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In a dusty laneway on the outskirts of Port Moresby, health workers are battling the spread of an age-old scourge.
They are vaccinating children against polio which is resurgent in Papua New Guinea nearly two decades after the country was officially declared free of the disease.
During the past three months, 14 polio cases have been confirmed in PNG, which is Australia’s nearest neighbour.
Volunteer Abas Arua is on the vaccination team that moves door-to-door in a neighbourhood known as 8-Mile settlement, identifying children not yet immunised.
“This is just so important for the next generation,” he told Fairfax Media.
After each child receives two drops of the life-saving vaccine on the tongue, the nail on their left pinky finger is marked with ink to show they have been immunised.
One of those vaccinated at the 8-Mile settlement was one-year-old Selina Abraham.
Her father David, a local taxi driver, is relieved the vaccination team has come to his neighbourhood.
“I was worried when I heard about these polio cases,” he said. “It made me think we must avoid this.”
Last month a six-year-old boy living at the nearby 5-Mile settlement was diagnosed with polio. It was the first case in Port Moresby and sparked fears the virus would spread further in the national capital and biggest city.
Officials have confirmed a nine-year-old boy with polio died in the north-western Enga province, although the World Health Organisation says the child was also diagnosed with TB-meningitis.
The WHO representative in PNG, Dr Luo Dapeng, said the boy’s death highlighted the need to ensure children are immunised.
“No child should die from any vaccine-preventable disease,” he said.
In late June a national emergency was declared in PNG after a case of polio was confirmed in the port city of Lae on the country’s north coast.
Since then, cases have been confirmed in a total of six provinces, including some in PNG’s rugged highlands region.
The government says around half a million children have been vaccinated in areas deemed to be at the highest risk.
Health officials are now scaling up an ambitious nation-wide polio vaccination drive to immunise every child in PNG under the age of 15 – a total of around 3.3 million.
The WHO said 9000 workers were being mobilised for the campaign, many of them volunteers.
Keith Feldon, the co-coordinator of PNG’s national polio emergency response, said relatively low vaccination rates in PNG has left many children vulnerable.
“The immunisation coverage has been suboptimal for many years, he said.
“We estimate that for children under the age of 15 in Papua New Guinea we have about 800,000 that are unprotected from polio before this vaccination campaign, which is a sizeable amount.”
PNG’s difficult terrain and the remoteness of many communities make it a challenging campaign.
“It’s a very big effort even though it’s a relatively small country,” said Feldon.
The polio outbreak has drawn attention to deficiencies with PNG’s health system.
Last month Foreign Minister Marise Payne announced Australia would provide an extra $10 million to support PNG’s polio vaccination campaign and help combat other infectious diseases.
“PNG is our nearest neighbour,” she said in a statement. “Outbreaks of infectious diseases are a threat to both PNG’s and Australia’s health security.”
PNG was declared polio-free in 2000, along with the rest of the Pacific region.
The re-emergence of polio in both large urban centres and small remote communities in PNG shows how easily and quickly the virus can spread.
Justine McMahon, the PNG country director of aid agency CARE International, said most of PNG’s population live in rural, and often remote, areas making basic health services difficult and expensive to deliver.
“To get good coverage across PNG, normal childhood immunisations have to happen routinely, as they do in Australia,” she said.
“Cost, location, education, availability of vaccines and an over-burdened health system mean that this isn’t happening as it should.”
More financial assistance will be needed if higher vaccination rates are to be sustained, McMahon said.
Polio, or poliomyelitis, is a highly infectious virus which is transmitted person-to-person and mainly affects young children.
Around one in every 200 cases results in irreversible paralysis with a small proportion of those dying because they cannot breathe. There is no cure for polio so it can only be combated by vaccination.
The polio virus is only known to be present in a small number of countries apart from PNG, including Nigeria, Pakistan and Afghanistan.
An official report on the polio outbreak response released on Monday provided some details on the initial case in PNG's polio emergency.
The patient, a six-year-old boy named Gafo from the Morobe province, has survived the illness but his paralysis "will never be cured".
The report said that a few weeks ago "Gafo was unable to walk and had to be carried everywhere" but that his mobility had since improved with therapy.
“He still cannot run, but has developed his own unique gait, moving rapidly to keep up with his friends and his sister Sola,” it said.
Pacific Islands News Association
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International News Safety Institute (INSI)
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