As vaccinators prepare to fan out across 24 nations on Saturday at the start of the four-day house-to-house campaign, concern is paramount for children in Côte d’Ivoire, where conflict has forced a postponement even though the paralyzing disease regained a foothold in the country in January with the importation of a virus from Nigeria.Since then, there have been 15 confirmed cases, and with the health system battered by political instability and routine immunization averaging only 45 per cent, thousands more children are at risk, UNICEF said. The upsurge in violence and resultant increase in cross border flight of refugees could carry the virus into neighbouring states.Polio re-established its grip in the region when immunization was suspended last year in various northern states of Nigeria after concerns by public figures there over the safety of oral polio vaccine, including rumours that it was contaminated by the HIV virus or that it could sterilize young girls. This led to the spread of the disease to 10 previously polio-free African countries, threatening efforts by the UN-backed Global Polio Eradication Initiative to totally eliminate it. The last suspension was finally lifted in July.Nations bordering all conflict-affected countries are being urged to strengthen polio surveillance and make special plans to immunize children who are difficult to reach, along borders or wherever there is high population movement.Meanwhile humanitarian agencies and local communities in Côte d’Ivoire are doing what they can to protect vaccine stockpiles until the campaigns can be re-started. When parts of the country lost electricity during recent violence, communities worked together to keep generators running and send tanks of fuel to remote villages to keep storage facilities cold, thus saving thousands of doses of vaccine.The continuing reach of the immunization drives is being curtailed by a funding shortfall of $200 million for the coming year – of which $35 million is needed urgently in order to carry out low-season campaigns in the early part of 2005.Despite the situation in Côte d’Ivoire, African Governments are hopeful that these immunization drives – the largest ever internationally coordinated activity in peacetime – will bring polio back under control in the region. Since Africa now has 86 per cent of all cases, stopping polio here is key to the global eradication effort. The efforts are backed by the Global Initiative, comprising UNICEF, the UN World Health Organization (WHO), Rotary International and the United States Centers for Disease Control and Prevention.