Turning point on polio eradication in Nigeria
Efforts to eradicate the paralytic poliovirus from Nigeria commenced in 1997 when the Federal Government established the defunct National Programme on Immunization (NPI). For several years epileptic progress was recorded in the polio eradication initiative (PEI), making the global goal of ridding the world of polio becoming increasingly unattainable.
Following re-organization in 2007, some progress was recorded from 2009 – 2010 but this could not be sustained. The global community was so concerned about the situation in Nigeria that it declared that Nigeria was holding the world back and that it will be the last to eradicate polio. The country became a pariah State in the global polio eradication initiative community.
However, in 2012, the Federal Government, under the leadership of his Excellency, President Goodluck Ebele Jonathan confronted the polio menace with renewed vigor by declaring polio a national health emergency and establishing the Presidential Task Force on Polio Eradication (PTFoPE) to provide oversight function to State and LGA Task Forces as well as providing real time feedback to the President on regular basis.
The PTFoPE set up the National Polio Emergency Operations Centre (EOC) as secretariat and operational arm to drive the Nigeria PEI programme in emergency mode. The EOC under the leadership of NPHCDA commenced operations in October 2012, bringing together diverse and critical expertise from government and the Global Polio Eradication Initiative (GPEI) partners, on different components of PEI.
The NPHCDA later established State EOCs in critical States and introduced innovations to enhance community engagement and create demand for the oral polio vaccine (OPV). Also, the EOC enforces the accountability framework, while the federal government supports the programme with additional funding of $50million annually.
Although polio paralyzed 122 children in Nigeria at the end of 2012, the EOC interventions started yielding result in 2013. At the end of 2013, the number of polio cases reduced to 53 with increased coverage and improved quality of the polio programme due to flexible programming based on emerging trends, quick-win innovations based on community preferences and perceptions, rapid response to any outbreaks, systematic engagement of key stakeholders and household and community mobilization.
In line with the 2014 Nigeria Polio Eradication Emergency Plan, the following innovations have been used to achieve groundbreaking results in the 11 low-performing States. Some of these interventions and best practices include health camps, engagement of Polio Survivor Groups, Volunteer Community Mobilizers, Religious Leaders, Community Clowns and Entertainers, and the use of local theatres and attractive pluses such as whistles for children.
The progress recorded in 2013 was sustained and improved upon in 2014 that is now said to be the best year for PEI in Nigeria. Only 6 polio cases were recorded in 2014, making Nigeria the country with the least number of polio cases amongst the three polio endemic countries of Nigeria, Pakistan and Afghanistan. Pakistan had 303 cases while Afghanistan had 28 cases. For over 6 months now, Nigeria has not recorded any case of polio. Consequently, the global community favours Nigeria as the country that will achieve the goal of polio eradication among the 3 countries. As at 9th February 2015, no new Wild Polio Virus Type 1 (WPV1) has been reported in Nigeria. However, amongst the endemic countries, Pakistan has reported 1 case this year.
The reported six Wild Polio Virus Type 1 (WPV1) cases in the country as of 2014 are from five Local Government Areas (LGAs) in two States – Kano (Gaya, Tarauni, Sumaila, and Tudun Wada) and Yobe (Gujba), compared to 53 cases in 30 LGAs in nine States for the same period in 2013. This is 89 per cent reduction in number of cases nationally. Also, there has been no confirmed Wild Polio Virus Type 3 (WPV3) in the past 26 months with the last reported case in November 2012. More importantly, there is only one WPV Type 1 (WPV1) genetic cluster circulating in Nigeria this year which is 87.5 percent fall from the eight genetic clusters that were crippling children below the age of five in 2013.
The year 2015 commenced with renewed determination by the federal government and GPEI partners to interrupt the transmission of wild polio virus in Nigeria. The Expert Review Committee (ERC) on Polio eradication at its 29th meeting in Abuja 21-22 January said the progress being made in PEI is encouraging and that the country must be prepared to interrupt the transmission of polio this year as ‘Eradication of polio in the African Region will be certified when no country in the Region, including Nigeria, has detected a case of polio for at least three years with documentation of adequate surveillance’.
The ERC then reiterated the fact that Nigeria will achieve eradication in 2018 provided it maintains its zero WPV position and stop the transmission of cVDPV, which is one of the major challenges currently facing the polio programme in Nigeria. Other challenges include huge funding gap, insecurity and political distractions particularly at the sub-national levels due to elections.
The Inter-Agency Coordinating Committee (ICC), chaired by the Hon. Minister of Health, has ensured the inclusion of the PEI issues in its meeting agenda. While PEI features prominently in the on-going electioneering campaigns, the NPHCDA will develop and implement an aggressive post-election advocacy action plan to secure the support of political leaders especially in the high-risk States. The programme will also ensure national consensus on polio eradication across civil society, traditional leaders and political parties.
This resolve was further re-enforced by the end of 2014 message of Mr. Bill Gates who took to his official twitter handle @BillGates to stating, “One of my favourite stories of 2014: In just one year, Nigeria went from 50 polio cases to six.” He further tweeted, “Good news you may have missed in 2014, Nigeria had a pretty good year,” while projecting that the country will be polio free in no distant time.
There is no gainsaying the fact that Nigeria has the capacity to eradicate polio as no polio case has been reported in southern Nigeria for five years now. As the ERC rightly concluded, ‘Nigeria is well positioned to interrupt the transmission of WPV’. The country is on the verge of interrupting polio transmission. The Federal government is determined to achieve this goal and the EOC is prepared to make this determination a reality by ensuring that there is no WPV case, sustaining the high quality of polio campaigns, adopting special approaches to reach children in security constrained areas, conducting timely and adequate outbreak responses, strengthening surveillance and expanding household and community engagement approaches to increase demand for polio and routine immunization services.
*Dr. Ado J. G. Muhammad is the Executive Director/Chief Executive Officer (CEO) of the National Primary Health Care Development Agency (NPHCDA), Abuja and can be reached on email address: firstname.lastname@example.org
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