The InterDependent

After nearly 20 years of state failure and conflict, the Democratic Republic of Congo has become a difficult place in which to be healthy. Life expectancy is only in the early 40s for both men and women; 1 in 13 women dies in childbirth; and 1 in 5 children does not survive to its fifth birthday.

The reasons for these tragic numbers are obvious: without a secure, stable environment to operate in, health care practitioners cannot provide all the services that the population needs. Clinics are often looted by armed groups in search of medications and medical equipment, and displaced populations – those who have fled violence in their hometowns – cannot always gain access to health centers. In addition, camps for displaced people often lack proper sanitation and water supplies, causing the spread of cholera, dysentery and other water-borne illnesses.

Amid such dire conditions, it is hard to find good news, which makes the success of recent vaccination campaigns against polio all the more astonishing. With support from Congolese health authorities and Unicef and high demand from a population keenly aware of polio’s debilitating effects, the campaigns have recently reached millions of Congolese with lifesaving vaccines.

From April 28 to May 2, 2011, the National Immunization Days campaign aimed to reach 23 million people, with follow-up supported by the UN to inoculate 12 million children under age 5. With vaccination teams going door to door in rural areas and standing on street corners to provide oral polio vaccine to drivers in Kinshasa, the capital, the campaign was a rousing success.

What accounts for this stunning work in a country where so many other public health efforts have failed? Experts point to several factors, including support from national authorities and international financial and technical support.

Dr. Abderrahmane Bah, a health specialist for Unicef in Congo, said that a strong commitment from the country’s political leaders contributed greatly to the campaign’s ability, as did local technical matters like ensuring the vaccines were present in each health zone before the campaign began.

International support was also vital. Pierrette Vu Thi, a Unicef Congo representative, said in an e-mail interview, “The fight against polio has rallied a wide range of private and public players.”

Thi also noted that support from the Bill & Melinda Gates Foundation, the people of Japan, US Agency for International Development and the Centers for Disease Control and Prevention in Atlanta were crucial to the campaign’s accomplishments. (The United Nations Foundation is an indirect supporter.)

Martine Perret/UN Photo

A carefully calibrated polio vaccine campaign by the UN and other organizations in the Democratic Republic of Congo inoculated millions of people and made inroads in one community, Kalemie, the epicenter of an epidemic.

Dr. Bah also pointed out that Unicef played a key role in coordinating activities, providing and transporting vaccines and communicating the necessity of getting vaccinated through radio and television messaging.

Another factor was a shift in local attitudes, spurred at the regional level. Before the campaign, health authorities faced major resistance to vaccinations from some religious communities in Kalemie, a city on the shore of Lake Tanganyika in eastern Congo. The resistance made Kalemie a center of the polio epidemic, so efforts to change mind-sets were important.

Unicef worked to alleviate concerns about vaccination by developing partnerships with five religious communities, engaging in “intense advocacy” and striving to improve hygiene and sanitation in the region to complement vaccination activities, Thi said.

The result? Only three new cases of polio have been registered in Kalemie in 2011 so far, down from eight in 2010.

The combination of local, national and international support for the campaign helps to explain why this particular effort triumphed when so many other public health efforts struggle in Congo.

Karen Grépin, an assistant professor of global health policy at New York University, also points out that an international focus on polio eradication most likely played a role as well.

“The government of the Congo was likely pressured,” she said, “to significantly step up efforts to control their polio program” -- and international actors “have provided additional financial resources to support the campaigns.”

Grépin also noted that the campaign’s comprehensive approach helped, involving “mass vaccination of the entire population, rather than attempting to screen among individuals in need of the vaccine.” This simplified the program and meant that “short term campaigns can work even in areas where other kinds of public health initiatives have failed.”

What lessons can public-health workers in other extremely weak countries learn from Congo’s campaign?

First, commitment from national health authorities and their local counterparts is critical. The program would have collapsed without a strong commitment at every government level.

Second, sustained community engagement enabled the change in attitudes in vaccination-resistant communities like Kalemie. By partnering, advocating and educating in such centers of opposition, health officials can influence people in a relatively short period of time.

Third, international support and engagement is necessary. The campaign would not have happened without the strong financial and technical support of Unicef and other international actors.

Congo still has a long way to go in improving overall public health and vaccinating every child and adult against serious, preventable illnesses, but this venture provides hope. It is possible to overcome barriers, beat the odds and create a healthier future for every Congolese.

Even in Congo.

For more information, go to:

http://www.afro.who.int/en/democratic-republic-of-congo/press-materials/...

http://www.unicefusa.org/news/news-from-the-field/unicef-supports-polio-....