Mothers in the Indonesian village of Cidadap don't have big dreams for their kids. Surviving infancy is often as much as they hope for, with everything else left to luck. Fikri Ramdani looked like one of the fortunate ones--active and well and, at 19 months, deep into toddlerhood. Today, however, he lies limp in his mother's arms, his eyes rolled back and his face shiny with sweat. "He used to like playing ball," says his mother Yayat. "Now he can't even stand up."
Yayat is hopeful. She tickles the boy's foot to show it still has feeling, but the foot hangs limp. It may never move again. Just last week polio was officially diagnosed in Fikri, the first Indonesian child to test positive for the virus in 10 years. Three other cases have been confirmed in the area, and hundreds of other children--some suspiciously sick already--are being examined. "The virus has probably been circulating for a month," says Dr. Georg Petersen, an on-site representative of the World Health Organization (WHO). "We can expect more cases."
The sickly village of Cidadap is not alone in its woes. Even as Americans celebrate the 50th anniversary of the Salk vaccine--the magic bullet that all but wiped out polio in the U.S.--the disease is on the march around the world. Since 2003 polio has been spreading in a fevered band across 16 countries mostly in western and central Africa and the Middle East. And with the news last week that the virus had leaped the Indian Ocean to Indonesia, other nations, including the U.S., have begun to worry about where the disease might turn up next.
What's behind the re-emergence of polio? More important, can the new outbreaks be contained and others prevented, or is the disease truly on the loose again?
For 15 years health officials were remarkably successful in trying to eradicate polio. In 1988 there were 350,000 fresh cases of polio in 125 countries, most of them in the developing world. That year four groups--WHO, Rotary International, UNICEF and the U.S. Centers for Disease Control (CDC)--made it their goal to vaccinate polio out of existence, and with the help of private and government funding, they came tantalizingly close. By 2003, the virus was confined to six countries--Nigeria, Niger, Egypt, Pakistan, Afghanistan and India--and was seemingly headed for extinction by 2005. But nobody reckoned on the Muslim clerics in northern Nigeria.
In the summer of 2003, leaders of the region stopped polio inoculations after rumors spread that the vaccine could transmit AIDS and render girls infertile. It was a bad time--and a very bad place--to halt vaccines. There are now 35 million Nigerian kids under age 5, and 20% have no polio vaccinations. Says Oliver Rosenbauer, spokesman for WHO's Global Polio Eradication Initiative: "That's a lot of breathing space for the poliovirus to survive."