Is this Nigeria’s Last Lap to Polio Freedom?

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In about six months, Nigeria will achieve what will arguably be one of her recent greatest public health achievements; being declared polio-free. The journey has been lengthy and tough, and required sustained efforts of all stakeholders; from frontline workers identifying and reporting cases in states like Kano and Niger, to volunteer community mobilisers ensuring every child is immunised in the north-eastern Borno; to government agencies such as the National Primary Healthcare Development Agency (NPHCDA) and the Nigeria Centre for Disease Control (NCDC), philanthropic organisations such as the Bill & Melinda Gates Foundation and multilateral organisations like the Global Alliance for Vaccine and Immunisation (GAVI).

One of the greatest challenges in this combined effort is the reluctance of some parents to present their children for immunisation, especially in the traditionally conservative north. The tide was however gradually turned with the involvement of traditional and religious leaders during awareness campaigns. The insurgency in the North East of the country is also a big challenge, as thousands of children deep in towns and villages especially in Borno State do not get the opportunity to be immunised. This contributed to the emergence of two new cases in Monguno Local Government Area in August 2016 that postponed  Nigeria’s polio-free declaration.

 

Image credit: Nigeria Health Watch

Nigeria has all it takes to eradicate polio in the areas of skills and human resources, says Dr Usman Adamu, Incident Manager at the National Emergency Operations Centre set up by NPHCDA. He restated that insecurity, especially in the northeast, remains the greatest challenge facing polio eradication initiatives. They are addressing this by collaborating with security agencies to implement innovative strategies to reach children wherever they are.

Also, the continuous detection of Circulating Vaccine-Derived Polio Virus type 2 (cVDPV2) continues to raise concerns. cVDPV2 is a weakened virus excreted by children who have previously been vaccinated with the polio vaccine and usually found in poor sanitary environments. cVDPV2 poses a danger to unvaccinated children and Nigeria recorded 34 cases in 2018 and two cases have been detected so far in 2019 in Borno State. The virus is found through the collection of environmental samples from select locations in communities.

In 2018, a multi-disciplinary team commissioned by the Independent Monitoring Board of the Global Polio Eradication Initiative (GPEI) on Progress in Afghanistan, Nigeria and Pakistan visited Nigeria to identify actions to help accelerate progress towards sustained interruption of Wild Polio Virus (WPV). The team stated in its report that it was unknown whether poliovirus was still being transmitted in Boko Haram controlled areas of Nigeria. Among other cross-cutting findings in the three countries reviewed, they described as extraordinary, the resilience of people working in volatile environments with poliovirus.

The GPEI is focused on strengthening surveillance to find and respond to the virus, wherever it emerges, and closing immunity gaps to protect the population and stop the virus from circulating. The programme is also committed to advocating for sustained political commitment and ensuring necessary financial resources and technical support for polio eradication at all levels.

While Nigeria may be back on track to attain the polio-free status, Professor of Virology and Chair of the Nigeria Expert Review Committee (ERC) on Poliomyelitis Eradication and Routine Immunization, Prof. Oyewale Tomori, pointed out that increasing Nigeria’s immunisation coverage to over 80% can help achieve the goal. Many of the countries that succeeded in eradicating polio were able to do so by attaining immunisation coverage over 80%.

Five-year-old Isah Amadu from Rimi village in Sumaila Local Government Area was diagnosed with polio in June 2014, the last confirmed case in Kano State. Photo credit: Nigeria Health Watch

NPHCDA set up the National Emergency Routine Immunisation Coordination Centre (NERICC) in 2017 to improve immunisation coverage. Dr Adamu said the NPHCDA is very optimistic that as different states and LGAs prioritise immunisation, the needed population immunity required to sustain polio eradication will be achieved.

On 27th November 2018, the World Health Organization (WHO) Director-General, Dr. Tedros Adhanom Ghebreyesus, convened a meeting of the International Health Regulations (IHR) Emergency Committee Regarding the International Spread of Poliovirus. The committee classified Nigeria as a country infected with cVDPV2s with the potential risk of international spread and recommended among other seven key recommendation for Nigeria to intensify efforts to increase routine immunisation coverage, including sharing coverage data.

Image credit: Nigeria Health Watch

Sustaining financial commitments is a key element in polio eradication efforts. The team commissioned by the GPEI suggested that prematurely reducing budgets prior to interrupting transmission threatens eradication. To cushion any potential fallouts from reduced funding, Nigeria paid $1.9 billion last year as a counterpart fund for the Global Alliance for Vaccine and Immunisation (GAVI) transition plan that will run until 2028.

In their 2019 annual letter, Bill and Melinda Gates said GAVI has vaccinated over 690 million children since they started operating 18 years ago. Last year, an innovative financing strategy was announced by the Bill & Melinda Gates Foundation to strengthen routine immunisation and access to primary healthcare for indigent populations.

As these concerted efforts are being made towards making Nigeria polio-free, an important question becomes how will Nigeria transition the resources invested in polio eradication to other public health interventions in the country? For now, the road to polio freedom seems to be nearing an end in Nigeria, a significant victory for public health and a step closer to eradicating polio forever.

Discussion7 Comments

  1. One must again commend te Nigerian HealthWatch for constantly bringing up issues we tend to forget or describe as “we are on top of the situation” For polio eradication, we dare not forget nor assume we are on top of the situation. There are two great concerns – i). the continuous detection of Circulating Vaccine-Derived Polio Virus type 2 (cVDPV2), Perhaps it is essential to state that cVDPV2 is a weakened virus which is “energised” to cause polio in unvaccinated or poorly immunised children. A child can be poorly immunised if he receives poorly kept or preserved vaccines that has become “impotent ”

    Three comments in your write up are significant
    1. Nigeria has all it takes to eradicate polio in the areas of skills and human resources, says Dr Usman Adamu, Incident Manager at the National Emergency Operations Centre set up by NPHCDA. …..Yes indeed, Nigeria has all it takes to eradicate polio, and indeed any disease we commit to eradicate/eliminate or control. The problem is that Nigeria has refused ALL it takes to achieve such objectives. Last year, the budget presented to National Assembly provided about 5 billion naira for polio eradication based on agreement with Gavi. The “experts” in the Assembly lumped off nearly 3 billion naira off the amount to cater for their constituency projects. Nigeria has to resort to borrowing money from the World Bank to according to your write up… cushion any potential fallouts from reduced funding. The Executive and the Legislature must work together on such issues and TAKE ALL WE HAVE to solve the problem of polio eradication in Nigeria. It is a pity that many of our leaders see no shame, feel no shame and indeed hear no shame when the status of Nigeria with regards to polio eradication is described as ……Nigeria-Status: has never stopped circulation of indigenous wild poliovirus and is currently affected by circulating vaccine-derived poliovirus type 2. Nigeria is one of only three countries in the world with ongoing wild poliovirus transmission, alongside Afghanistan and Pakistan. It is the only country in Africa with ongoing wild poliovirus transmission

    2. The second comment, attributed to Usman …”that insecurity, especially in the northeast, remains the greatest challenge facing polio eradication initiatives. This means until we have access to ALL AREAS of security compromised parts of Nigeria, nobody can say there is no polio in Nigeria.

    3. The most worrying is the statement in the GPEI report which stated that: it was unknown whether poliovirus was still being transmitted in Boko Haram controlled areas of Nigeria. If Boko haram is still controlling those areas and it is UNKNOWN if polio is still being transmitted in then areas, how can we ever confidently say we are polio free?

    So there lies our problem,… not until populations in every part of Nigeria (INCLUDING BOKO HARAM OCCUPIED TERRITORIES) has access to health interventions (immunisation, surveillance etc), can we ever be certain that Nigeria is free of polio transmission

    So Nigeria cannot roll out, now, the drums of celebration for polio eradication. There is a light at the end of the tunnel, but if we slack, it may be the headlights of a freight train we are seeing!

  2. I’m surprised that despite all their contributions to the Global Polio Eradication Initiative (GPEI) – cash in excess of $2 billion, field vaccinators and vaccinators – no one makes mention of contributions from Rotary.

    It’s either an innocent oversight of a deliberate lack of appreciation.

    Thank you.

    • Certainly Rotary deserves more recognition. Perhaps recognition of groups depends on which platform you are reading, There are other platforms where Rotary is duly acknowledged. One thing though which Rotary does and needs a review, is the rate Rotary dishes out her Polio Champion award, especially to Nigerian leaders. Every Nigerian leader from Obasanjo to Buhari has received the Polio Champion award, yet Nigeria remains the only country in Africa that has NEVER interrupted polio transmission and one of three in the world. How can you have so many champions and yet all we get is FAILURE!

  3. It’s surprising that despite all their contributions to the Global Polio Eradication Initiative (GPEI) – with cash in excess of US$2 billion, field supervision and vaccination activities – no one seems to make mention of contributions from Rotary and Rotarians as due.

    Is it an innocent oversight or a deliberate lack of appreciation?

    Thank you.

  4. Northeast is not the only danger zone in Nigeria as cVDPV2 has broken out in Kiara state necessitating outbreak response in contiguous states like Oyo. As a Primary Health Care Physician, I see a lot of indifference on the part of state governments towards polio eradication particularly in the South West where donor support is the only thing to show for the funding of health care programs either at routine or strategic intervention levels. Prompt, nationwide implementation of the Basic Health Care Provision Fund is a most desirable action now. Underfunding of surveillance and relevant preventive activities remains a huge threat to the gains we’ve made in the past.

    • Omotajo…you hit the nail on the head. This is an issue we discuss every time at the ERC polio meeting, The current case in Kwara may be the sign of worse things to come. We must continue to get the attention of our governments in the southern parts of Nigeria…so that we will not be stung at the last moment

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