Dr Ian Njeru is the man tasked with ending polio in Kenya. He is armed with the money and the vaccine. But religious sects and refugee influx have complicated the work. He outlines his new battle plan against the debilitating disease to Star's John Muchangi.
What is the polio situation in the country? India recently demanded that Kenyans travelling there be should vaccinated afresh.
Things are very good now. We last had an outbreak last year in Garissa. We had 14 cases, first on April 13 and the last on July 14. So we contained the outbreak within two months. The requirement by World Health Organisation (WHO) is you must control an outbreak within six months. We did it in two months. Once you stay for six months without polio, you're declared polio free.
So we consider ourselves polio free in Kenya. The issue is, even if we say we are polio free, we must continue working so hard to make sure it does not come again because we border Somalia. They reported 190 cases last year and the last for them was December 29. So you see it's been two months now for them, but unless they finish six months they cannot say they are polio free.
We have been having polio vaccination drives almost every month. Why is this necessary yet the last outbreak was six months ago?
We have been having them every month since May last year. Once there is an outbreak you are supposed to do monthly campaigns until you finish six months. Polio is very infectious and spreads very fast. Since May last year we have done eight campaigns. We give children under five years oral vaccination because their immunity is not well developed. We repeat the same people every month.
Like now, in January this year we did a campaign that targeted eight million kids under five. We
reached 104 per cent, meaning we exceeded our target.
So do we expect more campaigns this year?
Because Somalia has not finished six months after their December outbreak, we are still at risk, especially the kids being born. So we expect to do more campaigns. We have scheduled three more this year. We did one in January and the second one ended yesterday (early February). We have planned three more. The next is March 1-5 and April 5-9. The April campaign will cover 24 high risk counties. Most of them are on the national borders but we'll also include Nairobi.
In June 7-11 we'll do a countrywide one. Then we'll close the chapter, If we'll not have had any case. Most likely even Somalia will have controlled there. Routine birth immunisation will continue.
Some religious sects strongly oppose vaccination of their children. Are you concerned?
This is what I want to really highlight. We are actually mapping these sects, identifying them and where they exist. We are also putting a strategy how to engage them so they can accept vaccines. So far we have about 16 sects and we are looking for others. We don't like this thing of going to harass people using police. It's very bad. Now we know some in Nyanza and we are going to talk to their leaders. We will engage in dialogue and show them the importance of vaccination.
We are also tracking nomads. Once they go to graze the animals, even if you tell their leaders to come bring children for vaccination, they do not come. So we are tracking them and once we get those without immunisation they be given as part of routine.
But Kenya was at one point declared polio free. What happened?
We were declared polio free in 1984 until 2006. In 2006 we reported two cases in Garissa, most likely coming from Somalia. In 2009 we had cases in Turkana.
In 2011 we had one case in Rangwe district, Migori County. This one had just come from Uganda. But there are some other cases we have had, not related to the outbreak but to the vaccine. This is because vaccines have the virus which has been weakened. So the body fights it like a true virus. So when the real virus comes, your body has already developed immunity. But sometimes the weakened polio virus changes so you can have a kid who receives the vaccine and develops paralysis. That's what we call 'circulating vaccine derived polio virus.' You don't have to worry about this, and we have only ever had two such cases, in 2012.
And so between 1984 and 2013, we had 36 polio cases.
But the reason there is a very big concern with polio is that the world has agreed we're going to eradicate polio. When they see a country with a case, they get very frustrated.
Is there really hope of eradicating polio?
Yes. By the way, it's only three countries in the whole world still reporting polio. These are the endemic countries. They are Nigeria, Pakistan and Afghanistan. Kenya is not reporting polio anymore. Actually our last cases came from Somalia, but they were traced back to Nigeria. Soldiers from Nigeria went to Somalia in 2007 and spread polio there. The reason Nigeria has failed to eradicate it is because Boko Haram has banned vaccination in some areas.
So if we can eradicate polio in these three countries, that's all. Somalia has a poor system of vaccination because they have no proper government. But because nobody had introduced polio there they were ok until 2007.
Kenya's fate seems tied to that of Somalia. That means we need rigorous immunisation in refugee camps.
We have five refugee camps in Dadaab and each of these camps is manned by an NGO.
These camps have very good health systems. The problem is in 2011 there was this drought and so many refugees came. The government closed the border, but there are still refugees who come informally and stayed with the people in the camp secretly. So these refugees hiding are not vaccinated. They are the ones who are spreading the virus.
How long does protection from the vaccine last? Parents are also concerned that repeat doses might harm their children
In this country we give four oral doses to new born children. You first get an oral birth dose. Then at six weeks you get another, and then at 10 weeks and 14 weeks. The lifelong immunity is about 80 per cent if you get these four doses. But you see 20 per cent do not get this lifelong immunity. The reason we have these many campaigns is to capture this 20 per cent.
Are adults really at risk of polio?
If you're among the 20 per cent and you're an adult, you might get polio. Among the 14 cases last year, three of them were adults. Two were 19 years and one was 22 years. The sad thing is, if you get it as an adult you have a higher chances of dying because it paralyzes the legs and hands and it also affects your lungs. It paralyses the muscles you use for breathing – the respiratory muscles. Among the three cases, one died. It rarely kills children.
Even with all these efforts all Kenyans going to India must now get the vaccine afresh. This seems unfair.
It's not a very good thing because it's affecting our people. Most people go to India go for business. That group might be ok because they can plan months in advance because the requirement by India is you get the vaccine six weeks before. But we also have many people who go there for treatment. It's difficult for these people because their treatment is urgent and you cannot predict when you will get sick. We are already six months without a case, meaning we cannot be categorised as having polio. The only problem with India is a they are a bit reluctant to exempt us because they say they want to protect their country.
Is the ministry doing anything about this?
We are already bargaining with them. We are discussing but so far we have not borne fruits. We are very hopeful though because if you go for six months without a case you are polio free. Why should should they continue requiring our people to get vaccination when there's proof we do not have polio? They also say they are investing a lot of resources to make sure they don't have polio cases. They are saying we cannot be investing a lot of resources and then you people just come and bring the virus here. But you see we are not considered a country with polio. So we are discussing. I think its going to be a gentleman's agreement.
For now, where can travellers get the vaccine?
You get it in all the place you get the yellow fever vaccination, like the city council clinics. Major public and private hospitals like Mater, Nairobi Hospital and Aga Khan also.
Is there risk in adults getting the vaccine again?
No, there is no risk. The only caution is for those going for medication. Their immunity may be compromised. So we don't encourage them to get the oral vaccine because it is a weakened virus. These people would rather get the injectable ones. The injectable contains a killed virus, so there's no risk for them.
There are also other advantages of injection. Just one shot gives you immunity of about 80 per cent, just like the four doses of the oral vaccine. The reason we don't give the injectable in the monthly campaigns is that they must be administered by a health worker. We wouldn't have enough health workers to reach millions of children in a week.
The other thing is the cost. The oral is about Sh16 one dose. The injectable is about Sh150. But now the WHO has given us a new deadline of 2018 to eradicate polio. Who has also said we shift from the oral to the injectable, because the immunity of injectable is very high and oral, as I said, brought two cases of paralysis.
From next year we will start introducing the injectable. So we'll have both. At birth the first three polio vaccines will be oral and the last one will be injectable. We'll progressively phase out the oral one.
Who covers the cost of vaccination in Kenya?
We have many partners in a body called Global Polio Eradication Initiative. Who is the major partner in this initiative, then we have Unicef, CDC, Rotary and also Bill and Melinda Gates Foundation. These are the people who fund these campaigns. The routine vaccination given at birth is co-financed 50 per cent by the government and Gavi (Global Alliance for Vaccines and Immunisation).