ZAHLE, Lebanon: The girl arrived with her brother in tow. Ali, a 5-year-old Syrian refugee, had not been vaccinated against polio yet. He had missed class at the informal school that morning because he was helping chop wood for the family ahead of winter.
Ali was taken to the vaccination staff with Beyond Association, a local NGO responsible for the polio immunization drive in the camps which administered the oral vaccine and logged him in their running lists.
“Can I have my balloon?” he asked, and was on his way.
The boy was one of dozens of children in the makeshift settlement to receive the vaccine, part of a nationwide campaign meant to protect Lebanon against a resurgence of polio that began in war-torn Syria.
During Tuesday’s launch, Health Minister Wael Abu Faour warned that Lebanon had become “extremely susceptible” to a polio outbreak.
The Daily Star accompanied World Health Organization staff as they toured refugee settlements in the Bekaa Valley and vaccine storage facilities in an inspection meant to assess the ongoing campaign to vaccinate refugee and Lebanese children against polio.
Lebanon, along with other countries in Syria’s vicinity, began polio vaccination drives after an outbreak was detected in Syria. In October last year, the Syrian regime announced that 13 cases of type 1 polio had been detected in Deir al-Zor. A total of 24 cases had been reported by May 2014, the latest in Iraq.
The last case of polio in Lebanon was reported in 1994 and the country was declared polio-free in 2002 by the WHO.
For the vaccination campaign, UNICEF has procured some 1.5 million doses to be used in Lebanon.
The vaccine is the only tool available to protect the children, and so it is all the more important that it is widely received, given polio’s ease of transmission and the lack of treatment for the paralysis that could result from contracting the virus.
Polio can lurk hidden – for every child who develops paralysis from the disease, about 200 others may be infected but do not develop serious symptoms, though they could still transfer it to others.
Another problem is that, while most Lebanese have received the routine polio vaccine injection in visits to private physicians, they need to take the oral vaccine too.
And while they are individually immune to the virus, they could transmit it to vulnerable family members, like newborns, who have not been vaccinated.
Magdi Sharaf, the WHO’s point man on polio in Lebanon, roamed the camp asking women and children whether vaccination staff had visited them, examining the database, including the identification numbers of the children and their vaccination cards.
Sharaf said the aim of the vaccination drive was to raise the immunity levels of the Syrian and Lebanese communities here.
Since the Syrian community is dispersed, Beyond Association was assigned the task of vaccinating informal settlements where Syrians live, in a “house-to-house or tent-to-tent campaign.”
For the Lebanese, the WHO is overseeing vaccinations in schools, kindergartens, health care centers and hospitals, as well as providing vaccines to private physicians.
They have also toured the Lebanese government’s storage facilities which are, they said, among the more advanced systems globally, since they use solar power to ensure a steady electricity supply to keep the vaccines cool.
Lebanon held national immunization campaigns in November and December of last year in collaboration with the WHO, as well as in March and April 2014. These were followed with “mop-up” campaigns to vaccinate any children who had slipped through the cracks in high-risk communities.
The fifth national drive is currently ongoing until Oct. 21, and a sixth will occur in November.
The current campaign aims to vaccinate 550,000 children. It is impossible to vaccinate 100 percent of children, since there are roughly 10,000 Syrians arriving in Lebanon and 6,000 leaving the country on a daily basis.
There are over 1.1 million registered Syrian refugees in Lebanon, half of whom are under 17.
Still, the campaigns, which are synchronized with neighboring countries like Iraq, Jordan and Turkey, must continue until the polio threat in Syria is eradicated.
Sharaf said it was easier to immunize refugees than it was to immunize the Lebanese, because most don’t realize that their children need to take the oral vaccine in addition to the routine vaccine given to them by private doctors.
“Reaching refugees is easy, because these people are demanding it,” he said.
“They come from an infected area and have seen the paralyzed children, and they are suffering.
“Our challenge is the Lebanese themselves. They haven’t seen polio cases since 2002, so they have completely forgotten that disease.”
Sharaf said most parents were asking their private doctors if they should take the vaccines, and their doctors, who were not informed about the campaigns initially by the WHO, were saying no. So while 90 percent of Syrian children were vaccinated in the last immunization drives, just 70 percent of Lebanese children had been immunized.
The organization has since reached out to private doctors, who are now advising Lebanese patients to give their children the oral treatment.
The way the routine injection works is similar to the way most other vaccines work – it injects a weakened dose of the virus, which allows the body to produce antigens that can protect the body if it is infected.
But multiple doses of the vaccine are needed over time to keep the virus out.
Sharaf said the risk in Lebanon is “high,” because of the ongoing displacement of refugees from Syria.
“This is a continuous risk; we are not able to relax,” he said.
The risk is also rising with Iraqis fleeing to Lebanon amid the advance of ISIS there.
Though Iraq has a much smaller number of Syrian refugees than Lebanon, there have been cases of polio reported there.
That there have been none in Lebanon is largely due to the fact that all Syrian children entering Lebanon on the border are vaccinated against polio.
The four vaccination posts on the border, together with another set up at Beirut’s airport, vaccinate about 10,000 children per month.
But other challenges facing doctors in Lebanon include misinformation and negative attitudes to the vaccine caused by recent tragic cases of vaccine-related deaths in Syria.
At least 15 children died in Idlib this summer when they were given a measles vaccine that included Atracurium, a muscle relaxant that was not supposed to be mixed with the vaccine.
In addition, earlier this month, a Lebanese girl was said to have died after receiving a contaminated vaccination, although the family maid was later blamed for the death.
Another challenge is posed by Arsal, the troubled northeastern town that was briefly overrun by ISIS and Nusra Front militants in August. In addition to the recent unrest in the town, problems are caused by the fact that refugees arrive illegally through the mountain region on Arsal’s outskirts to Qaa near the border.
Maria Assi, the CEO of Beyond, said the NGO maintained a presence in the area nevertheless and had pledged to vaccinate all the children in Arsal’s refugee camps, as well as children in Qaa, despite the security concerns. And she said physicians had repeatedly allayed the fears of refugees about the vaccines.
Sharaf has messages for two key demographics that he said were crucial to the fight against polio. First, mothers are the ones who are able to stop the polio virus in the region, he said, by vaccinating their children.
Secondly, he said: “I am asking the private physicians ... to support our campaign.”
