Children in school uniforms and toddlers with their parents lined up Monday for polio vaccinations in a square in the town of Sigli on the northern tip of the Indonesian island of Sumatra, after four children were found infected with the highly contagious disease that was declared less extinct in the country than what a decade ago. The virus was first detected in October in a 7-year-old boy suffering from partial paralysis in Aceh province near Sigli, and three more cases have since been identified, prompting mass immunization and awareness. Officials say polio vaccination rates in the conservative province lag far behind the rest of the country, with efforts hampered by widespread misinformation that the vaccine is incompatible with religious beliefs, among other things. The government has also prioritized vaccinations against COVID-19 since they became available. The campaign launched on Monday aims to vaccinate about 1.2 million children in the province, said Maxi Rain Rondonu, the health ministry’s director general for disease control and prevention. “There is no cure for polio, the only cure is prevention and the prevention tool is vaccination,” said Rondonuwu, adding that the child can still walk, albeit with a limp. With about 275 million people, Indonesia is the fourth most populous in the world and the largest Muslim-majority nation. Aceh is highly conservative and is the only Indonesian province allowed to practice Sharia, which was a concession made by the national government in 2006 to end a war with separatists. False rumors that the polio vaccine contains pork or alcohol, prohibited under Muslim beliefs, have proliferated, especially in rural areas, complicating vaccination efforts, said Aceh Health Bureau chief Hanif, who has only a name like many Indonesians. “We cannot work alone, we need support from all parties, including religious leaders, so that people understand the importance of vaccination,” Hanif said. Azhar, the father of the 7-year-old who contracted polio, said he chose not to vaccinate his son after other villagers where he lived told him that vaccines could cause harmful chemicals or non-halal substances. “My neighbors told me that my son doesn’t need to be vaccinated and I didn’t want my son to get sick because of harmful chemicals that are against Islam,” the 45-year-old said. For Dewi Safitri, a mother of three who was getting them vaccinated on Monday, it was just a matter of not knowing it was necessary. She said she was convinced after health workers explained the risks of paralysis or death if her children were not vaccinated. “I didn’t even know about the vaccination,” she said. The World Health Assembly passed a resolution to eradicate polio worldwide in 1988, and since then, cases of wild poliovirus have declined by more than 99 percent, according to the World Health Organization. It was eradicated in Indonesia in 2014 and today it is still endemic in only two countries – Afghanistan and Pakistan. Polio mainly affects children under the age of 5, according to the WHO. However, unvaccinated people of any age can contract the disease, and sporadic cases continue to occur. In New York in September, for example, the state stepped up its efforts to combat polio after the disease was found in sewage in the New York area. Officials began checking for signs of the virus there after the first case of polio in the United States was identified in July in Rockland County, which is north of the city. Confirmed in an unvaccinated young adult. The statewide polio vaccination rate is 79%, but Rockland’s rate was lower, and New York health officials urged all unvaccinated residents, including children as young as 2 months old, to get vaccinated immediately. Last week, new cases of the polio virus were detected in Afghanistan, Algeria, Chad, the Democratic Republic of Congo, Ethiopia and Nigeria, according to the WHO’s Global Polio Eradication Initiative. Of the three other children in Indonesia from the same village as the first confirmed case, none had their basic vaccinations, Rondonuwu said. “It should be reported as an outbreak, because it had been declared eradicated in Indonesia, but it turns out there is still wild polio virus,” he said. Rondonuwu said his ministry is closely monitoring cases by doing door-to-door checks to ensure there are no additional unreported infections. The polio virus is spread from person to person, generally through the “fecal-oral route,” according to the WHO. In Indonesia, authorities have also pointed to unsanitary conditions as a possible cause of the new infections after finding that some local residents still defecate directly into a river where children are often found playing. Across Indonesia, polio vaccination coverage has declined since the COVID-19 outbreak. Despite the challenges of reaching people in the archipelago nation of five main islands and thousands of smaller ones, 73.4% of Indonesians are now fully vaccinated against COVID-19 and 87.5% have received at least one shot. For polio, 86.8% of babies were vaccinated in their first year in 2020 across the country, which dropped to 80.7% in 2021 as the country was forced to focus most of its health facilities and workers on dealing with the pandemic. In comparison, only 50.9% of infants born in Aceh in 2021 received polio vaccination. It was the second lowest nationally after West Papua, where only 43.4% of babies were vaccinated. The decline across the country was part of a wider decline in essential vaccinations, such as for measles and rubella, according to UNICEF. Dicky Budiman, an Indonesian epidemiologist from Australia’s Griffith University, said the discovery of polio in Aceh must be taken seriously because “the threat is real to Indonesia,” noting that basic vaccination coverage is still low, putting the country in high risk category. “This is something the government should really pursue, because it’s dangerous if we don’t,” Budiman said. “We must move immediately by strengthening basic vaccination or there will be a potential additional health disaster for Indonesia.” —— Karmini reported from Jakarta, Indonesia.
