vaccination Week (April 24—30). Such endorsement emphasises the recognition of poliomyelitis eradication as both a prime challenge and an extraordinary opportunity for the Muslim world. The Taliban’s intimidation must be excoriated by the Muslim community, for Pakistan has a truly critical role in global poliomyelitis eradication, which, with definitive Muslim intervention, will finally be relegated to history.

Source: lancet