Martha Rial, Post-Gazette Firdausi Adamu, 9, contracted polio when she was four. She smiles after an appointment at the National Orthopaedic Hospital in Kano, Nigeria, where her right leg was measured for a new brace. Click photo for larger image. Related stories In Africa Polio's final chapter: Index Photo Journal: More pictures by Martha Rial In Pittsburgh The Salk vaccine: 50 years later

KANO, Nigeria -- Polio left at least 17 children paralyzed in Amina Awwal's community last year.

This densely populated slum in northern Nigeria is the perfect breeding ground for the virus, which lives in human waste. Water taps and uncovered wells sit precariously close to the open sewer trenches that cut through the narrow, dusty paths where barefoot children run and play. A confetti mix of trash stretches everywhere. And the dry season's soaring temperatures drive throngs from their sweltering homes to congregate outside in search of a breeze.

Awwal has seen the paralyzed people -- the guragus -- begging on street corners. She's seen them crawling in the dirt. But she's also heard that the polio vaccine might sterilize her child. Or infect her with HIV.

So when vaccinators appeared at her door on March 1, there were shrieks from her home.

"Asoro! Asoro!" she cried. "I'm afraid."

"My baby is only 50 days old. She's too young. She's not strong."

Hafsat Sulaiman, a vaccination co-trainer from the community, talked to the young mother in her native language of Hausa. She told her that her baby girl was so vulnerable. She told her the vaccine would protect her, not harm her. Awwal shooed her away.

As she left, Sulaiman wrote with chalk on Awwal's door: Rx -- Rejection.

	Martha Rial, Post-Gazette Vaccinator Aisha Rumfa coos "hoo baby, sweet sweet," to urge an reluctant child to open her mouth for oral polio vaccine near Ungogo, Nigeria, where villagers refused to accept the vaccine last year because they wanted the government to also give them a new water system. Click photo for larger image.

This is supposed to be the year that polio is eradicated from the planet. But at least here, in the epicenter of the world's largest polio outbreak, the first vaccination program of 2005 appeared to be in trouble.

In addition to sporadic rejections from women like Awwal, immunizations were delayed in one community after its freezers and generator -- the vital tools needed to keep the polio vaccine cold enough to be useful in the blistering heat -- had gone missing. Freezers in several other areas were broken.

A religious sect with nearly 500 at-risk children refused to let vaccinators in because it eschewed anything "modern." Too-perfect vaccination tally sheets in another area appeared to have been doctored.

Citizens in a densely populated village in Ungogo, another local community, rejected the vaccine unless they got a better water system. The group had blocked the vaccinators during the four immunization rounds in 2004, and it was digging in its heels again.

The Feb. 26-March 1 campaign was almost over, and time was running out.

Dr. Hamisu Walla, a polio surveillance officer with the World Health Organization, shook his head as he talked about the stubborn Ungogo group.

"If polio is going to hide anywhere in the community, it is going to be there."

Fear of sterility, AIDS

Fifty years since the announcement that the University of Pittsburgh's Dr. Jonas Salk had developed the first safe and effective vaccine against poliomyelitis, the disease is alive and thriving in Africa.

	Martha Rial, Post-Gazette Boys race up Dala Hill, which overlooks Kano's Old City, to play just after sunrise. Kano, the epicenter of the world's largest concentration of polio cases, is covered with red dust during Nigeria's dry season, which stretches from November to late April. Click photo for larger image.

Almost snuffed out by 2003, it won a reprieve from global death, thanks to an 11-month boycott of the vaccination program in this Islamic state over false claims the serum was contaminated with anti-fertility agents and the AIDS virus. Although vaccinations resumed here in July 2004, the disease has now spread to 14 previously polio-free countries -- the latest Ethiopia -- leaving hundreds of paralyzed children in its wake.

Mounted by the public-private partnership of the World Health Organization, United Nations Children's Fund, Rotary International and the U.S. Centers for Disease Control and Prevention, the $4 billion polio eradication effort is going full throttle, against almost insurmountable odds and dwindling funds, to squelch transmission before it spreads any further.

When the health partners launched their campaign in 1988, polio was being transmitted in 125 countries, infecting more than 350,000 children -- a thousand became paralyzed each day. Before the 2004 outbreak, the total number of cases had dipped to fewer than 800, cornered in just six countries: Nigeria, Niger and Egypt in Africa; India, Pakistan and Afghanistan in Asia.

The spread from Nigeria has cost the program an additional $200 million, said Dr. David L. Heymann, WHO's executive director for communicable diseases. Addressing the new cases just in Ethiopia will cost $12 million.

To try to stem the tide, polio immunization campaigns in February were launched simultaneously in 23 at-risk countries.

	Martha Rial, Post-Gazette In the Old City of Kano, open sewer trenches cut through the narrow footpaths where children play. The polio virus lives in human waste. There were 17 children paralyzed in this densely populated slum last year. Click photo for larger image.

"By doing it synchronized, the virus can't hide in one country or spring into another country," said Heymann, who led the assault on the SARS epidemic before taking over WHO's polio campaign. "It's being cornered."

Health officials are scrambling to raise money to address a $75 million shortfall for the second half of 2005 and face $200 million in expenses for 2006.

Heymann, who was born in the foothills of the Allegheny Mountains in north central Pennsylvania, won't make a prediction until June on whether 2005 will be the year.

But he's optimistic. "The political commitment has never been higher. We've never had a more effective vaccination campaign."

Each country must be free of the disease for three years before the eradication is certified. Those like Saudi Arabia, which had its last case in 1995 until two cases surfaced there late last year, must start the clock all over again.

Officials of Rotary International, which has pumped more than $600 million into the effort and had hoped to reach its goal for its 100th anniversary this year, are confident, at least, that the more than 1 billion people in India will see their last case in 2005.

But in probably no place is the task more critical than in Nigeria, Africa's most populous country, where vaccinators need to reach 40 million children. Twenty-nine new cases already have popped up this year, including a cluster in the nomadic tribes in western Nigeria that migrate between Niger and Chad.

Children still are being missed. They're missed partly because of the unfounded fears of Awwal and other misinformed parents. But the reasons are far more complicated.

"Public health is always politics," said Dr. Elias Durry, with a knowing smile.

	Martha Rial, Post-Gazette The Wudil River, about 17 miles from Kano, is a perfect hiding place for the polio virus. Here, children bathe in the cool waters, men fill jugs for their families, young girls wash clothes and many drink the river water. Click photo for larger image.

The WHO polio team leader for Nigeria who led vaccination teams in the Horn of Africa has faced myriad challenges as he's chased the disease across the continent. There were Tranquility Days, when soldiers in war-torn areas laid down their weapons to allow children to be vaccinated, problems with washed-out roads or no roads at all and encounters with gunfire, even crocodiles.

"The virus has a way of trying to hide from us," he said. "We have a good strategy so it cannot survive. We know where to go and look for it."

Durry is confident the program will succeed in Nigeria, despite the widespread poverty (more than half of the 137 million people live on $1 or less a day) and corruption spawned by years of military rule; poor sanitation and water systems; sporadic electricity; and cultural difficulties that are slowing the campaign.

Others are not so sure. Families here are growing weary of all the attention on polio -- a disease they rarely see -- when far more children are dying of measles, malaria and other illnesses. More than 600 children already have died of measles this year, most in the north.

"People don't share the same vision to eradicate polio," said Auwalu A. Kawu, a Ph.D. who has been program officer for the U.S. Agency for International Development and previously worked for WHO.

"Unless families take the responsibility to eradicate it, polio will likely linger awhile, and the exercise will continue to deteriorate."

How the virus spreads

Polio is known as Shan-inna, or the spirit of paralysis, in northern Nigeria's Hausa tribal tradition. It most commonly spreads through contaminated drinking water. Shed through the stool for weeks after a person is infected, it enters through the mouth and multiplies in the intestine.

	Martha Rial, Post-Gazette Most people in Nigeria's northern states obtain water from hand-dug wells or rivers. This well in Yargawa, a small village east of Kano, is about 65 feet deep. Men and boys come to fill 20-litre jugs with untreated water, which is used for drinking, bathing, cooking and washing clothes and pots. Click photo for larger image.

Once in the body, the virus invades the nervous system. It may spark fever, headache, vomiting, stiffness in the neck and pain in the limbs. Only one in 200 infections will cause irreversible paralysis, usually in the legs and almost always in young children.

Among those, 5 to 10 percent will die when their breathing muscles freeze. In Nigeria, they will be among the thousands of unexplained deaths of young children who are sick, malnourished and impoverished.

While the Salk vaccine helped wipe out polio in the Western world, it has been the live oral vaccine, developed by Dr. Albert Sabin in 1961, that has made immunization possible for the masses in undeveloped countries.

Using the drops, thousands of lay people have been able to administer the vaccine, without the same medical training that would be needed to give injections of the killed Salk vaccine. The whole process is so simple that even the most uneducated can be trained, or so it would seem.

The CDC recommends that U.S. children have four doses of the polio vaccine. Children here, whose bodies are weakened by poor nutrition and diseases like malaria, often need more doses to reach full immunity.

The oral vaccine also allows for "herd immunization" -- because it is a weakened form of the live virus, the vaccine can spread through children's feces to indirectly vaccinate others. This is actually made easier because of the country's poor sanitation and hygiene.

In rare cases, the vaccine itself can cause polio, which is the reason the United States in 2000 stopped using the Sabin vaccine in favor of the inactivated Salk vaccine, which doesn't carry that risk.

Martha Rial, Post-Gazette Women are tapped as vaccinators and recorders in heavily Muslim areas because they are the only ones who can enter the housing compounds -- known as ba shiga or "Do Not Enter" -- when the husbands are not present. The women, who are part of six-member sweep teams, walk miles through neighborhoods during the four-day campaign. They receive about $3 a day for their work. The portable coolers contain two ice packs and 11 vials of polio vaccine. Each vial contains 40 drops, or a total of 20 doses. Click photo for larger image.

Following a grass-roots approach that has proved successful in other countries, health officials in Nigeria recruit vaccinators from local communities to go house-to-house to place two drops of the oral vaccine in the mouths of all children under 5. They're part of six-member sweep teams that include recorders, a guide and supervisor, who are familiar with the neighborhood and which families have children.

After administering a dose, the vaccinators mark the left pinkie or thumb of each child with indelible ink. They also mark the door or wall of the home entrance with chalk to show they've visited the home. A check means they've been successful; N, no eligible child; R, a revisit is needed; Rx, a rejection or noncompliance.

In India, where a Rotarian couple from Murrysville and a University of Pittsburgh vice chancellor traveled for a campaign in February, the vaccine also is administered at booths set up at markets and at other public places. Vaccinators also stop cars, trucks, boats, even ox carts, to give out the drops to young passengers.

In Nigeria, states are divided into Local Government Areas, or LGAs. There are 44 in Kano state, home to an estimated 3.8 million children under 5. Some LGAs are made up of tiny villages that have changed little over the centuries.

The vaccinators and recorders, who are paid about $3 a day, are women because, under Islamic law, they're the only ones who can enter a home when the husband is not present (and he's rarely home during the day).

The intense sense of privacy is symbolized by the name of the compounds in which families live -- ba shigas -- which means "Do Not Enter" in Hausa. From the front door, a narrow hallway opens into a communal courtyard surrounded by 8 to 10 small rooms, one for each family. Men can have up to four wives (as long as he loves them equally, according to the Koran), and the wives may live in the ba shiga together. Some compounds are home to 40 or more children.

	Martha Rial, Post-Gazette A reluctant mother rests against a tree as vaccinator Halima Abubakar cajoles her to have her children immunized against polio on the first day of campaign in Tudun Wada, Nigeria. Click photo for larger image.

The vaccinators carry the vials in "Kick Polio Out of Africa" coolers, where they must be chilled at 40 degrees Fahrenheit or below to be effective. Every vial has a temperature indicator. "It's like a mood ring that changes colors," said Melissa Corkum, a WHO spokeswoman.

Representatives from Rotary, UNICEF, WHO and other organizations often serve as monitors to do spot checks with families to make sure that every child under 5 is reached.

On paper, the system appears foolproof. However, there are frequent breakdowns.

Turnover in Nigeria is high, so many of the young vaccinators, despite two days of training, have difficulty filling out the tally sheets or getting the house markings straight. Many are too timid to stand up to resistant families. Some fail to immunize children who are visiting -- they only vaccinate those who live there -- so children are missed.

There are cultural challenges, too. Hassana Waziri, WHO's social mobilization officer, explained that some mothers may not present their firstborn to vaccinators because of old social customs. The firstborn is considered "the first gift from the Lord." Mothers, out of respect, don't openly show the oldest child affection or call him or her by name.

"It's not that the mother doesn't love him," Waziri said. "She can't show him affection."

In India, the deeply entrenched social preference for sons also played a role in the vaccination campaign. Margaret "Maggie" McDonald, Pitt's vice chancellor for academic affairs in health sciences, observed when she was there that some families were more reluctant to bring forth their sons than daughters for the polio vaccine.

Islam and suspicion

When looking at the history of Kano, it's not surprising to see how a cascade of rumors, fears and suspicion led to the halt of the vaccination program in August 2003.

	Martha Rial, Post-Gazette Westerners are often viewed with suspicion in Kano, a heavily Muslim region closely aligned with Afghanistan and Iraq. The U.S. invasions of these countries has created a climate of distrust and anger that fuels suspicion about the safety of U.S.-backed polio immunization. Click photo for larger image.

The Hausa tribal lands of northern Nigeria are very different from other parts of this former British colony. While southern Nigeria is mostly Christian, Islam came to the north centuries ago through the Sahara trade routes. The Hausa people first adopted Islamic dress, then its culture, and finally its religion.

There's a mosque in every village, with a call to prayer five times a day. Sharia, or Islamic law -- the strict religious code that sometimes calls for stonings and beheadings for moral offenses -- began to take hold in 1999.

Because the area aligns itself closely with Muslim groups in Iraq and Afghanistan, the U.S.-led invasions of those countries after Sept. 11 drew cries of protest from many Muslim clerics, who cast suspicion on any program supported by the United States. In Central Kano, the words over one doorway read: "Bin Laden Forever."

Even before the latest military invasions, suspicion was high because of what happened after the U.S. drug manufacturer Pfizer treated 100 children in Kano for free in 1996 with the experimental antibiotic trovafloxicin, or Trovan, during an outbreak of bacterial meningitis. According to a lawsuit still pending in U.S. District Court in New York, up to 11 children died and others experienced disabilities. The suit claimed the company never received proper consent to test the drug. Pfizer, in a statement, denies any wrongdoing, noting that the disease kills four out of every 10 people infected, and that the trial, in fact, saved lives.

	Martha Rial, Post-Gazette Vaccination co-trainer Hafsat Sulaiman, 19, marks an Rx for rejection on the entrance of a family compound after the father refused to allow his children to be vaccinated. Click photo for larger image.

In 1999, religious and political tensions mounted between the Islamic northern states and the Nigerian government after the election of President Olusegun Obasanjo, a devout Christian. He endorsed the stepped-up polio vaccination program at a time when the nation's routine immunizations against measles, tuberculosis, tetanus and other common diseases -- which kill far more children than polio -- had faltered.

Nigerians, just gaining access to the Internet, also were discovering Web sites that questioned the safety of vaccines. The involvement of Rotary, an organization that Muslims see as another religion, added to the suspicions.

Radical Muslim clerics took up the charge, assailing the U.S.-backed polio vaccination program during prayer sessions.

"People started passing rumors that the vaccine was a special way to control the population and that it was introducing new diseases, like HIV," said Dr. Sadiq Wali, a professor at the University of Kano School of Medicine, who played a key role in getting the vaccination program restarted.

One of the most vocal critics was Kano physician Ibrahim Datti Ahmed, who was president of Nigeria's Supreme Council of Sharia Law. He, too, saw the anti-vaccine Web sites.

He stirred up people with his radio messages, asking "Why is it free? Why is it free?"

	Martha Rial, Post-Gazette A Nigerian man pretends to be angry at vaccinators for trying to immunize his son during a skit at an opening ceremony on the first day of the National Immunization Campaign in Tudun Wada. The skits are held to stress the importance of immunizing children against polio. Click photo for larger image.

By 2003, the vaccination compliance rate in Kano had dropped from a high of 80 to 90 percent to about 15 percent, Wali said.

Finally, leaders in Kano and some other northern states halted the campaign.

"We refused to go along with the rest of the world without establishing the safety of the vaccine," said Kano Health Minister Sanda Mohammad. "We were the odd one out."

Kano officials set up a committee of doctors, clerics, pharmacologists and technicians to analyze the vaccine. Samples were tested in labs in Nigeria, South Africa, India and Indonesia.

"There was no HIV, no hepatitis A, no carcinogens," Wali said. The tests, however, did detect traces of the hormones used in birth control pills.

Wali, 63, a specialist in internal and infectious disease who was trained in health planning at Johns Hopkins University in 1975, directed a committee of physicians to sift through the hundreds of documents on the tests to advise the government.

The panel concluded that the traces of hormone were picked up through the production chain -- the oral vaccine is grown in cell cultures of the kidney tissue of rhesus monkeys, which apparently contained traces of estrogen and other hormones from the reproductive organs. Although the samples are washed to extract the vaccine, "you cannot get 100 percent purity," Wali said.

His panel then had to convince government leaders that the traces had no clinical significance. The hormones metabolize in the body quickly. "Such minute quantities given to a child under 5 could have no effect on fertility down the road," he said.

To allay concerns, new batches of the vaccine were ordered from plants in heavily Muslim Indonesia. Wali and others then traveled throughout northern Nigeria to speak with state, religious and traditional leaders to try to convince them that the vaccine was safe.

	Martha Rial, Post-Gazette Dr. Magdillel Hadari, center, of Sudan, persuades a reluctant father to allow his four children to be vaccinated for polio on the final day of a campaign last month. He was assisted in the conversation by 19-year-old vaccination co-trainer Hafsat Sulaiman, right, who served as translator. Click photo for larger image.

By the time the National Immunization Days resumed in July 2004, polio cases were spreading, even though critics had toned down their warnings.

Reached by telephone, Ahmed, the most vocal opponent of the vaccine, said only: "We have moved on to other things."

To their credit, Nigerian leaders are working hard to persuade the public to accept the vaccine.

At the African Union heads of state meeting in January, Obasanjo apologized for how polio had spread to other African nations. At a ceremony near Lagos before the February campaign, he and the president of neighboring Benin squeezed drops of polio vaccine into the mouths of babies.

At another ceremony at a stadium in the north, Emir Alhaji Ado Bayero -- the highest traditional leader in Kano and the state's closest thing to royalty -- walked through the crowds under a gold silk umbrella to vaccinate children from Nigeria's northern states.

Vaccination figures in Kano show that acceptance is growing. When the campaign resumed in July, 56.3 percent of young children were vaccinated. It grew to 65.2 percent in August, 81.5 percent in October and finally 92.4 percent in November.

From ice to water

On the eve of February's campaign in Kano, however, preparations were off to a rocky start.

	Martha Rial, Post-Gazette On the day before the four-day national immunization campaign begins, Dr. Hamisu Walla, a polio surveillance officer with the World Health Organization, inspects the "cold store" in the local government area in Ungogo. Walla, born in Kano, was disappointed to find unfrozen ice packs in the dilapidated health clinic. Click photo for larger image.

During a morning visit to the health center's "cold store" in Ungogo, a farming village about 10 miles east of Kano, WHO's Dr. Walla was disappointed.

There was no fuel to run the generator to operate the freezer, so the ice packs needed to chill the vaccine as workers made their rounds in the heat were just water.

He was visibly frustrated. "In Kano, we've had these [National Immunization Days] since 1997. By now, one would not expect to come to a cold store and find things not functioning. There's no excuse for an LGA to not have a functioning freezer and for the cold room to be in such a dilapidated state."

The problem at Ungogo's clinic was not an isolated case.

At an evening meeting of health leaders at the Ministry of Health office in Kano, advisers reported similar problems with ice packs, broken freezers and inadequate training.

At one point, some suggested that the state's whole campaign be suspended, but in the end, Dr. Sani Jibril, state deputy director of primary health care, ordered that only the immunization at Shanono, a longtime trouble spot, be stopped until the problems were addressed.

Lieven Desomer, UNICEF's supplementary immunization activity officer, said ice packs should be frozen at least five days before the campaign.

"Are they serious about their job?" he asked about the facilitators in Shanono. "People wake up 24 hours before the campaign and say, 'I forgot to freeze my ice packs'? There is something definitely, seriously wrong."

Desomer has been involved in similar campaigns in Congo, Somalia and Kenya, and had never seen such problems. "For me, it's a little bit surprising. It shouldn't happen."

Durry, WHO's team leader, agreed, but said the problems would be resolved, noting that the Red Cross and even corporations could help freeze the ice packs.

"It's like planning a wedding," he said. "There are a lot of last-minute problems. But in the end, it all works."

Preparing for the final push

By the end of day three in Kano Municipal Council, the densely populated Old City where Awwal lives, the 70 sweep teams had reached just 66 percent of the 211,176 children under 5. There was still a lot of work to be done.

	Martha Rial, Post-Gazette A young girl in Ungogo, Nigeria, receives two drops of oral polio vaccine. The vaccinators target children under the age of five. Click photo for larger image.

On the last day of the campaign -- when temperatures peaked at 108 degrees -- Dr. Magdillel Hadari, a WHO official from Sudan, wanted to return to two areas where Kano's last two polio cases of 2004 had been reported. This was called the "mop up," to make sure no children were missed.

"All the factors are here for transmission," he explained, noting the dense population and poor sanitation. In one ba shiga, the open sewer sliced through the home's courtyard, essentially the "living room" where families gathered. In the rainy season that starts in late April, this and other trenches in the community will overflow.

After being rejected at Awwal's home, Sulaiman, the vaccination co-trainer, didn't have to go far to face more resistance.

A home down the path had no markings on the door. Had it been missed?

She entered, calling out the standard greeting: Salamu Alaykum, "Peace Upon You."

Khadija Ibrahim was in the back of the courtyard washing clothes.

"You are trying to reduce the number of my children," she told Sulaiman. She has four children aged 20 months to 4 years. "My husband says 'No.'"

Hadari, waiting outside, asked that the husband come out to speak with him.

"I've immunized my kids 10 times," Hadari told the father. "We are afraid for you. This disease can paralyze your children."

"I'm not the only one rejecting this," said the father. "There are many others."

Hadari stood his ground. "I want the best for you and your family. It's your responsibility and my responsibility in front of God."

The father, after much discussion, finally agreed.

Breakthroughs, and hope

Remarkably, there was good news on the last night of the Kano campaign. The religious sect that had blocked vaccinators because they didn't follow modern medical practices agreed to allow health officials to train their own people to give the vaccine. That would start the next day.

	Martha Rial, Post-Gazette Generator and freezers are working at the Kano Muncipal Council, so sweep teams of vaccinators, recorders and supervisors will have ice packs to keep the polio vaccine cool as they make their rounds in northern Nigeria's intense heat. Click photo for larger image.

In Ungogo, the traditional leader, in his grand robe and headdress, walked house-to-house with vaccinators and persuaded the stubborn families to take the vaccine, while also promising to speak with government leaders about a new water system. Shanono's program began a day late, but was expected to wrap up without difficulty. Rejections in most other communities also were conquered with much work and negotiation.

So slowly, very slowly, the campaign is chipping away at polio's hiding places.

According to WHO figures released last week, the February campaign reached 40.9 million children in Nigeria, including 3.6 million of the 3.8 million estimated to live in Kano state. How close these numbers came to the actual number of children is only a guess, since the country -- which has an annual growth rate of 3.3 percent -- has not had a full census since 1992.

The proof of success will be in new cases, many of which may not show up until the fall. But health officials are aiming to stop transmission before summer, when the number of cases typically soars.

To shore up procedures, health officials started training workers earlier for the next round, which begins Saturday. And with a new outbreak in Kebbi, the nomadic area in western Nigeria, they'll be following families there, as they move with the cattle herds, to vaccinate everyone in their path.

"These next two rounds [in April and May] are very critical to us," Durry said. "We have to stop the virus before the high season."

And after those next two rounds, they'll go out again in September. And then again in October. And again in November.

	Martha Rial, Post-Gazette A mark on a young boy's hand indicates he has received two drops of the polio vaccine. Click photo for larger image.

The clock also is ticking on finances. Although foundations and new donor countries have stepped up to support the eradication campaign -- Sweden, France, Russia and Spain, for example -- funding the effort is becoming more difficult.

"It's taking much more time to convince donors to fund polio eradication because of fatigue," said Brandao Co, UNICEF's polio team leader in Nigeria.

Organizers are knocking on doors in Saudi Arabia and other Middle Eastern countries to try to generate new support. "It's critical we finish this job as soon as possible," Co said.

Whether the goal is reached this year or not, Durry said, a key point in this effort not to be overlooked has been the development of a grass-roots health-delivery system that can be mobilized to administer other vaccines, such as one for measles, or even a vaccine in the future against AIDS.

And what of Rotary? Will it take on another global cause once polio is eradicated?

"That's the question of the hour," said Carol Pandak, head of Rotary International's PolioPlus program in Chicago. "But actually the leadership of Rotary has decided not to discuss the issue until we achieve the goal of polio eradication. We want Rotary and the world completely focused on polio.

"At the end of 2005, we want a polio-free world. All our efforts are geared to that."