This is the final installment in our series on the fight to eradicate polio, from Rotarian Stella Roy, who writes about her eye-witness experience on the ground in countries like India, Madagascar, and now Nigeria. (First published May 2016)
Last year, Nigeria reached a milestone when the World Health Organization (WHO) removed it from the list of polio endemic countries, after going more than a year without any reported cases of wild polio. Nigeria’s progress has been a long time coming: in 2003, people in northern states boycotted the vaccine because of a scare that it caused sterilisation, which set the country back in its attempts to eradicate polio. The Nigerian government galvanized the anti-polio campaign in 2013.
By Stella Roy
In December of last year, I visited Nigeria a second time – my first trip there was in 2013, and I wrote about those experiences in Touch BASE as well. I saw enormous changes in attention to detail, monitoring, and government and partner cooperation on this visit.
I spent a morning travelling with a doctor from WHO (World Health Organization) whose name was Adou Musa. He told me of his sleepless nights because his area was the last one to still have active circulating wild polio virus. I could see the passion in his eyes and his words, desperately wanting his state and country to be polio-free. Dr Musa showed us the river in Kaduna State where the live virus was last found in 2014, and told me of the agonising four months that followed, when it kept testing positive for the virus.
Finally, it tested negative, so it is now his mission to insure it doesn’t return, and he travels to all the villages on the national immunization days and encourages everyone to keep it up. He personally visits each of the teams daily, and talks to the children, encouraging them to be vaccinated. He drops in on the meetings twice a day, keeping track of compliance and other issues to be resolved before the next day.
I saw a major difference in the compliance, monitoring and reporting this time around. In Nigeria, WHO, Rotary, UNICEF, The Bill and Melinda Gates Foundation and the government all work together much like in India.
Healthcare workers are crucial to this effort, so if they were not performing well at their jobs, they were let go and replaced immediately. If they had innovative ideas, they were rewarded and those ideas shared at the meetings that occured daily during the campaigns.
At these meetings, statistics were graphed and shared at the state level. But there was also a palpable passion in the people around the table, and a nervousness about being sure there are no more cases. Nigeria needs three consecutive years without reported cases to be declared polio-free, but surveillance has shown no wild polio virus in the rivers and sewage.
The healthcare workers used innovative ways to reach people, such as offering other medical help at clinics. At places where gas is in demand and there are line-ups, they vaccinated the children in cars before the family was allowed gas. The workers went to weekly markets and vaccinated any child they saw.
The country now rewards healthcare workers who have high compliance in their area with a day in Abuja, a certificate and their name in the paper. All these strategies are working well to keep them polio free. This time around, I saw very few refusals. Schools couldn’t refuse the government mandated vaccinations. I saw areas of non compliance where the group do pre-vaccination sessions.
In Nigeria, their greatest fear is complacency, and of mothers thinking it over. They know they have to be vigilant for the next few years until there is no wild virus in the world.
Polio is still active in Pakistan and Afghanistan, but the number of cases there is now, thankfully, dwindling.
If the endgame in polio must succeed, a coordinated and complex vaccine switch is crucial. Until now, many countries have been using a shot that protects against the three types of wild polio virus – type-1, type-2 and type-3. But type-2 polio transmission has been stopped since 1999, meaning immunising against it now makes no sense.
In rare cases it also poses a risk that the weakened type-2 virus in the vaccine can seep into circulation and cause “vaccine-derived” polio infections. So from April 17 to May 1, some 150 countries will engage in a synchronised switch to a bivalent, or two-strain, vaccine that contains no type-2 virus but targets types 1 and 3.
It’s a massive undertaking and a major step towards eradication, says Michel Zaffran, WHO’s Director of Polio Eradication. “We’re entering into uncharted territory. This has never been done before. But there’s no going back now,” he says.