Vaccinations are celebrated as one of the miracles of modern medicine. In the past 50 years, it has saved more lives worldwide than any other medical product or procedure.The development of the polio vaccines led to the first modern mass vaccination campaigns. The global effort to eradicate polio began in 1988, and as of 2010, polio remained endemic in only four countries, including Nigeria. The country’s polio eradication program suffered a major setback in 2003 when rumors swept across northern Nigeria that immunization activities were part of an effort to sterilize the population.
So when one of the most obvious “magic bullets” of all our public health interventions failed, as it did in Nigeria – almost crippling the polio eradication programme – public health professionals were at their wits end as to how to respond. What to do? Public health problems like this are complex and require innovative solutions.
Slowly and steadily, colleagues ploughed their way back from the brink. While Nigeria remains one of four remaining polio-endemic countries, reporting the highest number of polio cases anywhere in the world in 2008 (798), in 2009, this number was down to 388. From January through to 12 October 2010 only eight cases had been reported, representing an all-time low, and a reduction of over 98 percent.
How has this been achieved?
Well there are a few innovative approaches used in Nigeria that you will probably not find their way into many public health textbooks!
Firstly, there was an increased involvement of traditional, religious and political leaders in promoting vaccinations and encouraging acceptance within our communities, helping to turn the tide. This was not some token involvement, but a real integration into the response. From planning, to implementation through to evaluation cycles. While this engagement of traditional rulers occurred all over Northern Nigeria, extra mention is deserving of the of the Sultan of Sokoto. When the articulate Sultan engaged with the programme and joined hands with the community, people again recognized the problem as their own and engaged in its solution. The video below from the Wall Street Journal shows an articulate Sultan engaging with Bill Gates in Nigeria.
But it was not just the Sultan. Across northern Nigeria, traditional rulers were mobilised at all levels. They joined the state governments and international agencies in the micro planning and decision making. The leaders adopted the program as their own, and vigorously promoted it in their communities. A media campaign was undertaken to help ensure that messages of support from the Sultan were widely disseminated. Something truly amazing was taking place here. A complex problem was being solved by the ingenuity and engagement of the local leaders.
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