Polio is back in Indonesia, prompting a vaccination campaign

Children in school uniforms and young children with their parents lined up Monday to be vaccinated against polio in the town square of Sigli, on the northern tip of the Indonesian island of Sumatra, after four children were found highly infected with the disease. contagious that was declared eliminated in the country less than a decade ago.

The virus was first detected in October in a 7-year-old boy suffering from partial paralysis in Aceh province near Sigli, and three more cases have since been detected, prompting mass immunization and the campaign of information.

Officials say polio immunization rates in the conservative province are well below the rest of the country, and efforts are hampered by widespread misinformation that the vaccine is incompatible with religious beliefs, among other things. The government has also prioritized COVID-19 vaccines since they became available.

The campaign that started on Monday aims to vaccinate some 1.2 million children in the province, said Maxi Rein Rondonuwu, director general of disease control and prevention at the Ministry of Health.

“There is no cure for polio, the only treatment is prevention and the tool for prevention is vaccination,” Rondonuwu said, adding that the boy can still walk, although he limps.

With some 275 million people, Indonesia is the fourth most populous nation in the world and the largest Muslim-majority nation.

Aceh is particularly conservative and is the only Indonesian province allowed to practice sharia, which was a concession made by the national government in 2006 to end a war with separatists.

False rumors that the polio vaccine contains pork or alcohol, which is prohibited according to Muslim beliefs, have proliferated, especially in rural areas, complicating vaccination efforts, the head of the Aceh Health Bureau said. , Hanif, who like many Indonesians only has one name.

“We cannot work alone, we need the support of all parties, including religious leaders, so that people understand the importance of immunization,” Hanif said.

Azhar, the father of the 7-year-old boy who contracted polio, said he had chosen not to immunize his son after other villagers where he lived told him that vaccines can cause harmful chemicals or non-halal substances.

“My neighbors said that my son does not need to be immunized and that I did not want my son to get sick because of the harmful chemicals that are against Islam,” the 45-year-old said.

For Dewi Safitri, a mother of three who was vaccinating them on Monday, it was simply a matter of not knowing it was necessary.

She said she was convinced after health workers explained the risks of paralysis or death if her children were not vaccinated.

“I didn’t even know about immunization,” he said.

The World Health Assembly adopted a resolution for the global eradication of polio in 1988, and since then, wild poliovirus cases have decreased by more than 99%, according to the World Health Organization.

It was eliminated in Indonesia in 2014, and today it remains endemic in only two countries: Afghanistan and Pakistan .

Polio mainly affects children. under 5 years of age, according to the WHO. However, unvaccinated people of any age can contract the disease, and sporadic cases continue to occur.

In September in New York, For example, the state intensified its efforts to fight polio after the disease was detected in sewage from the New York City area.

Authorities began looking for signs of the virus there after the first US case of polio was identified in July in Rockland County, north of the city. It was confirmed in a young adult who was not vaccinated.

The statewide polio vaccination rate is 79%, but Rockland’s rate was lower, and New York health officials urged all unvaccinated residents, including 2-month-old children, get vaccinated immediately.

Last week, new cases of poliovirus were found in Afghanistan, Algeria, Chad, the Democratic Republic of the Congo, Ethiopia and Nigeria, according to the WHO Global Polio Eradication Initiative.

Of the three other children in Indonesia from the same village as the initially confirmed case, none had their basic vaccinations, Rondonuwu said.

“It has to be reported as an outbreak, because it had been declared eradicated in Indonesia, but it turns out that there is still wild poliovirus,” he said.

Rondonuwu said his ministry is closely monitoring the cases through door-to-door screening to make sure there are no additional unreported infections.

The polio virus is transmitted from person to person, usually by the “fecal-oral” route, according to the WHO. In Indonesia, authorities have also pointed to unsanitary conditions as a likely cause of the new infections after discovering that some local residents are still defecating directly into a river where children are often found playing.

In Indonesia, polio vaccination coverage has declined since the COVID-19 outbreak. Despite the challenges of reaching people in the archipelago nation of five main islands and thousands of smaller islands, 73.4% of Indonesians are now fully vaccinated against COVID-19 and 87.5% have at least one vaccine.

For polio, 86.8% of babies were vaccinated in their first year in 2020 nationwide, a figure that fell to 80.7% in 2021, as the country was forced to concentrate most of its facilities and health workers in the approach to the pandemic.

By comparison, only 50.9% of babies born in Aceh in 2021 received a polio vaccine. It was the second lowest nationally after West Papua, where only 43.4% of babies were vaccinated.

The nationwide decline was part of a broader drop in basic immunizations, such as measles and rubella, according to UNICEF.

Dicky Budiman, an Indonesian epidemiologist at Australia’s Griffith University, said the discovery of polio in Aceh should be responded to seriously because “the threat is real to Indonesia,” noting that basic immunization coverage is still low, which puts the country in a high-risk situation. category.

“This is what the government really has to go after, because it’s dangerous if we don’t,” Budiman said.

“We must act immediately by strengthening basic immunization or there will be a potential further health disaster for Indonesia.”