Nigeria Pushes Polio to the Brink
Nigeria is the only country in Africa to have never eradicated polio. However, the country’s polio eradication program suffered a major setback in 2003 when rumors swept across northern Nigeria that house-to-house immunization activities were part of an effort to sterilize Muslim girls. Alarmed and uninformed religious leaders and politicians pushed for a suspension of all campaign activities in several states, and a near freeze in others.
Sadly, this interruption led to large outbreaks of polio that not only crippled thousands of Nigerian children but also spread across Africa and beyond, eventually returning to 20 countries that were previously polio free. Activities resumed in 2005, but the program suffered from inertia. Multiple rounds of intensive but ineffective immunization were carried out annually by unmotivated, poorly trained, and inadequately supervised teams.
Nigeria was widely criticized at the 2008 World Health Assembly, not only by western governments, but by the country’s African neighbors and many Islamic nations for its ineffective polio response.
Revitalization of the Nigerian polio program has been an effort that has involved the highest levels of the Nigerian government, USAID, and other donors. The Nigerian government revitalized its immunization program, giving it a higher degree of importance in its national healthcare delivery system. Efforts were also made to actively engage traditional and religious leaders in northern Nigeria, educating them on the realities of polio and soliciting their help to dispel the untruths about the immunization program. Over time, the leaders adopted the program as their own and now vigorously promote it in their communities with each immunization cycle.
A media campaign was undertaken to help ensure that messages of support from key leaders, such as the Sultan of Sokoto, the spiritual leader of Nigeria’s Muslims, were widely disseminated. The government also appointed a new head for the National Primary Health Care Development Agency who committed himself to addressing other public concerns.
USAID/Nigeria and several other donors’ health programs worked to improve routine immunization and other child health services in a concerted effort to reduce the imbalance between prevention of polio and other diseases. Vitamin A distribution, anti-malaria bednets, and other items were added to polio immunization campaigns to make them “Immunization Plus Days” to broaden their reach and effectiveness. New polio vaccines were introduced to improve the effectiveness of each round.
USAID worked closely with Nigerian counterparts to reinforce these efforts and revitalized the polio immunization teams by hiring “independent monitors” to conduct spot checks to quickly identify problems and improve motivation and coverage. Working outside their own communities and the polio team structure, the monitors have proven to be very effective.
Effective polio control measures have been put in place over the last five years. Data from immunization campaigns show a declining rate of parents who are refusing polio vaccination for their children and an increase in vaccination follow-up. Reports from independent monitors show increased coverage rates in most states. Data on children paralyzed by diseases other than polio show that the proportion of children in 10 states who have never been vaccinated for polio has decreased from 30 percent in 2005 to less than 10 percent in 2009.
Finally, with better case detection and tracking, minimal polio virus transmission has been recorded from late 2009 through April 2010, with only two confirmed cases in the first four months of 2010 compared to 388 in the same period of 2009. These are the lowest rates found in Nigeria since the inception of the program.
This evidence that the polio virus is yielding to improved immunization efforts is gratifying, but there still remain some states and local governments where control efforts are not adequate and the risk of another upsurge in polio is a constant threat.
The Nigerian government and its partners have scheduled a robust series of polio immunization rounds in 2010 in a further effort to increase coverage in the remaining problematic areas and to maintain hard-won gains elsewhere. For the first time, Nigeria appears to be on track to fully interrupt polio transmission, and perhaps eventually eradicate the disease.