Nigeria is about to cross an important milestone in its fight to eradicate polio. July 24th will mark one year since the last polio case was recorded in the country. Nigeria Health Watch team member Ifeanyi Nsofor reflects on the effort it has taken to get us here and what it will take to maintain Nigeria’s polio-free status.
Poliomyelitis (polio) is a highly infectious viral disease, which mainly affects young children. The virus is transmitted from person to person and spreads mainly through the faecal-oral route, sometimes resulting in paralysis. In fatal cases, paralysed children die once the muscles that control breathing are also paralysed. Polio is therefore life-threatening and can limit the quality of a child’s life.
Nigeria is one of only three countries in the world where polio is still endemic, together with Pakistan and Afghanistan. Since July 24, 2014, Nigeria has not recorded any new case of the Wild Polio Virus (WPV). In 2014, Nigeria recorded only 6 cases of WPV. This is a huge deal in a country that has battled polio for a long time.
How was Nigeria able to achieve this?
In recent months several innovative approaches have been used to increase the effectiveness of polio immunisation in the “frontline” states. One of these have been mechanisms to ensure accountability of vaccination activities; e.g. using GPS devices to ensure that the there is greater certainty that vaccinators actually reach communities that they are responsible for reaching. In states with security challenges in the past four years in Nigeria, periods of relative calm were used as opportunities to gain access and reach children wherever they are. Emergency operations centres supported by the Bill and Melinda Gates Foundation were built in seven states with recent transmission as well as one at the national level to coordinate response activities. Specific leaders were recruited for the EOCs from outside government bureaucracies to coordinate activities and ensure that decision making is rapid and effective in planning and executing response activities. Another key factor has been the continued engagement of traditional and community leaders in the efforts.
The Global Polio Eradication Initiative is the body in that coordinates efforts to eradicate polio. Established in 1998, the initiative is financed by various private and public donors. So far, $11 billion has been spent to reduce the global incidence of polio by 99%. The 2013-2018 target date for polio eradication is projected to cost an additional $5.5billion. Keeping up the flow of funds has been a particular challenge and recently, a Nigerian philanthropist Sir Emeka Offor announced a $1 million gift to The Rotary Foundation for polio eradication efforts. Eradication efforts in Nigeria involve various partners led by the National Primary Health Care Development Agency (NPHCDA) and supported by State and Local Governments. Together, they implement a series of supplemental immunization days, mop-up campaigns and Maternal, Newborn and Child Health Week.
Next Steps to Sustainability
Are there really no WPVs circulating in Nigeria or are health officials simply not picking up such cases? The answer lies in robust surveillance. Nigeria has a good method of assuring the quality of polio surveillance by seeking and detecting cases of acute flaccid paralysis (AFP) in communities. This involves finding and reporting children with AFP, collecting and transporting their stool samples for analysis, then testing the stool samples for the polio virus. The data from this is publicly available for Nigeria and all other countries on this portal. This is a systematic and costly process and government must continue to commit funds to it because that is really the only way to know if we are truly polio-free. This is particularly important in the states in Nigeria with on-going security challenges.
While we are lucky to have vaccines that have been so effective against polio, it is important to remember that the transmission of the polio virus is faeco-oral. This means that disease-causing agents present in faeces infects food or water, which when ingested, cause disease. Forty five million Nigerians still defecate in the open and have no access to toilets. This amounts to 1 in 4 Nigerians openly defecating in public and creating a medium for the potential transmission of polio virus and other infectious diseases such as cholera. We must prioritise the provision of toilets and clean water if the benefits gained from vaccination are to be sustained.
Strengthening routine immunisation in all health centres is also critical to Nigeria sustaining the interruption of polio transmission, especially in Northern Nigeria where most WPVs in the past have been identified. In a functional routine immunisation system, a child is fully immunised against polio for life at four months old after receiving four (4) doses of the Oral Polio Vaccine (OPV). At birth, 6 weeks, 10 weeks and 14 weeks, a child receives OPV0, OPV1, OPV2 and OPV3 respectively. This underscores the need to ensure that routine immunisation works. The number of children immunised with DPT3 (one of the childhood vaccines) is considered a measure of the efficiency of a routine immunisation system. The 2013 National Demographic and Health Survey (NDHS) reports Nigeria’s national DPT3 coverage to be 38%. This is low and signifies that routine immunisation coverage in Nigeria is very poor.
A functional routine immunisation system also involves deploying the right staff, developing a sustainable supply of vaccines and maintaining an adequate cold chain system. A very important link in the cold chain system is constant electricity to store vaccines and freeze icepacks that are necessary to maintain vaccine potency.
Polio eradication requires a lot of funds and all levels of government across Nigeria must continue to make financial commitments to eradicate polio. A source of funds backed by law is the Basic Health Care Provision Fund contained in Nigeria’s National Health Act 2014. The Act makes provisions for funding primary health care and vaccines.
For 12 months Nigeria has been polio-free but the struggle is not yet over. We must ensure that we do not lose the momentum we have gained and continue to work together to eradicate polio in Nigeria. It is the right thing to do. We must no longer watch as our younger generations are paralysed for life by a disease that is so easily preventable.
While we are proud that some progress is finally being made with eradication in Nigeria, when the history of polio eradication efforts are written, we will be recognised as the last country on the African continent and one of the last three countries in the world to have eliminated polio.