\n<\/p>\n
As a seven-year-old boy is treated for polio at a hospital in Malawi, the country has launched a major vaccination campaign to stem an outbreak of the disease.<\/p>\n
The effort in Malawi, one of the world\u2019s poorest countries and badly hit by the aid cuts, has seen an astonishing 1.3 million children already vaccinated against the disease in just four days after emergency supplies were airlifted in by the World Health Organization (WHO) just over a week ago.<\/p>\n
Malawi declared the outbreak after the virus was detected in two \u201cenvironmental samples\u201d taken from two sewage plants in Blantyre, the country\u2019s second-largest city and where the only known victim lives.<\/p>\n
double quotation markI don\u2019t know much about the vaccine. I am also not interested \u2026 I feel my child has had enough vaccines in her lifeFrida Seva<\/p>\n
A single case of polio is considered dangerous, particularly in areas with low vaccination rates, because it is a highly infectious virus that spreads silently and as many people have very mild symptoms. It causes permanent, irreversible paralysis or death in a small but significant percentage of cases, especially in children. Malawi has not had a case of wild poliovirus since 2022.<\/p>\n
It is the latest setback to the global efforts to eradicate polio, something that had seemed tantalisingly close 28 years ago, when there were just 2,880 cases remaining in 20 countries thanks to a vaccine given as drops into a child\u2019s mouth. But the virus has remained stubbornly persistent in some of the most remote parts of the world.<\/p>\n
<\/span>Health workers prepare to administer oral polio vaccines to children in Blantyre\u2019s Ndirande township last week. <\/span> Photograph: Kenneth Jali\/AP<\/p>\n Dr Jamal Ahmed, the WHO\u2019s polio chief, issued a stark warning earlier this year: \u201cRemember that eradication is all or nothing. You\u2019re either done with it, or it comes back in full force.\u201d<\/p>\n Those pushing to finally stamp out a disease that has killed and paralysed millions globally are fighting a battle on two fronts \u2013 against the virus itself, and for the trust of the communities where it is making its last stand.<\/p>\n double quotation markYou can give her any argument. And then you have a local influencer walk in, he says \u2018vaccinate\u2019 and she just hands you the childSheeba Afghani<\/p>\n In Malawi, as community health workers visited nursery, primary schools and homes in Ndirande township, Blantyre, the Guardian spoke to six young mothers aged between 21 and 31. Half knew nothing about the disease, while the other three were wary of allowing their child to receive the vaccine.<\/p>\n \u201cMy child is four years old but I don\u2019t know much about the vaccine. I am also not interested in getting the child vaccinated. I feel my child has had enough vaccines in her life,\u201d says 21-year-old Frida Seva.<\/p>\n At Chisime primary school, dozens of children lined up to receive the drop. Health workers had contacted the teachers in advance in order for the pupils to get consent for the vaccination from their parents. About one in 10 of them, whose parents had not given permission, remained seated at their desks.<\/p>\n \u201cThere are some reasons including religion but to some parents it is just a choice,\u201d says one teacher, Georgina Donasi.<\/p>\n <\/span>Community leaders and influencers have worked hard in Malawi to overcome vaccine hesitancy. <\/span> Photograph: Kenneth Jali\/AP<\/p>\n Malawi\u2019s communities have stepped up in this campaign, with social mobilisers, health workers, religious leaders and traditional authorities all giving advice and working to correct misinformation and reassure families.<\/p>\n Their efforts worked: in Ndirande, a township on the outskirts of Blantyre,of 84 households that were initially reluctant, 45 then acceptedthanks to this targeted engagement.<\/p>\n It is a common experience for polio workers in its remaining strongholds, especially in the border areas of Afghanistan and Pakistan, where the wild virus remains endemic, that local communities prove essential in building the trust needed for successful vaccination drives.<\/p>\n double quotation markEven before we\u2019ve had the opportunity to arrive in the community, it\u2019ll be on social media<\/p>\n Sheeba Afghani has sat with mothers adamant that their child will not be vaccinated against polio. \u201cYou can give her any argument,\u201d says Afghani, a senior manager with Unicef\u2019s polio eradication programme. \u201cIt doesn\u2019t matter. And then you have a local influencer walk in, and he says \u2018vaccinate\u2019, and she just hands you the child.\u201d<\/p>\n \u201cI\u2019m thinking \u2018woah\u2019: we gave her so much logical, scientific [argument]. Every information possible.\u201d<\/p>\n Social media also inflames misinformation, says Afghani. Once, if a death was incorrectly linked to vaccination, \u201cwe would have the community influencers, the doctor on duty etc, arrive in that particular family and address it locally,\u201d she says.<\/p>\n \u201cNow, even before we\u2019ve had the opportunity to arrive in the community, it\u2019ll be on social media,\u201d she says.<\/p>\n <\/span>Children show their marked fingers after their polio vaccination during a door-to-door campaign in Pakistan this month. <\/span> Photograph: Saood Rehman\/EPA<\/p>\n Many places where polio has a foothold are also regions struggling with insecurity and poor health infrastructure, so people might have little faith in the state, helping to make mistrust deeply seated, says Afghani.<\/p>\n Malawi\u2019s outbreak is the newest threat: a sporadic outbreak of variant poliovirus, also known as circulating vaccine-derived poliovirus, which occurs when the weakened virus used in the oral polio vaccine is excreted in someone\u2019s faeces.<\/p>\n In places with poor sanitation, it begins to spread from person to person. This is initially helpful, spreading protection. But in places where vaccination rates are low, the virus can mutate into a form that can cause paralysis. There were 225 cases reported last year.<\/p>\n double quotation markA lot of the misguided things coming out of the US now are really causing confusion \u2026 it\u2019s fertile ground for rumoursProf Heidi Larson<\/p>\n Misinformation and disinformation are rated as two of the biggest threats globally over the next few years, and vaccination campaigns are particularly vulnerable.<\/p>\n \u201cThe same misinformation can land in different places and play out very differently,\u201d says Prof Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. \u201cIn some cases, it\u2019ll roll like water off a duck\u2019s back, and then in another, it can disrupt a whole programme and cause major problems.\u201d<\/p>\n With polio, the very phrase \u201cvaccine-derived\u201d, she says, \u201clends itself to very innocent misinformation because it makes it sound like you get the vaccine and you can get polio, which is not the case.\u201d<\/p>\n <\/span>US health secretary Robert F Kennedy Jr with Donald Trump. <\/span> Photograph: Reuters<\/p>\n US leaders \u2013 including Robert F Kennedy Jr, Donald Trump\u2019s health secretary \u2013 casting doubt on vaccinations have harmful potential, Larson says. \u201cThere were suggestions that polio wasn\u2019t important any more.<\/p>\n \u201cAnd even though that was highly challenged, one of our challenges with the internet and social media is people hear one piece of the story,\u201d she says. \u201cA lot of the misguided things coming out of the US right now are really causing confusion. And when there\u2019s uncertainty, it\u2019s fertile ground for rumours.\u201d<\/p>\n In 2019, staged videos of children collapsing after polio vaccinations forced a programme in Pakistan to be suspended. The videos led to panic, with health clinics set on fire, thousands of children rushed to hospital by parents and the deaths of a health worker and two police officers.<\/p>\n In Afghanistan, where half last year\u2019s recorded cases of wild polio virus occurred, there are unique challenges with the population fearing its own government\u2019s directives. The Taliban have stopped women working, mothers are behind closed doors, and girls are not in school, all locked away from vaccination teams who are unable go on outreach drives and can only lobby the government for a change in policy.<\/p>\n Money is also an issue. The Global Polio Eradication Initiative saw funding fall last year, as leading donors including the US and Britain cut aid spending. With its 2022-29 strategy facing a $1.7bn ($1.3bn) funding shortfall, the initiative said it would no longer be able to respond \u201cat scale\u201d to all outbreaks as it did in Malawi this month.<\/p>\n Dr Mike Chisema, Malawi\u2019s Ministry of Health immunisation programme manager, says: \u201cThe funding space has really shrunk, and this has affected a lot of services that we offer concurrently on the emergencies that we face time and time again, beyond the emergency funding that could always be there.<\/p>\n \u201cWe would like to mount a coordinated and organised response to make sure that we protect our children and not have a disability cohort of children in future, which can also affect productivity of the country,\u201d he says.<\/p>\n The polio outbreak comes at a time when Malawi, with 55% of its total health expenditure funded by donors, is also suffering the impact of the massive aid funding cuts.<\/p>\n <\/span>A child receives the polio vaccine in Kabul in 2025. Restrictions placed on women by the Taliban have hindered campaigns in Afghanistan.<\/span> Photograph: Saifurahman Safi\/Xinhua\/Alamy<\/p>\n \u201cWhile the funds may not be adequate, there is always something to push the countries to respond, including the procurement of the vaccinations, delivering the service, the actual vaccination, making sure the logistics of the vaccines are well catered for so that we have the vaccine even at the very last mile,\u201d says Chisema.<\/p>\n \u201cEvery time we have a case, we tend to mount a huge response because we don\u2019t want to see it any more. So we want to control it from the source. We do testing every week in some places, and we also do testing fortnightly in some places.<\/p>\n \u201cAnd we continue to look for these cases in the communities and we promote reporting of any of such cases because we want to make sure that it is no longer there,\u201d he adds.<\/p>\n <\/span>James Tungama, a health worker, performing in a play to teach children about polio at a Blantyre school. <\/span> Photograph: Eldson Chagara\/Reuters<\/p>\n If Malawi\u2019s effort seem to be breaking through to people, Unicef teams have found that agreement to vaccinate in some regions can be conditional, either on the go-ahead from a local leader or on the family also receiving something else \u2013 food, for example, or other types of healthcare.<\/p>\n Polio vaccination boycotts are often led by people who actually support the programme, Afghani says. \u201cAnd they\u2019re pretty conflicted, but their first loyalty is to their community. And they have bigger challenges there.\u201d<\/p>\n Her team has recruited \u201cmicroinfluencers\u201d charged with challenging misinformation online, and havea dashboard on the wall of their New York headquarters with the output of software scouring social media for mentions of polio or vaccination. Any spike, potentially showing false rumours are spreading, ahead of a planned campaign, can be responded to swiftly.<\/p>\n As Malawi continues with its vaccination efforts, the country is hopeful that it is protecting its children. \u201cIt\u2019s very important that we work very well with our stakeholders, the communities who are the beneficiaries of this important response,\u201d adds Chisema. \u201c[Otherwise] people will die, because polio can get hold of the respiratory muscles. We have a huge history of polio in Malawi.\u201d<\/p>\n At Malabada health centre in Ndirande, Ruth Kutaombe is holding her eight-month-old boy. She is firmly pro-vaccination. \u201cIt will protect him from contracting the disease,\u201d she says.<\/p>\n \u201cI visited the hospital for the routine under-five clinic but after hearing they are giving the vaccine, I made a choice to have him vaccinated.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" As a seven-year-old boy is treated for polio at a hospital in Malawi, the country has launched a major vaccination campaign to stem an outbreak of the disease. 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