Polio de-listing: Not yet uhuru for Nigeria

There was excitement in Nigeria and around the world recently, when Nigeria officially exited the list of three polio endemic countries in the world. Only two countries, Pakistan and Afghanistan, are now left on the list.
But Nigeria still needs to wait for another two years to be certified polio-free by the World Health Organization (WHO). In fact, stakeholders are worried that building the resilience to stay polio-free until 2017 is the major issue before Nigeria.

The World Health Organization announced that polio is no longer endemic in Nigeria. This is the first time that Nigeria has interrupted transmission of wild polio virus, bringing the country and the African region closer than ever to being certified polio-free.
President of the Nigerian Academy of Science (NAS), Prof. Oyewole Tomori, has drawn attention to the several challenges that still stand between Nigeria and actual polio free certification in 2017. He told The Guardian: “Yes indeed these are great times for Nigeria…a situation I have always hoped for. I always was confident that my country would reach this stage. This is an important milestone for Nigeria, although it took so long to reach.

We still have a major milestone to remain polio free for two years more so as to be declared polio free, not just removal from list of polio endemic countries. These two years will be tough, but we are poised to overcome any challenges to achieve polio free status by 2017. We must move our surveillance to a higher level of alert, our response to any polio case (if any) must be rapid, focused and complete; our government must continue to have the will and the commitment to see no Nigerian child come down with polio ever again.

Our traditional and community leaders must be fully engaged and involved in not only polio eradication but ensuring that every Nigerian child is protected from any vaccine preventable diseases. Finally we must be experts at communicating with our people on the need to get their children vaccinated and take advantage of health interventions provided by government and have confidence in them.”

An epidemiologist and Country Programme Leader of the John Hopkins International Vaccine Access Centre (IVAC), Chizoba Wonodi, stressed the need for sustained efforts. She emphasized the need for the political will to sustain the end polio battle.
She told The Guardian: “Nigerians should be very proud that we achieved this feat. It was the collective effort of government, partners and the people. While we celebrate, we must not relent in our efforts. We must leverage the polio assets to sustain the interruption – that is, the massive political will, human resources, cold chain infrastructure, delivery know-how and community engagement that stopped polio in its tracks. We must bequeath those assets to strengthening routine immunization and increasing coverage equitably.
“Doing this will not only maintain population immunity to keep polio at bay, it will help protect against some of the biggest child killers like pneumonia, diarrhea and measles. Strengthening and creating demand for routine immunization is the next challenge to conquer.”

In its reaction, the Global Polio Eradication Initiative (GPEI), the public-private partnership leading the effort to eradicate polio, called this a ‘historic achievement’ in global health. Nigeria has not reported a case of wild poliovirus since 24 July 2014, and all laboratory data have confirmed a full 12 months have passed without any new cases.

According to the World Health Organization, as recently as 2012, Nigeria accounted for more than half of all polio cases worldwide.
A statement announcing the feat noted: “This success is the result of a concerted effort by all levels of government, civil society, religious leaders and tens of thousands of dedicated health workers. More than 200,000 volunteers across the country repeatedly immunized more than 45 million children under the age of five years, to ensure that no child would suffer from this paralysing disease. Innovative approaches, such as increased community involvement and the establishment of Emergency Operations Centres at the national and state level, have also been pivotal to Nigeria’s success.

The interruption of wild poliovirus transmission in Nigeria would have been impossible without the support and commitment of donors and development partners. Their continued support, along with continued domestic funding from Nigeria, will be essential to keep Nigeria and the entire region polio-free.

Polio, which can cause lifelong paralysis, has now been stopped nearly everywhere in the world following a 25-year concerted international effort. Polio remains endemic in only two countries – Pakistan and Afghanistan. The eradication of polio globally now depends primarily on stopping the disease in these countries. As long as polio exists anywhere, it’s a threat to children everywhere.”

Nigeria has made remarkable progress against polio, but continued vigilance is needed to protect these gains and ensure that polio does not return. Immunization and surveillance activities must continue to rapidly detect a potential re-introduction or re-emergence of the virus. After three years have passed without a case of wild poliovirus on the continent, official ‘certification’ of polio eradication will be conducted at the regional level in Africa.

Eradicating polio will be one of the greatest achievements in human history, and have a positive impact on global health for generations to come. Nigeria has brought the world one major step closer to achieving this goal and it’s critical that we seize this opportunity to end polio for good and ensure future generations of children are free from this devastating disease.”

President, Rotary International, K.R. Ravindran, congratulated Nigeria on its accomplishment in stopping polio.
He said:  On behalf of the entire Global Polio Eradication Initiative, we thank volunteers, health workers and parents in communities across Nigeria for their tireless commitment to ensuring every last child is protected against this devastating disease. In the months ahead, their dedication will remain as important as ever, as we work to keep Nigeria polio-free and to eliminate polio from its final strongholds in Pakistan and Afghanistan.”

Director-General, World Health Organization, Dr. Margaret Chan, said the tempo to free Africa of Polio must be sustained. “The outstanding commitment and efforts that got Nigeria off the endemic list must continue, to keep Africa polio-free. We must now support the efforts in Pakistan and Afghanistan so they soon join the polio-free world, she stated.”
Executive Director, National Primary Health Care Development Agency, Dr. Ado Muhammad, noted that: “Nigerians are proud today. With local innovation and national persistence, we have beaten polio. We know our vigilance and efforts must continue in order to keep Nigeria polio-free.”

ON his part, WHO Regional Director for Africa, Dr. Matshidiso Moeti, said: “Stopping polio in Nigeria has been a clear example that political engagement, strong partnerships and community engagement are the engines that drive the momentum of public health programmes, enabling them to achieve great things. I would like to congratulate everyone, particularly political, religious and community leaders in Nigeria and across Africa, for reaching a year without cases of wild polio.”

Director of the U.S. Centers for Disease Control and Prevention, and Chairman of the Polio Oversight Board, Dr. Tom Frieden, described the feat as a clear example of success under very difficult circumstances.

He noted: “It shows we can eradicate polio if proven strategies are fully implemented. Combined with the news of the eradication of type 2 wild polio virus last week, we are moving decisively toward ending a disease that has paralyzed tens of millions of children. In this final mile, we must remain committed to providing the resources and the support to the front lines to make this worthy goal a reality.”

Executive Director of the United Nations Fund (UNICEF), Anthony Lake described the development as a major victory for Nigeria’s children.
“It is a testament to the commitment and dedication of the Government of Nigeria, local leaders, and front line workers. And it is proof positive that if we work together in partnership to reach every community and immunize every child, we can finish the job of eradicating this evil disease everywhere, once and for all,” Lake noted.