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Polio Resurgence, Control in Saudi Arabia and Surrounding Areas.

Medical Anthropology
Short paper on current issues in infectious diseases
February 25, 2005
Yongho Kim

Poliomyelitis, called “polio” for short, is a viral infectious disease affecting mostly young children between the age of 3 to 5 years. It is caused by the poliovirus, with three recognized strains – non-paralytic, spinal paralytic, and bulbar – and transmitted through mouth contact with fecally infected water or foods. The virus attacks parts of the central nervous system (the spinal column or the brain stem depending on the strain), causing first fever, vomiting, headaches, pains in the neck and extremities, paralysis and/or death. (Wikipedia, 2005) The virus has a long permanence time, up to 35 days, and is usually found when the child presents floppy and lifeless limbs, a condition known as the acute flaccid paralysis (AFP).

Polio was first reported in 1840 and has been decreasing in instances in since the first vaccination was practiced in 1954. The WHO has called for the worldwide eradication of Polio in 1988, aiming initially for the year 2000 and then adjusting for 2005. The Western Hemisphere was declared polio-free in 1999, but Haiti and the Domincan Republic reported instances of polio the following year (Pan-American Health Organization, 2000) Today, polio spread is pocketed around small portions across Asia and Africa, with the largest concentration in the Kana Province of Northern Nigeria, accounting for 63% of world polio infection cases, (Polio Eradication, 2005) followed by smaller portions in South Sudan and India. (Wikipedia, 2005) Muslim leaders in the Northern province of Nigeria rejected vaccines on the basis that U.S. interests could have coerced Western vaccine providers into poisoning the vaccine, in particular fertility-reducing drugs and HIV viruses. (BBC, 2004)

During November and December of 2004, two cases of polio were reported in Saudi Arabia, an incident unseen since 1995. (CDC, 1998) Further investigation revealed in February 10th of 2005 that the second case of polio was not an infection channeled through foreign pilgrims visiting Mecca during the Haji of late January, but was a strain already established in Saudi soil; their family had been in Saudi Arabia for several years now, in an undocumented immigrant slum outside of Mecca. (McNeil, 2005)

This report follows measures taken by governments and health organizations to prevent the further sprawal of polio in Saudi Arabia and demographically nearby geographic areas (South Sudan, Eritrea and Yemen) and asseses their current impact.

The Immigration Factor

It is of note the peculiar parallel between the geopolitical positionality of Saudi Arabia, Yemen and Eritrea – separated by land, and sea respectively, and the relationship of the United States, Mexico and Cuba – in light of the immigration policies of the second term of the Bush administration. The 3-year temporary worker identification program, aka neo-bracero, resembles very much that of Saudi Arabia: cheap, politicaly dead labor exploited for a short period of time. (Kriokorian, 2004) Indeed, Saudi Arabia is following the United States’ example by building a fence along the border with Yemen under the pretext that “terrorists” and “drug smugglers” cross the border illegally. (Bradley, 2004)

What highlights this case is how it deviates from the usual rhetoric of blaming the foreign and the darker – as in industrialized nations the two categories often overlap – of any extraneous diseases worthy of public scandal. (Farmer, 1992: 237) While much emphasis is still put on the fact that the origin of polio is an “illegal” camp in the outskirts of Mecca, trying to focus the attention on Yemen and the “immigration problem” and that the disease is “imported”, (Briggs and Briggs, 2003: 278) emphasis is put in how the health systems in poorer nations is being trusted and in the internal measures of the Saudi organizations. Bruce Aylard, coordinator of the health organization’s Global Polio Eradication Initiative, can be heard commenting: “Some Sudanese officials blamed refugees fleeing fighting in southern Sudan, but Dr. Aylward said that made no sense because cases were exploding in Port Sudan, the jumping-off point for Mecca.” (McNeil, 2005) Thus while reliance on external blame to channel out public fears about its own nation-state seems low at the moment, it is a factor to keep an eye upon.

Responses

The outbreaks, however, nearly coincide in time with the weeklong, UNICEF-coordinated mass polio immunization initiative that starts today, February 25th of 2005, with the support of various governments of west coast and central african nations. Following the previous campaign during October and November of 2004, several vaccination spaces will be mixing vitamin A drops for improved effect. (Reuters, 2005) Liberia initiated its vaccination campaign with a large ritual (The Analyst, 2005) and governments of other affected nations are joining in: Cuba (Prensa Latina, 2005)

In a stretch, claims made by Nigerian muslim leaders are not completely unfounded. Early vaccines in the 1955-63 period are known to be contaminated with the simian virus 40. Although there are claims that this virus causes cancer, a recent study demonstrated that the question is for the moment without conclusion. (Institute of Medicine, 2002) However distant a claim to HIV poisoning rings from a SIV-40 contamination that occured fifty years ago, the post 9-11 climate in the muslim world puts their charges in context.

In Saudi Arabia, there is much speculation concerning what caused the polio infection in the 5 year old Nigerian child living in the encampment. One key point is whether or not the infection was “imported”. Others are the effectiveness of the vaccine (the child was vaccinated) in tropical climates, (CBC, 2005) the resistance that polio viruses develop to oral polio vaccines.

Effectiveness

I can’t gage the Saudi government’s effectiveness in treating with the Haji and the polio as the incubation period is just finishing now. It remains to be seen how widespread the effects of polio infections (if at all) in Saudi Arabia during the haji were.

Reference

AFP
2005 Polio cases in Saudi Arabia show risk of spread with pilgrims: WHO. February 11.

Briggs, Charles L. and Clara Martini-Briggs
2004 Sanitation and Global Citizenship. In Stories in the Times of Cholera: Racial Profiling during a Medical Nightmare. University of California Press.

Bush, George Walker
2004 President Bush Proposes New Temporary Worker Program: Remarks by the President on Immigration Policy, Speech Transcript. January 7.

BBC News
2004 Nigeria seeks Asia polio vaccines. BBC. March 9.

Bradley, John R.
2004 Saudi Arabia enrages Yemen with fence. The Independent, February 11.

CBC News
2005 WHO on look out for polio spread after Saudi case. CBC News, February 11.

Centers for Disease Control
1998 Virologic Surveillance and Progress Toward Poliomyelitis Eradication — Eastern Mediterranean Region, 1995-September 1998 In Morbidity and Mortality Weekly Report, 47(46):1001-5

Farmer, Paul
1992 AIDS and Accusation: Haiti and the Geography of Blame. University of California Press.

Krikorian, Mark
2004 Immigration, Saudi Style: A radical disconnect. National Review Online, January 13.

McNeil Jr, Donald G.
2005 Mecca Pilgrims May Be Spreading Polio, Experts Say. New York Times, February 11. A1, p.3.

Nature News Service
2002 Polio vaccine bites back. March 15.

Pan-American Health Organization
2000 Outbreak of Poliomyelitis in the Dominican Republic and Haiti. In Epidemiological Health Bulletin. Vol.2, No. 4. p.13

Polio Eradication
2005a Polio Eradication Website. Electronic Document, http://www.polioeradication.org
2005b Polio Eradication Situation Report. Electronic Document (PDF), accessed February 25

Prensa Latina
2005 Anti-polio Vaccination Drive Begins in Cuba, February 25

Reuters
2005 AFRICA: Continent-wide polio immunisation drive begins, February 25.

Board on Health Promotion and Disease Prevention, Institute of Medicine
2002 Immunization Safety Review: SV40 Contamination of Polio Vaccine and Cancer. Kathleen Stratton, Donna A. Alamario and Marie C. McCormick, editors.

The Analyst
2005 Bryant Gives First Drops, Launches Anti Polio Drive, February 25

Wikipedia
2005 Polio. Electronic Document, http://en.wikipedia.org/wiki/Polio, accessed February 24.

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