Global survey raises concern over polio eradication

The International Monitoring Board (IMB) has released a new report cautioning Nigeria on the growing impression among its politicians that polio is gone out of the country.

The Board has therefore made it absolutely clear that Nigeria has not yet been certified polio-free.

To sustain the tempo on the polio programme in Nigeria, the report recommends that Nigeria’s incoming President makes a clear public declaration that polio cannot yet be considered gone from Nigeria, and should set out and lead a plan to achieve polio-free certification in 2017.

Similarly, the report estimates that Afghanistan, Nigeria and Pakistan have a combined estimated 760,000 children who have never received even a single drop of polio vaccine.

“These persistently missed children are being failed by the programme, and are the key to stopping polio transmission worldwide,” the report noted.

The Independent Monitoring Board provides an independent assessment of the progress being made by the Global Polio Eradication Initiative in the detection and interruption of polio transmission globally.

The report, obtained by The Guardian yesterday, noted how Nigeria has been congratulating itself of triumph against polio and observes that though there has not been any polio case in the country since July 24, 2014, the country needs to thread with caution.

The report noted: “In its last report, the IMB praised the Nigeria programme for staying free of wild polio virus for three months. This period has now extended to ten months.

“Some press coverage has suggested that the country has already rid itself of polio. This is dangerous thinking. The challenge for the Nigeria programme is now one of resilience. Certification of a polio-free Nigeria cannot happen until 2017. Excellent programme performance is as vital over the next three years as it has been over the last three years.”

It therefore called attention for Nigeria and its partners to institute need a clear, coordinated communication and advocacy plan to ensure that the public and political leaders understand the substantial work that lies ahead.

In the meantime, it stressed why the growing triumphalism surrounding the prospect of a polio-free Africa must be halted.

The IMB stressed: “A great deal rests in the hands of Nigeria’s new government. With strong commitment, there is good potential that Nigeria will eradicate polio within their term, and will be able to celebrate a great Nigerian victory. But if the polio programme loses momentum or support, the country could be responsible not only for polio coming back to Nigeria, but elsewhere in Africa too.”

It explained further: “In its last report, the IMB praised the Nigeria programme for staying free of wild polio virus for three months. This period has now extended to ten months. Nigeria poliovirus has regularly infected other African countries in the past, but that has not happened for more than a year now. No circulating vaccine-derived poliovirus has been detected since January 2015.

The Nigerian general election has come and gone without the deterioration in programme performance that accompanied past elections. The improvements in the Nigeria programme are most evident in the large jumps in immunity achieved in the worst performing local government areas.

“The most important factors in Nigeria’s progress to date seem to have been: firstly, the establishment of Emergency Operations Centres (EOCs) that have transformed the quality of planning, decision-making, coordination and inter-agency working; secondly, embracing an approach of innovation and rapid scale-up; and, thirdly, addressing poor individual performance.

“The area with greatest vulnerability is the Northeast of the country. Here, 62 per cent of settlements remain inaccessible to vaccinators. This creates worrying blind spots for the programme. There is an urgent need to establish who is living where, and to reinstitute vaccination campaigns that run as close to normally as is achievable. This requires innovation, and a willingness to reach out to a range of partners. Strong surveillance is also crucial, so that Nigeria can quickly respond to any polio presence. Surveillance is generally strong, but there are still areas of weakness that need to be addressed. There were 35 compatible cases in 2014, demonstrating surveillance gaps. The programme has identified 40 Local Government Areas in which surveillance needs to be improved.”

It went on: “A great deal rests in the hands of Nigeria’s new government. With strong commitment, there is good potential that Nigeria will eradicate polio within their term, and will be able to celebrate a great Nigerian victory. But if the polio programme loses momentum or support, the country could be responsible not only for polio coming back to Nigeria, but elsewhere in Africa too. India faced and met the challenge of staying polio-free between its last detected case and its official polio-free declaration.

“The IMB judges that Nigeria currently falls short of the levels of programmatic excellence achieved in India. The areas of risk we have described mean that Nigeria is not yet safe. Nigeria must build further resilience and, over the next six months, move its programme from good to great. The IMB is very concerned that national, state and local government politicians, as well as the Nigerian public, will now start to believe that polio is gone permanently from Nigeria. It needs to be made absolutely clear that Nigeria has not yet been certified polio-free. The programme and its partners need a clear, coordinated communication and advocacy plan to ensure that the public and political leaders understand the substantial work that lies ahead. In the meantime, the growing triumphalism surrounding the prospect of a polio-free Africa must be halted.”

It stressed further: “…when victories occur along the path to eradication, these need to be recognized and celebrated as victories of the people whose hard work brought them about. In Nigeria, most pressingly, it should be made clear that the progress against polio belongs to the people of Nigeria. In time, when global eradication is reached, it should be celebrated as a victory for the many programme workers – especially those who have risked their lives.

“This is not only the right and proper course to take – it can also help galvanise the momentum needed to continue down the path, and then to move on to other health-boosting endeavours. Victory will belong to the vaccinators who visited every home repeatedly. It will belong to the programme managers who worked seven days a week to close the gaps in campaign implementation. The important contribution of programme funders must be acknowledged, but the victory is not – and must not be seen as – primarily theirs. The partner agencies deserve applause when things go well, but they too should not be central in the spotlight.

“Persistently missed children reside not only in the endemic countries. There are 1.9 million of them in the countries that had outbreaks in 2013 to 14. Each of them is a reason for the virus to return.

“These shockingly large numbers show how far below excellence the polio eradication programme is falling.”