Letter From Niamey

Amadou amina is on the prowl. striding along a sandy street in a middle-class suburb of Niamey, capital of Niger, she barks questions to passers-by and to the small bands of women who peer from their gated compounds. "Who has not been vaccinated?" she shouts in the crackling dry, 43-degree heat. "Every child under five must be vaccinated against polio. Who missed out yesterday?" A mother nursing a baby girl nods and Amadou and her assistant Ibrahim Nouhou head toward her house. Inside the shaded courtyard Ibrahim opens a cardboard-and-foam box and digs out a capsule of vaccine buried underneath ice.

Amadou, 28, who is wearing a pink apron over her bright orange and blue boubou, or dress, takes the capsule, fits a new dropper onto it, then squeezes the baby girl's mouth open. One, two drops and it's over. The girl starts to cry. "Who else hasn't been done?" Amadou asks the gathering mothers, hands on hips as she begins remonstrating with one who volunteered only two of her three children. A few mothers push their reluctant children forward. "You don't have to be firm, just calm them down and promise them some goodies," explains Amadou later. Then she smiles. "Of course we don't have anything extra. The real goodies are the drops."

For the want of such goodiestwo drops of oral polio vaccinepoliomyelitis has crippled millions of children around the world. In Africa and south Asia, where the disease remains most prevalent, victims are hidden away at home or forced to beg on the streets. If they're lucky they own crutches or homemade wheelchairs. If not, they drag themselves along on their callused hands. The number of polio cases has dropped from an estimated 350,000 in 1988 to 5,200 in 1999. Polio has been eradicated from the Americas, Europe, and much of the Middle East and disappeared from most of northern and southern Africa.

Now, in a campaign that has made no headlines despite its global importance, the United Nations Children Fund, the World Health Organization, Rotary International and the U.S. Centers for Disease Control and Prevention are leading a final push to eradicate polio completely. If successful, it will be only the second time that a disease has been wiped out. The first was smallpox, which the w.h.o. declared beaten in 1979 after a 12-year campaign. But the battle against polio has yet to be won. Bangladeshi Prime Minister Sheikh Hasina, who has taken a personal interest in the polio eradication campaign, calls it "one of the greatest mass efforts in history."

In Niger, that effort is cause for national celebration. The West African nation of 10 million is one of the world's poorest. More than a quarter of all children die before the age of five, a third are undernourished, and two out of five receive no immunization at all. Eradicating polio will "give us one less thing to worry about," says Barkire Arouna, national director of immunization programs at the Health Ministry. "It won't make us a rich country, but at least we could become more productive." Those sentiments are shared by President Mamadou Tandja, who declared this year's two rounds of polio immunization national holidays and administered the first vaccination himself. "Mothers, fathers, sisters, brothers, aunts and uncles, support immunization for the good of Niger," he implored before the first round in May.

In a country as large and sparsely populated as Niger that message isn't easily heard. The 250,000 sq km Saharan Bilma region, for example, has just 10,000 people, most of them nomadic. Few own radios on which to hear news of vaccination days and most have never visited a healthcare clinic in their lives. Islamic traditions discouraging women from leaving the home have also hindered past immunization efforts. The government and agencies sought the support of village and religious leaders to get the message out. Children are vaccinated door-to-door rather than mothers asked to visit a clinic. "People feel more comfortable in their own house. They don't have to stop working and make the extra effort to go somewhere," says Dr. Yacouba Harouna, chief medical officer in a Niamey district hospital.

At least Niger is not at war. Renewed rebel attacks in Sierra Leone have forced agencies to postpone immunization days there and though the various warring factions in the Democratic Republic of Congo called a temporary cease-fire last year to allow for vaccinations, sporadic fighting threatens to disrupt the campaign in that huge country. Just last week a vaccinator in Angola was killed. The w.h.o. has now conceded that it can't meet the goal of complete eradication by the end of this year. That's bad news even for those countries where vaccinations are taking place. In the village of Ndouga, 15 km southeast of Niamey, nine-month-old baby Roukaya received her two drops of vaccine in May as a nearby donkey brayed in the heat. "Any help is welcome here," said Roukaya's mother, Balkissa Abdoulaye, 27. "I want my girl to be healthier than me." But until polio is finally wiped out everywhere such dreams will continue to be crippled.