365 days without polio

Finally, July 24 and it’s one year since the last recorded infection of wild poliovirus in Nigeria. By contrast, Pakistan -listed as a polio-endemic country – has had 28 cases.
But the pressure now is to keep Nigeria’s zero polio cases that way for another two years, in time for the World Health Organisation to declare Nigeria free of polio.
“It is a journey one can say was difficult, along rocky pathways,” says Dr Muhammad Ado, executive director of National Primary Health Care Development Agency, which coordinates the primary health care and immunisation programmes nationwide.
“There were a lot of challenges which we surmounted before reaching where we are now.”
Some 123 children were infected with WPV by the end of 2012 when Ado was appointed to head the agency. By 2013, cases fell to 53 and further to 6 in 2014.
Since July last year, no single case of WPV has been reported. Only one case of cVDPV (circulating vaccine derived polio virus) blemishes Nigeria’s record next to Pakistan and Afghanistan, according to data by the Global Polio Eradication Initiative.
In emergency operations centres that have sprung up across Nigeria, analysts follow data streams that feed onto the Vaccination Tracking System.
Anyone can see the figures as they come in. Average coverage across eight northern states is safely in the green-light zone-87% from last November to 86% this June. Interpretation: at least 86% of children who needed vaccines got their oral polio virus drops. Put another way: nearly eight in 10 children have had their immunity boosted up to 80%.
Bauchi State in particular clawed its way out of 59% coverage last December – smack in the red zone – to a slightly yellow 70% this April and up to 72% by June.
The journey to July 24 has been hard fought and fraught with near-misses, costing naira and necks.
Kano is safely in dark green zone – 91% coverage from last November till this June. It has long been regarded a hotbed of transmission, and threw up what field workers call the most challenging period.
Tragedy hit anti-polio campaign in February 2013 when gunmen shot dead 16 vaccinators – 13 in Kano and three more in Maiduguri – in a day. It would take another six months before any immunisation activity could resume in Kano.
“We had to reassure vaccinators and health workers of the security. We had to talk to security agencies to guarantee their safety and to plan and work with security agencies in such a way that no harm will come on any health worker in the cause of their duties,” says Ado.
When a bomb went off in Nyanya district of Abuja, some vaccinators who “had gone to collect vaccines and were on their way to vaccinate children were caught up in it,” he adds.
Anti-polio campaign had also had to take on opposition spreading claims that the vaccine was a clever way to depopulate targeted parts of the country by sterilising children.
Says Ado: “We had to go in and involve religious and traditional leaders to carry out interpersonal communication to resolve some of these issues. We also had elite refusing; when you have the elite sending misinformation about polio that will constitute a major stumbling block that was why we experience huge refusal for immunisation.
“We had to sit with them and explain to them the benefits and the content of the vaccine to make them see reason that Nigeria cannot lag behind in the interruption. So far, with combination of interventions and using even polio victims as advocates, we were able to address some of these concerns.”
It took a taskforce at federal level and replications of the same at state levels to get things going.
The Governors Forum decided all states must have state taskforces chaired by their deputy governors,” said Muhammad Ali Pate, predicting the break in transmission of wild polio. “With this kind of leadership, we are very positive that we are going to get to our destination towards the end of the year.”
Pate had coordinated Nigeria’s effort to eradicate polio since 2008, but he was in 2012 a minister of state for health and his prediction did not reckon with attacks the following year in Kano.
But the Kano incident was also instrumental to changing how vaccinators work in insecure environments: they targeted communities, laid low in wait for a lull in tension, got the all-clear signal and rushed in to vaccinate children, then were back out before anyone even knew they were there.
The world awaits a full declaration of eradication. Four months before July 24, India passed on Rotary International’s “End Polio Now” torch – an Olympic sort of flame that passes through cities as Rotary tries to raise funds for polio programmes.
Rotary coordinates fund raising from governments, organisations and individuals to complement Nigeria’s spending on polio – and estimates it has spent $1.2 billion since 1985 when the initiative started.
India’s high commissioner to Nigeria, Ajjampur Rangaiah, who accepted the torch in Abuja, said Nigeria was taking the steps India took shortly before it was declared polio free.
“We fought against polio for 20 years at an enormous cost and we are now planning to continue to sustain it,” said Rangaiah. “We want the rest of the world also to be with us.”
The Global Polio Eradication Initiative estimates Nigeria will need to find $256.9m to fund its total polio activities for 2015 and $169.6m in 2016 – exclusive of tentative funding that comes through WHO and UNICEF.
With money from both UN agencies, the funding gap could fall to $196m and $158.2m.
Nigeria’s polio story comes with huge irony. Polio emergency operations provided the model for response to Ebola virus disease – its experts set up central command at operations centres from Lagos to Enugu to contain the virus. Now, containing Ebola is grounds for fresh hope that Nigeria can be declared free of poliovirus. The two-year countdown has just begun.