Polio campaign hampered by rumors, ignorance

Polio campaign hampered by rumors, ignorance

Michael Casey, Associated Press, Cikeusal, W. Java

Holding her 2-year-old boy, Sari sits in the ramshackle health clinic listening intently as the medical staff assures her and other villagers that the polio vaccine being used to fight a fast-moving outbreak is safe.

But the impoverished mother of two remains unconvinced. She hints she won't take part in Tuesday's nationwide immunization campaign -- the country's largest ever public health exercise -- because of unfounded rumors that a neighbor's child contracted polio after ingesting drops of the vaccine earlier this year.

"I'm afraid," said Sari, who was among 62 percent of parents in her village who refused to get their children vaccinated in June. "Maybe my boy will get paralyzed."

With Indonesia's caseload rising to 226 and the World Health Organization saying the virus could spread to other Southeast Asian nations, the country is pulling out all stops to win over a skeptical public in its effort to vaccinate 24 million children under 5. A second round will follow Sept. 27.

Busloads of soap opera stars and singers are making the rounds to promote the US$24 million campaign that is comparable to a general election in its scope and preparation. More than 750,000 vaccinators will be on hand Tuesday at 245,000 posts set up at health clinics, bus depots, rail stations and airports.

The country's two largest Muslim organizations are endorsing it in television ads and the military and police have been called on to help deliver the oral vaccine -- by plane, boat, bicycle and even on foot -- to some of Indonesia's 6,000 inhabited islands.

"The biggest challenge is public trust," said Claire Hajaj of UNICEF, the United Nations Children's Fund, who works on the U.N. agency's global campaign to eradicate polio in six countries where it is endemic and 17 others, including Indonesia, that have recently been re-infected.

"The key is that community fears get addressed and they don't turn into widespread vaccine avoidance," she said.

A 20-month-old toddler diagnosed with polio in March was the country's first case since 1995. Authorities believe the child came in contact with a migrant worker or tourist who was infected in Africa or the Middle East.

Since then, Indonesia has seen its caseload rise steadily mostly on the country's main island of Java.

Polio spreads when unvaccinated people come into contact with the feces of those with the virus, often through contaminated water in places with poor hygiene or inadequate sewage systems.

It usually attacks the nervous system in children under 5, causing paralysis, muscular atrophy, deformation and sometimes death, although only about one in 200 of those infected ever develop symptoms.

The potential for the virus to spread beyond Indonesia has prompted East Timor, the Philippines and Thailand to launch smaller, polio vaccination campaigns.

UNICEF said a series of factors -- from government complacency, to public ignorance, to a lack of funding for polio drives -- made Indonesia vulnerable to the reintroduction of the virus.

"If this virus continues to spread, we are talking potentially hundreds more Indonesians becoming paralyzed," said Arun Thapa, who is overseeing WHO's polio eradication campaign in Southeast Asia and visited Indonesian this week.

Indonesia's polio outbreak prompted authorities to vaccinate up to 6.5 million children in Java province over two rounds earlier this year.

But health officials missed a million children in the second round, after parents were scared off by reports in the national media that three children died from taking vaccine -- later proven unfounded -- or that the vaccine violated Islamic law because it was produced using monkey kidney cells.

Most parents avoided getting their children vaccinated by claiming they were sick. Others fled into the mountains or jungles to escape house calls of health workers.

The rumors mirrored those that spread across Nigeria in 2003, where polio vaccinations were suspended for several months after radical Islamic preachers told parents they were dangerous and part of a U.S. plot against Muslims.

Islamic leaders in Indonesia -- the world's most populous Muslim nation -- have done their part to put to rest any rumors, issuing a fatwa saying it was halal (permitted by Muslim law) to take the vaccine.

But in provinces like West Java, which has 58 polio cases, rumors persist largely due to the government's failure to quickly counter them. Confusion also lingers among health workers over basic policies -- such as whether sick children can be vaccinated, which according to UNICEF they can.

From one farming village to the next, parents peppered UNICEF officials with questions over the latest rumors. One heard that children got diarrhea from the virus, another that it caused itchiness. Many keep repeating the stories that immunized children were dying.

"Everything is going well, but we are still worried people won't take the vaccine," said Dr. Agus Gusmara, who is heading up the campaign in Serang district. "We have still have bad memories of the last two rounds."