Immunization against polio | credits: ecnx.net
This month – July – was a very auspicious one for Nigeria in 2014. Two health-related occurrences took place in that month. On Sunday, July 20, 2014, Patrick Sawyer flew into Lagos airport, a sick man with the Ebola Virus Disease. He died five days later, but not before infecting other people – his primary contacts -health workers who took care of him and who subsequently infected other people. By the time Nigeria was finally declared free of the disease, 20 people had been infected with eight of them dying from the disease, and spent three months tracing nearly 900 contacts.
The second health issue occurred far away from Lagos. On July 24, 2014, a day before Sawyer died, a one-year-old child in Sumaila LGA of Kano State had an onset of a disease later confirmed to be polio. This has been the last polio case confirmed in Nigeria for the past one year. Never has Nigeria gone on for so many months (12 months) without reporting at least one case of polio. The last time we went free of polio was for only three months between May and July 2014. If we get our acts together and maintain zero polio case until the end of July 2015, Nigeria will be removed from the list of polio endemic countries, that is, countries that have never interrupted polio transmission. Do not expect WHO to remove our country from the ignoble list of polio endemic countries, until late August or early September 2015, by which time all of the samples collected on or before July 24 this year would have been tested and found negative for polio. Delisting from polio endemic countries is only a step towards Nigeria being declared a polio-free nation. This will only happen if we report no polio case for another two years; that is, after July 2017. So let us not bring out the drums and the palm wine tumblers in premature celebrations.
This leads us to three questions. First, why did it take us so long to get to this stage, making us one of the last three polio endemic countries in the world? Second, what did we suddenly do to achieve the current status, and third and more importantly, what must we continue to do to ensure that we finally reach polio-free status in 2017 and forever?
During the five-year period between 2005 and 2009, the total number of reported polio cases in Africa was 4,039 and Nigeria alone accounted for 3,729 (92 per cent) of the continental cases. This number is far above our contribution to Africa’s population- I think we boast that there is a Nigerian for every five Africans; this time round, Nigeria was contributing more than nine out of every 10 polio cases in Africa. In addition to the sub-optimal performance of the national immunisation programme and the poor routine immunisation coverage, the main stimulus for our poor performance was the call in 2003, for the boycott of anti-polio vaccination in northern states because of suspected contamination of the polio vaccine with anti-fertility steroids. The call was made by a frontline medical practitioner and a prominent member of the Supreme Council for Sharia in Nigeria. The resulting boycott brought a wobbling national polio eradication programme to a total collapse as the average annual number of reported polio cases increased from 400 (between 1998 and 2002) to 750 cases after the call. Frantic national and international efforts were made to end the boycott. This included the adoption of a resolution in 2008 at the 61st World Health Assembly, calling on Nigeria to reduce the risk of international spread of poliovirus by ensuring that all children in the north of the country are vaccinated against polio. This special mention of Nigeria – a naming and shaming- at a global level, appears to have moved Nigeria in the right direction for achieving polio eradication. A series of activities, including a change in the leadership of the agency charged with polio eradication in the country, engagement of traditional and community leaders, civil society organisations, women groups, and encouraging the community to “own” the eradication initiative began to yield positive results. These activities were further strengthened by ensuring adequate and efficient implementation of detailed immunisation micro plans, improved monitoring of staff and their activities through the use of modern communication gadgets and systems. Another input that enhanced the performance on the field included the institution of an accountability framework for all stakeholders and partners (federal and state governments, LGAs, international development partners, NGOs, and members of the community). Individuals, not the system or the organisation were held responsible and accountable for their performance – commending good performance and sanctioning poor performance at each and every level.
Of note was the intervention of the Bill and Melinda Gates Foundation which sponsored a leadership challenge for state governors to encourage, assure and improve their leadership and “ownership” of, as well as commitment to eradicating polio and improving routine immunisation services at the state and LGA levels. The initiative was supported by the NPHCDA, the Federal Ministry of Health, and the WHO, and managed by the Secretariat of the Nigeria Governors’ Forum. The establishment of Emergency Operations Centres at Abuja and in six Northern states contributed significantly to the success recorded in the last 2-3 years. The EOCs were designed to serve as central command and control facilities for government and non-governmental agencies to be able to respond in real-time to a polio outbreak in key endemic states and coordinate prevention activities, provide modern technology to health workers, and offer a common place for agencies and organisations to pool resources and participate on projects together. One positive outcome of the establishment of the EOC was the deployment and use of the EOC system to control the 2014 Ebola outbreak. Funding for the EOCs were provided by the BMGF and supported by the Dangote Foundation
Apart from the 2003 setback arising from the boycott call, Nigeria was never really serious about polio eradication. Until we had special “negative” mention at the WHA, polio eradication was conducted in a typical laissez affaire fashion. The attitude of the government was at best non-chalant, often taking external stimulus and “push” from external agencies -, the WHA, BMGF, the UN Rotary for our government to act. It is inconceivable to think that state governors needed a BMGF-sponsored initiative to challenge them to politically commit to, and provide necessary funds for eradicating polio and improving immunisation services in their states. The BMGF Governors leadership challenge ran for two years from 2013 and 2014. While it lasted polio eradication and routine immunisation featured prominently in the discussion of the Governors’ Forum.
Source: punch
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