A polio-free Nigeria as a critical step to a polio-free world

Guest post by Iruka N Okeke
…and we endorse and actively support its content! 
Nigerian scientists, doctors and technical experts  joined their colleagues from around the world to launch the Scientific Declaration on Polio Eradication on 11 April 2013. Today, the world is closer than ever to eradicating polio, with just 223 cases in five countries last year. To capitalize on this time-limited opportunity to finally end the disease, a wide range of experts have signed the declaration to emphasize the achievability of polio eradication and endorse the Eradication and Endgame Strategic Plan, a new strategy by the Global Polio Eradication Initiative (GPEI) to reach the end of polio by 2018. The scientists and experts signing the declaration come from more than 75 countries and include Nobel laureates, vaccine and infectious disease experts, public health school deans, paediatricians and other health authorities. For additional information about the Scientific Declaration or to view a full list of signatories, please visit the Emory Vaccine Center Website.
Image courtesy of GPEI/ Scientific Declaration on Polio Eradication
Image courtesy of GPEI/ Scientific Declaration on Polio Eradication

 Polio.  Frightening, crippling and, half a century ago, a leading cause of death and disability worldwide.  The battle against this deleterious and transmissible threat to human health has spurred major advances in health care science and delivery.  Many of the vaccine development strategies used to control a range of diseases today were pioneered by poliovirus specialists like Sabin, Salk and Koprowski.  Polio was also the initial focus of the March of Dimes, a US health charity that pioneered methods to fundraise for research and health care.  And on an international scale, polio is one of few diseases around for which we have both the tools and international consensus to eradicate.

Image courtesy of GPEI/ Scientific Declaration on Polio Eradication
Close to home, we can credit polio, and the international eradication effort against it, for a cold chain for essential vaccines for Nigerian children. Oral polio vaccine itself is one of the easiest to administer.  The polio eradication program has also been the driver for a network of virology laboratories in Nigeria and other African countries, which have boosted diagnostic capacity for a range of infections and will continue to serve public health after polio is gone.    Nigerian virologists have played leading roles in the Global Polio Eradication Initiative and thousands of paid and volunteer health workers and advocates have worked tirelessly to drastically reduce the incidence of this disease in recent years, successfully eliminating polio from most states in Nigeria.
Image courtesy of GPEI/ Scientific Declaration on Polio Eradication
In spite of these advantages and advances, and in visible contrast to over 125 other countries that have halted poliovirus transmission in the last three decades, Nigeria is yet to see its happy ending to the saga on polio.  It was originally hypothesized that India would be
the greatest challenge for polio eradication but India has recorded no cases in the last two years.  In 2013 Nigeria remains one of only three countries worldwide, and the only one in Africa, where children still contract the disease in nature.  And each time that it looks as though we might be getting our handle on polio, something unexpected happens.  Far too often, the happenings that set us back have nothing to do with the virus or the disease.  Rumour-fuelled
vaccine boycotts have more than once derailed Nigeria’s eradication program, allowed children that should have been protected become paralysed, and facilitated reintroduction of the polio to other countries that have successfully eliminated the disease.  And an unconscionable number of Nigerian deaths in the last year can be connected to polio, sadly, not all of them to the virus.

Eradication is an absolute term.  Just as a woman is either pregnant or not, a disease is either globally eradicated or it is not.  Elimination and control are good things but they do not offer the supreme benefits the world gains from eradication.  As long as poliovirus in transmitted anywhere in the world, all children remain at risk from an infection that could disable or kill them.  Until eradication, expenses will continue to be incurred from vaccine programs that could otherwise be stopped and there is a small but real possibility that the virus will evolve away from current control tools into something that we are less able to contain.

Thankfully, we are close enough to eradication to avoid the dire consequences of failure.  Perhaps the greatest concern is that now that polio is almost gone, stakeholder support for the eradication program that got us this far could start to wane.  We need to reassure our supporters that their long-term investments will combat this disease for good.  While it is true that fewer children are stricken by polio – even in Nigeria – than by malaria, diarrhoeal disease or pneumonia, we MUST press on and finish the job we began three decades ago.  Eradication of smallpox in the 1970s – through a program that cost an estimated US$1 billion has saved the global community US$1.4 billion in control costs each year.  Thousands of lives have been saved and millions have been protected from scarring and blindness.  In a world where polio is eradicated, comparatively more could be saved when it no longer becomes necessary to vaccinate against this dreaded disease or to provide life-long rehabilitation to those that are disabled by it. And in spite of the fact that the polio eradication effort is past its due date, we are so close that ending transmission now will be easier than at any time previously in history. If the eradication program is neglected at this point, countries like Nigeria that are still endemic for polio will be hit hard by resurgence of the virus first.  At this crucial point in the endgame, we must motivate our overworked, threatened and justifiably disillusioned workforce, make the necessary investments and encourage Nigerians like people everywhere to work together and obliterate this disease.  We know eradication is possible because cases in Nigeria have fallen dramatically in recent years and most countries in the world have eliminated the disease.  We are close to the end of this challenge and must marshal all efforts to complete it.

Image courtesy of GPEI/ Scientific Declaration on Polio Eradication
Scientists often view the battle against disease as a straightforward between an infectious enemy and immune and pharmaceutical allies.  The current situation with polio has made us sit up and take a hard look at every piece of the complex paradigm that stands in the way of polio eradication.  In Nigeria, mitigating factors extend beyond the biological to socio-economic, health system and behavioural concerns.  Along with similarly motivated scientists and clinicians worldwide, Nigerian scientists and clinicians are supporting the all-encompassing polio endgame with a target date for completion of 2018 laid out in the Polio Scientific Declaration.   This enhanced plan builds on the strategies that have been used to eliminate polio from most of the world with a renewed push to address roadblocks that come from insecurity, resource-limitation and public outreach.  We invite other scientists and clinicians, public health practitioners and advocates, vaccine producers and distributors, our government and our civil society as well as international partners and sponsors to join us and the rest of the world in this essential and historic effort.  Lest you think that the declaration represents externally-imposed  agenda,  I emphasize that as many as 5% of the over 400 signatories are Nigerians based at home or abroad who are concerned that, unless we act decisively and now, the current situation within our country represents a perpetual threat to children in Nigeria and globally.  We’re in it for as long and for whatever it takes and will work with everyone to ensure that we do come out on top.   Let’s End Polio.
Image courtesy of GPEI/ Scientific Declaration on Polio Eradication
Iruka N Okeke,
 Department of Biology, H
averford College

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (www.epiafric.com), which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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