We learn the hard way…


When in 2003, the Polio crisis first broke in Kano and threatend the Global Polio Eradication efforts, the public health community around the world were dumbstruck. First we ignored the situation, but then as the outbreak spread across Africa and beyond we reacted with anger. But finally we realised that neither silence nor anger was going to solve this one.

We needed to go back to those ancient public health tools of community engagement and social mobilisation. So a process of slowly regaining the support of the population in Northern Nigeria started.

Thisday reports that on the 6th of May foremost traditional leaders from Northern Nigeria met in Kaduna and expressed their commitment to ensuring that polio is totally eradicated from the region. What a turn of events!

The Sultan of Sokoto, His Eminence, Alhaji Sa’ad Muhammad Abubakar III, tasked the traditional rulers to be personally involved in polio eradication initiatives. He is the head of the Nigerian National Supreme Council for Islamic Affairs and is considered the spiritual leader of Nigeria’s muslims. On November 2, 2006, Sa’adu Abubakar succeeded his brother, Mohammadu Maccido, who died on ADC Airlines Flight 53.

The Sultan has been a relevation since his emergence in the Nigerian polity.

Now we have learnt that to win the hearts and minds of the people …we have to speak to them. Our leaders have to engage. See if you recognise any of these…

You will probably be wondering where the president of the country with the most case of Polio in the world is…but thats an isue for another day. Today, let us celebrate The Sultan.

But talking is not enough. Polio vaccination too is not enough. With routine vaccine coverage remaining persistently below 40% since 1997, measles has remained hyperendemic in many parts of the country, especially the north…which we have frequently blogged about.

Improving routine immunisation (as opposed to campaigns) can prevent many deaths, yet we do not seem to be able to muster the required resolve to pursue this goal without disease specific targets. A window of opportunity exists to broaden the benefits of these vertical programmes beyond the specific disease, in this case poliomyelitis. Active efforts should be made to plan for the diversification of these skills. This can only be achieved if the donor that supports these programmes actively demands integration.

Sustained vaccine coverage for measles of below 40%, as in Nigeria, in an era of regular national immunisation days for polio eradication is a modern tragedy.

These are the issues we expect the Sultan to challenge the Government on, indeed these are issues we should all challenge our government about. With the renewed energy in the National Primary Health Care Development Agency…Nigerians are hopeful…..we deserve more.


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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