Mass polio vaccinations hampered by rumors, fear

CIKEUSAL, Indonesia -- Holding her 2-year-old son, Sari listens intently in a ramshackle health clinic as the medical staff assures her and other villagers about the safety of the vaccine being used to fight Indonesia's first polio outbreak in a decade.

But the impoverished mother of two remains unconvinced. She hints she will not participate in Tuesday's nationwide immunization campaign because of unfounded rumors that a neighbor's child contracted polio after being given the oral vaccine earlier this year.

"I'm afraid. Maybe my boy will get paralyzed," said Sari, who was among 62 percent of parents in her village who refused to get their children vaccinated in June during a regional campaign on Java, the main island where most of the nation's 226 polio cases have occurred.

Such fears are threatening the biggest public health exercise ever mounted in Indonesia, whose rising caseload has the World Health Organization worried that the virus could spread throughout Southeast Asia.

Indonesian leaders are pulling out all stops to win over a public skeptical about the drive to vaccinate 24 million children under age 5 on Tuesday and then again on Sept. 27.

Comparable to election

The two largest Muslim organizations in the world's most populous Islamic nation are endorsing vaccinations in TV ads, and busloads of soap opera stars and singers are making the rounds to promote a $24 million campaign comparable in preparation to a general election.

More than 750,000 vaccinators will be on hand Tuesday at 245,000 posts set up at health clinics, bus depots, rail stations and airports. The army and police will help deliver vaccine -- by plane, boat, bicycle and foot -- to some of Indonesia's 6,000 inhabited islands.

"The biggest challenge is public trust," said UNICEF's Claire Hajaj.

She works on the U.N. agency's global campaign to eradicate polio in the six countries where it remains endemic, as well as in Indonesia and 16 other nations that recently have been re-infected.

"The key is that community fears get addressed and they don't turn into widespread vaccine avoidance," Hajaj said.

First outbreak in a decade

A 20-month-old diagnosed with polio in March was the country's first case since 1995. Authorities believe the child caught it from a migrant worker or tourist who was infected in Africa or the Middle East.

Polio spreads when unvaccinated people come into contact with the feces of those with the virus, often through contaminated water in places with poor hygiene or inadequate sewage systems. It attacks the nervous system in children under 5, causing paralysis, muscular atrophy and sometimes death, although only about one in 200 of those infected ever develops symptoms.

The potential for the virus to spread beyond Indonesia's 210 million people has prompted East Timor, the Philippines and Thailand to launch smaller vaccination campaigns.

"If this virus continues to spread, we are talking potentially hundreds more Indonesians becoming paralyzed," said Arun Thapa, who is overseeing WHO's polio eradication campaign in Southeast Asia and visited Indonesia this past week.

Indonesia's polio outbreak first prompted authorities to vaccinate as many as 6.5 million children in Java province during two rounds earlier this year.

But officials missed 1 million children in the second round after parents were scared off by media reports that three children died from taking vaccine -- later proven unfounded -- or rumors that the vaccine violates Islamic law because it was produced using monkey kidney cells.

The rumors mirrored those that spread across the West African nation of Nigeria in 2003, where polio vaccinations were suspended for several months after radical Islamic preachers told parents they were dangerous and part of a U.S. plot against Muslims.

Islamic leaders in Indonesia sought to put such rumors to rest by issuing a fatwa saying the vaccine does not violate Muslim dietary law. But in provinces like West Java, which has 58 polio cases, that and other rumors persist.

Confusion also lingers among health workers over basic policies, such as whether sick children can be vaccinated. UNICEF says they can.

"Everything is going well, but we are still worried people won't take the vaccine," said Dr. Agus Gusmara, who heads the campaign in Serang district. "We have still have bad memories of the last two rounds."