Getting closer to polio eradication

IT is no longer news that if everything goes as planned, Nigeria would be delisted as polio endemic nation in August 2015 and declared polio free in July 2017.

But what pertinent, according to stakeholders in the fight against polio, are what must be done to maintain the tempo of not recording any case of the Wild Polio Virus (WPV) beyond three years.

To end polio and finish the job, the stakeholders led by the National Primary Health Care Development Agency (NPHCDA), the Global Polio Eradication Initiative (GPEI), the World Health Organisation (WHO), Rotary International and United Nation Children Fund (UNICEF) recommended among other things high quality surveillance and vaccination campaigns.

Friday July 24, 2015, marked one year since Nigeria’s last reported case of wild poliovirus paralyzed a child. Final laboratory results on all specimens from acute flaccid paralysis cases and environmental samples for the full 12-month period are expected by September 2015.

The GPEI and other stakeholders commend the hard work of the Nigerian government, partners, religious and community leaders, and health workers for such strong progress towards stopping polio.

The GPEI in a statement said: “While Nigeria is closer than ever to ending polio, the job is not yet finished. At least two more years must pass without a case of wild poliovirus for Nigeria to be certified polio-free along with the rest of the WHO’s African region.

“To achieve this goal, Nigeria and all countries in Africa must maintain domestic funding for polio, ensure high-quality surveillance for poliovirus, strengthen vaccination campaigns, particularly in hard-to-reach and insecure areas, and improve routine immunization. At the same time, until polio has been eradicated from all remaining infected areas, all countries must maintain high immunity levels and strong disease surveillance to minimize the risk and consequences of re-infection.”

Executive Director NPHCDA, Dr. Ado Gana Muhammad, told The Guardian: “Nigeria is one step closer to achieving the goal of eradicating polio in 2017 as it has been one year since the last case of polio was reported in the country. The last case of polio in Nigeria was reported exactly a year today in a 16 months old boy from Sumaila, LGA in Kano State. If all pending laboratory investigations return negative in the next few weeks, Nigeria will officially be taken off the list of polio-endemic countries.

“However, Nigeria will only be certified polio free by WHO in 2017, provided it maintains its zero case status, further strengthens its surveillance system, improves routine immunization and maintains high quality campaigns. Consequently, achieving one year without polio is just one of the hurdles the country needs to surmount before being certified polio free in 2017.

“As early as 2012, Nigeria with 122 poliovirus cases, had reported the highest number of polio cases globally and the polio epicentre of the world. As the immediate past Minister of State for Health, Engr. Fidelis Nwankwo, said, ‘Our eyes are on the prize, but this is the most critical time in the programme. Because the stakes are so high we know that the eyes of the world are on us all to deliver and there is no room for complacency until we achieve eradication in 2017. We are far from there yet.’”

Muhammad further stated: “We’re really excited by the historic progress that has been made here in Nigeria, however we can’t get distracted by this progress. We are now looking ahead to our next challenge which is to sustain the momentum on an emergency footing until 2017, with strong government oversight and continued levels of funding, so that Nigeria can hit the three year mark with no cases, and finally eradicate this crippling disease.”

Indeed, if this progress is sustained with no re-infection and surveillance remains strong, Nigeria and the rest of Africa will achieve polio eradication by 2017.

Government and partners reiterate that it’s going to take a lot of hard work. Polio campaigns will need to continue and reach all children in the country several times a year. He added: “While there is polio anywhere in this world, every child is at risk. Surveillance needs to become even more sensitive so that no virus will be missed. And routine immunization coverage needs to improve significantly, especially in the northern states.”
Specific actions that worked for Nigeria

Nigeria launched an “all-out” effort, with focused attention, resources and activities on the remaining polio strongholds of the country, particularly the northern states. Special approaches were developed in the security compromised areas, including a focus on reaching the internally displaced populations. “We recognize that it will only be through strong commitment, coordination underpinned by accountability that Nigeria will be in a position to stop transmission and sustain the gains through to eradication in 2017,” Muhammad said.

He added: “Today we are looking forward to 2017. We remain committed to finding concrete and sharp solutions to overcome the remaining bottlenecks until we achieve eradication in this country. We recognize the need to sustain and re-double our efforts to ensure every child is reached.

The NPHCDA also paid tribute to the hundreds of thoughts of vaccinators, community mobilizers, traditional and religious leaders, parents and caregivers who have supported polio eradication efforts for more than a decade, despite the challenges. “Nigeria’s achievement in stopping polio will save hundreds of thousands of children from lifelong paralysis or death each year. Polio efforts have contributed substantively to improving the health system, including disease surveillance, routine immunization and maternal and child health,” he said.

Muhammad further stated: “Today is an important health milestone for Nigerians. But now we call on all Nigerians – health workers, political traditional, religious and community leaders and communities themselves to help us to sustain the gains made towards polio eradication by 2017, when Nigeria will be certified polio-free by WHO. Let us not leave any stone unturned until we achieve this collective goal for our country. Working together we can do better.”

The Expert Review Committee (ERC) on Polio Eradication and Routine Immunization in Nigeria meets regularly in order to discuss progress and challenges against the virus in the last polio endemic country in Africa. The ERC is set to meet in second week of August.

Chairman ERC and President Nigerian Academy of Science (NAS), Prof. Oyewale Tomori, said: “…Nigeria has shown the world that polio eradication is possible. With the help of seven Emergency Operations Centres throughout the country, the government and partners have been able to respond in real-time to polio outbreaks and coordinate vaccination campaigns. At the local level, health workers, often drawn from the communities they serve, have partnered with polio survivors and religious leaders to help parents understand the importance of the vaccine for their children.

“We have also learned from others. Nigeria built on India’s polio eradication success by improving immunization microplans, where local leaders and health workers walk through their communities and map each house so that vaccinators know where to go and no child is missed. In conflict zones, health workers have learned to be nimble and take advantage of short periods of calm to vaccinate children.

“But I hope that the most important lesson we’ve learned is not to be complacent. Nigeria is the only country in Africa that has never stopped polio. We have been close before to ridding our country of the deadly virus, but we let our guard down and the disease came roaring back, re-infecting dozens of other African countries.

“Yet, despite all the lessons we’ve learned, the end of polio will not come quietly. Insecurity in the northeast part of the country has left many settlements in the area inaccessible to health workers. A recent case of circulating vaccine-derived poliovirus (cVDPV) – a very rare form of the virus mutated from the oral polio vaccine that emerges in under-immunized populations – shows that polio vaccination rates in Nigeria are still not high enough.

“Buhari has the historic opportunity to end polio forever on his watch, but only if he dedicates the necessary resources to improve campaign quality, intensify surveillance measures, and reach children in all parts of the country – particularly in insecure areas in the northeast. Until we reach every child, all children remain at risk.

“Freeing my country of polio will have benefits beyond just taking Nigeria’s name off that short, inglorious list. The polio program has provided a framework for reaching children all over the country with life-saving vaccines and critical health services. It also taught us how to effectively respond to disease outbreaks, as we did when Ebola came calling.

“While it’s critical that we don’t lose focus on eradication, we must also increase investment in our often fragile health system. One in eight Nigerian children still die before reaching their fifth birthday – the vast majority from preventable diseases – making Nigeria one of the most dangerous countries in the world to be a child. A strong and resilient Nigeria rests on building an effective health system that delivers for its citizens, and for its children.

“I dream that I will live the last years of my life in Nigeria – in a country where no child becomes paralyzed by polio, or dies from vaccine preventable diseases. So, to Buhari and our friend to the West, let us commit, once again and finally, to rid Nigeria and Africa of polio. Our children, our country and our continent depend on it.”