Polio: Expected Result of Low Priority Given to Basic Health Care

Headline Polio: Expected result of low priority given to basic health care MediaTitle Manila Times(manilatimes.net) Date 30 Sep 2019 Section NEWS Order Rank 1 Language English Journalist N/A Frequency Daily Polio: Expected result of low priority given to basic health care NO new cases of polio were reported in the past week, but health authorities are monitoring a case in Cotabato City. A three-month-old infant with fever and paralysis in one leg was brought to hospital for treatment and tests. There is reason to fear additional cases of polio in Muslim Mindanao. Why? Because immunization rates in the region — now the Bangsamoro Autonomous Region in Muslim Mindanao, or BARMM — are disturbingly low. In 2018, only 18 percent of children aged 12 to 23 months had received all basic vaccinations. The national figure is 69.9 percent. The World Bank in “Supply Side Readiness of Primary Health Care in [BARMM]” (2019) explains why. For instance, “fewer than five percent of the [Rural Health Units] had adequate refrigerator temperatures to stock vaccines on the day of the survey.” The World Bank also found that “one-third of the facilities did not have measles or pentavalent vaccines in stock, and oral polio vaccine (OPV) was available at fewer than half of the facilities.” Lack of trained personnel, electric power, running water, emergency transportation and communication equipment are common. It was noted that health services were given low priority by local government units — municipalities in BARMM spend about 1.5 percent of their total operating expenditure on health services, compared to the national average of 8.6 percent. The first case of polio in the Philippines since the country was declared polio-free involved a three- year-old girl from Marogong, Lanao del Sur, BARMM. Marogong, a fourth-class municipality with a population of little over 20,000, is located only a few kilometers from Butig, once the bastion of the Maute family. Eight days before the siege in May 2017, 11 members of the Maute group were arrested in Marogong. In January this year, three suspected terrorists were killed by army troops in the boundary between Marogong and Sultan Dumalundong. Clashes in March resulted in the displacement of the residents of four towns, with hundreds evacuating to Marogong. According to a report by Froilan Gallardo in Mindanews.com, the polio-afflicted girl spent her first year in Quiapo, Manila before being brought to Marogong by her parents. In other words, it was around the time of the Marawi siege that the girl arrived in Marogong. There is nothing like armed conflict, displacement and migration in general to disrupt vaccine schedules. If Lanao del Sur had low immunization rates before the siege, the displacement caused by the war would have prevented even more children than usual from getting their routine vaccinations. Eighteen of Marogong’s 24 barangay (villages) are considered “geographically isolated.” Barangay Mayaman, one of the 18 isolated villages, was featured by GMA’s “Reporter’s Notebook” in April 2016. Here, the crew found then 10-year-old Mawiuag Moslemen who could neither talk nor walk. Since the nearest clinic was two hours away, the family had not been able to seek medical attention or treatment for Mawiuag. With the help of GMA, the father brought the son to a hospital in Marawi City. The examining doctor said that he would consider Miwiuag’s case a case of polio. I wonder if laboratory tests were conducted to determine whether his paralysis was indeed caused by poliovirus. I wonder how Mawiag and his family are now. Children living in isolated communities are often not able to receive their routine vaccines. Even China, with a a 99-percent vaccination rate, has reported one case of vaccine-derived poliovirus type 2 in 2019, in Liangshan Yi Autonomous Prefecture. Liangshan is famous for its ‘cliff villages’ — villages located high up on cliffs accessible only through rattan ladders. However, whether the infected person was from this place, I do not know. The Department of Health and local health authorities are preparing for a massive immunization campaign. In Mindanao, the campaign will start in Davao City and Lanao del Sur. The World Health Organization is providing monovalent oral polio vaccine type 2. Type 2 was removed from OPV in 2016 after the eradication of wild poliovirus type 2. But a global stockpile of OPV type 2 has been maintained in case of future outbreaks of type 2 polio. This stockpile is managed by Unicef and released only at the direction of the WHO director-general. The Center for International and Strategic Studies (CSIS) recently published a report entitled “Enhancing US Leadership in a New Era of Global Immunization.” The report emphasizes that immunizations “contribute to global stability and economic growth by improving health worldwide.” Infectious disease epidemics pose real threats to our way of life, to productivity and the economy, to fundamental security and stability. The Philippines is one of 15 countries “home to the most children missed by vaccination campaigns” (CSIS, September 27). Now is the time to change this, make the Philippines polio-free again and ensure that all Filipino children are protected from debilitating infectious diseases. .

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