Having been polio free for nearly 5 years, Cameroon has recently recorded four new cases. Are Pentecostalism's anti-medicine teachings responsible?

Douala - Last year, the government of Cameroon initiated a clampdown on illegal Pentecostal churches.

According to the government, there were around 500 Pentecostal churches operating in the country without a licence, and the authorities' lenience up to then had allowed "an anarchical proliferation of those churches, engaging in all kinds of negative, indecent and harmful practices."

The government accused the churches - which have mushroomed in popularity in recent years - of performing fake miracles, killing citizens in deadly exorcisms, and deceiving their congregations.

More recently, however, a new allegation was added to this list. Last year, Cameroon recorded four cases of wild poliovirus, the first since 2009, and officials at the Ministry of Health say Pentecostal pastors may be to blame.

Pentecostal preachings

Until October of last year, Cameroon seemed to be free of polio, a viral disease which assaults the central nervous system and can cause paralysis.

This was largely thanks to the success of vaccination campaigns. In fact, the sudden outbreak of new cases last year can only have been possible because some children had not been immunised, and many believe this lack of vaccination may have been because of hard-line Pentecostal doctrine which teaches that healing is a sign of the presence of God and that followers should therefore refrain from taking medicine.

"The first case was detected in a seven-year-old child, which is unusual because a seven-year-old should have been vaccinated," says Marie Ekobela, coordinator of the National Immunisation Programme in the Ministry of Health.

"The child belonged to a family in which the grandfather is an official with a Pentecostal church and who doesn't want to hear anything about vaccination. So this child was not immunised and when the virus arrives and infects an unvaccinated child, an epidemic is triggered."

That child would not have been the first. 15-year-old Delphine Manka'a, the daughter of a Pentecostal churchgoing mother in the city of Douala has not walked since she was two when she was struck by polio.

Paralysed in both legs, Manka'a has since been reliant on a wheelchair and crutches. She has still not forgiven her mother for denying her immunisation against the highly infectious and incurable disease.

"I wouldn't be paralysed if she had let me get the vaccine when I was young," she says, tearfully. "It was only after my case that she decided to go against the church belief which does not accept vaccination. My two brothers are all fine because they were vaccinated."

Eradicating polio

Health experts agree the Pentecostal dogma against immunisation as well as the suspicion towards vaccines amongst certain Muslim communities provide some of the last lingering hurdles in Cameroon's struggle against polio.

Since the recent outbreak, the government began a door-to-door immunisation campaign targeting children under 10 years old.

The first of the three phases of the plan began in January, and some inoculators say they think there has been a decline in outright resistance to the vaccine though point out that difficulties remain.

"Several people are still hesitant," says Fokou, a campaign supervisor in Douala. "In my coverage area, I did not really experience resistance so to speak, but some hesitation.

People don't easily understand the reason for the repeated vaccination campaigns and so are a bit suspicious, but once we explain that it's because four cases were detected last year and could spread countrywide, most understand and let us in."

Nevertheless, for the two remaining phases of the vaccination campaign - which will take place in February and March - health workers are trying to devise incentives to boost coverage rates.

"We decided that every mother who brings their kids for vaccination will receive three lumps of soap," reveals Enerstine Rose Tsafack, a health district service head, "we think this will encourage them."

Similar enticements have been effective in local contexts in the past, but Cameroon still faces challenges in successfully completing its polio campaigns.

"Some parents don't respect vaccination calendars and, on our side, healthcare delivery is scaled down by the lack of sufficient funds," says Ekobela.

Furthermore, with Nigeria - one of the three countries in the world where polio is still endemic - to its west, and Chad and the Central African Republic - each of which have recorded polio cases in recent years - to the east, Cameroon also faces added regional complications.

"Since the start of 2013, there has been a steady influx of refugees fleeing conflicts in Nigeria and the Central African Republic and there's no guarantee that these people are polio-free," explains Ekobela.

Ultimately, she explains, surveillance gaps must be bridged, rapid detection should must be established, cross-border collaboration needs to be made to work, and year-round immunisation campaigns must be set up.

Furthermore, if Cameroon can think about eradicating polio again by 2015, it will have to find a way to convince followers of Pentecostal churches to accept vaccinations and protect their children, communities and country from the disease.