Democratic Republic of the Congo: Smallpox Today, Polio Tomorrow?
"Smallpox eradication in the Democratic Republic of the Congo (DRC),formerly known as Zaire (1971–1997), was particularly challenging given the vast size of the country and poor infrastructure. The speed with which eradication was accomplished is considered to be one of the most remarkable accomplishments of the global eradication program." (Muyembe-Tamfum et al., 2011, p. D13)
The campaign to end smallpox in the Democratic Republic of the Congo (DRC) began with the signing of an official partnership with the World Health Organization (WHO) in 1965. This move was followed in 1966 by the creation of the Campagne Nationale d’éradication de la variole (National Campaign for Smallpox Eradication), which was relatively ambitious compared to its counterparts on the continent in that it sought to simultaneously control tuberculosis in addition to eliminating smallpox. Although the desire to kill two diseases with one campaign was certainly admirable, logistical complications soon arose: the vaccine used against tuberculosis ideally required patients to take a medical test, and it took several days for the results to come back. The test would be scrapped when the vaccination campaign expanded beyond its initial phases, and syringes would be replaced with jet injectors.
Mobutu Sese Seko
1976 photo of Mobutu Sese Seko, president of the Democratic Republic of the Congo (then Zaire) during the smallpox eradication campaign
Other problems faced by the vaccination campaign were of a political character. In 1965, Mobutu Sese Seko began his tenure as president of the DRC-- a tenure that would span over three decades-- and his authoritarian regime would mismanage the logistics of the smallpox eradication campaign. Funds allocated to the eradication effort were occasionally frozen and vaccination teams were often understaffed; furthermore, Mobutu's government did little to support or expand the ersatz road system left behind by Belgian colonizers, making it quite difficult for medics to reach remote villages in the sprawling country (the DRC is the second-largest country in Africa and the largest in sub-Saharan Africa). Transportation difficulties were particularly pernicious because they meant that the quality of vaccines declined the further vaccinators traveled away from domestic production centers. Thankfully, by 1969, the DRC acquired freeze-dried vaccines from the Soviet Union, which removed the problem of vaccine degradation. By 1971, vaccination teams were able to hire more staff and significant progress towards eradication was made, with vaccinators effectively containing suspected outbreaks of smallpox. The last known case of smallpox was reported in the country was reported in July 1971.
A woman in the Democratic Republic of Congo (DRC) administers a polio vaccine
2007 photo taken in Kinshasa by the U.S. Aid Agency for International Development, showing a woman administering a polio vaccine
The success of the DRC smallpox eradication in less-than-ideal circumstances has inspired efforts decades later to eradicate polio within the country. The DRC was declared polio-free in 2001, yet after the disease was reintroduced to the country (likely from Angola), minor outbreaks have stubbornly persisted. Why is this so? While smallpox vaccination requires only one shot, polio immunity typically requires five or six shots, which means thorough vaccination coverage is especially important for defeating polio. Efforts to surveil the spread of polio are frustrated by the fact that, unlike smallpox, most cases are subclinical, and only 1% of polio patients will develop the disease's signature paralysis. It has been proposed that new methods of monitoring polio be implemented, with some talk of using a technique pioneered in Mexico in which PCR (i.e., polymerase chain reaction, a method to test DNA samples) is used on sewage. To help organize a standardized vaccination program, Congolese officials have introduced National Immunization Days, which parallel previous efforts to control smallpox and measles in a single campaign. Other commentators stress the importance of developing positive relationships with local leaders, particularly those tied to health care, such as traditional healers birth attendants, and religious leaders.