Volunteers vaccinated 134-million children against polio in India in a single day last year, and doctors negotiated weeklong cease-fires among warring factions to immunize Afghan children.
Mass vaccination campaigns around the globe are proving successful enough that the World Health Organization declared Saturday it may eradicate the paralyzing disease by 2000, after all.
"If we don't make it, we're going to be pretty, pretty, pretty close," said Dr. Harry Hull, who heads WHO's polio campaign.
Health experts have questioned whether polio will be eradicated by the WHO's deadline, particularly as the disease is still endemic in 116 countries. In 12 countries, less than half of children are immunized. Some of the most troublesome areas are in Africa and in pockets of Asia, including India and Afghanistan.
Wild polio has been eradicated from the Western Hemisphere since 1991. But all children, even in polio-free countries such as the United States, must continue to be vaccinated until the virus is wiped out worldwide _ because infected travelers easily can spread polio to any part of the world.
"In Africa, we're scrambling," Hull said, noting that fighting has prevented health workers from even attempting the first "national immunization days" in Congo, Sierra Leone, Liberia or southern Somalia.
These mass vaccination campaigns already are established in every other polio-endemic country as a simple strategy to reach hordes of children in a few days. Rotary International, which is helping to fund the eradication campaign, mobilizes thousands of volunteers _ no health expertise is required to squirt two drops of vaccine into a child's mouth.
In India, billboards mounted on elephants who rambled through villages drew crowds to the event.
The WHO's global status report on polio, released Saturday, said 450-million young children were immunized last year during these mass campaigns, about two-thirds of the world's population under age 5.
If vaccinations continue at that rate, polio would disappear on time, the report said. But it will take another $1-billion by 2005 to have vaccinations keep pace with births and then to verify that polio is truly gone. For 1998 alone, the polio budget is $60-million short, Hull said.
The United States this week offered an extra $9-million in emergency funds, dedicated to expand vaccination into the last four African nations, said Dr. Steve Cochi, polio chief at the U.S. Centers for Disease Control and Prevention. The move brought U.S. spending on polio eradication to $81-million this year.
Polio has dropped 90 percent since eradication efforts began in 1988, "but that last 10 percent is the hardest 10 percent, and it's in the most difficult areas of the world," Cochi said.
Indeed, Hull recalled when WHO last attempted negotiations for vaccinations in Sierra Leone _ officials landed at the airport during a coup. In northern Somalia, a WHO vaccine team was detained by armed troops.
Congo, known as Zaire until a bloody civil war last year, "is going to be very, very difficult because the health infrastructure has been destroyed," he said _ although an $8-million attempt to vaccinate 4 million children is set for August.