The theme for World Well being Day in 1995 was “Target 2000 — A World Without Polio”. I delivered a lecture titled “Polio Eradication Race: Will Nigeria Finish Last?” to mark the event. Ending final appeared probably as a result of within the 1990s Nigeria’s routine immunisation charges have been within the 30%-40% vary for all vaccine preventable illnesses. International locations in Southern and East Africa that had eradicated polio had protection within the 80%-90% vary.
Twenty-four years later, the query is just not whether or not Nigeria will end final in Africa. That is already the case. The query is whether or not it will likely be the final globally.
In 1988 polio was endemic in 125 nations and there have been greater than 350,000 instances a 12 months. Moreover Nigeria, the one nations nonetheless confronting polio now are Pakistan and Afghanistan, with 33 reported instances between them in 2018.
Nigeria’s race to polio eradication has been lengthy and winding, hampered by at the least 4 sorts of obstacles, a few of them of the nation’s personal making.
However what it has finally achieved proper is deal with every impediment in an modern and proactive manner. For instance, it established an emergency operation centre to get and handle data and actions shortly, utilizing fashionable communication instruments. It improved coaching, labored with non secular and conventional leaders who’d been against immunisation, and made additional efforts to cowl inaccessible components of the nation.
The primary impediment to polio eradication was an insufficient programme of routine immunisation. Because the Nigerian Expanded Programme on Immunisation (EPI) was initiated in 1976, it has been underfunded and poorly supported by authorities and communities alike. Tens of millions of Nigerian youngsters have been left unvaccinated.
Nigeria reportedly attained the Common Baby Immunisation goal protection of 80% by 1990. However this did not final, partly due to frequent adjustments of presidency through the navy period and adjustments in insurance policies. There was additionally a neglect of well being care typically and a failure to construct on progress made by earlier governments. For example the Nigerian Main Well being Care Growth Company was established in 1992. However between 1993 and 1998, immunisation protection declined to 20%-46% for diphtheria-tetanus-pertussis.
In 1997 the Nationwide Programme on Immunisation was arrange. It merged with the first company in 2007 following the Federal Authorities Well being Sector Reform. This didn’t translate into instant success however progress was made out of 2010.
Nonetheless, the harm achieved to routine immunisation through the early years continues to be felt. In keeping with a 2016-2017 survey, about 4.5 million Nigerian youngsters have been under-immunised. The survey additionally revealed the deep inequities in immunisation between geographic areas and between earnings teams.
The second impediment is that Nigeria started severe polio eradication actions very late. It was virtually 20 years after the 1988 World Well being Meeting resolution calling for the worldwide eradication of poliomyelitis, and about 5 years earlier than the preliminary eradication goal of the 12 months 2000.
Nigeria didn’t successfully get began till 1996, by which period 15 African nations had efficiently interrupted the transmission of polio. In different phrases, these nations had gone with out reporting any case of untamed polio virus for 3 years. Of the 1,949 polio instances reported in Africa in 1996, Nigeria accounted for 942 or 48.3%.
Eight years later, in 2004, Nigeria reported 782 (83.7%) of the 934 polio instances in Africa.
Third, in 2003, Nigeria’s gradual crawl to eradicate polio virtually got here to a standstill with the polio vaccine boycott. This lasted for simply over a 12 months. It occurred after political, non secular and tutorial leaders within the predominantly Muslim Kano, Zamfara and Kaduna states referred to as on dad and mom to reject the polio vaccine, and never permit their youngsters to be vaccinated. They spoke of fears that the vaccines have been intentionally tainted.
The boycott had long-lasting repercussions inside and outdoors Nigeria. That 12 months, Nigeria reported 355 polio instances. The variety of reported instances galloped to 833 in 2005 and peaked in 2006 at 1,144 instances, two years after the resumption of polio vaccination in boycotting states.
The boycott was finally overcome principally by way of the intervention of conventional and spiritual leaders who satisfied their followers to relent.
From 2003 to 2007, kind 1 polio originating in northern Nigeria spread to trigger outbreaks in 20 beforehand polio-free nations in Africa and as distant as Indonesia and Yemen. The variety of instances reported in Nigeria dropped to 356 in 2007 and elevated to 866 in 2008. That was the 12 months Nigeria drew unflattering consideration on the World Well being Meeting. The Meeting adopted a resolution calling on Nigeria
to cut back the danger of worldwide unfold of poliovirus … by way of intensified eradication actions that guarantee all youngsters are vaccinated.
This consideration appeared to spur Nigeria to motion, leading to a gradual decline within the variety of polio instances from 543 in 2009 to 130 in 2012. The variety of cases dropped to 36 by 2014, and Nigeria was trying ahead to being declared polio free by 2017.
However that was to not be.
The fourth impediment to polio eradication was the Boko Haram insurgency, which has prevented entry to areas occupied by the group. 4 instances of polio have been reported in July and August 2016 in areas liberated from Boko Haram management. Genetic evaluation confirmed that the virus had been circulating for between 4 and 5 years within the inaccessible areas below Boko Haram occupation.
Is the tip in sight?
Since August 2016, Nigeria has not reported any case of untamed (naturally occurring) polio in any of the accessible areas of the nation. This has been doable for a variety of causes. Nigeria has labored with donor companies and authorities dedication and monetary assist have improved.
Additional and modern efforts have been put in place to achieve populations in partially and completely inaccessible components of Borno state. This space is the place Boko Haram historically operates. It’s now estimated that fewer than 100,000 youngsters are trapped within the inaccessible areas.
Nigeria should now submit documentation to the African Regional Certification Committee, which is able to affirm the nation’s polio free status after a rigorous means of checking in opposition to the factors.
What Nigeria has learnt
Ending the insurgency is the one factor that may see Nigeria by way of to the tip of this race – and others to manage and stop disease outbreaks.
There are a number of classes for Nigeria arising from the story of polio. The nation should sustain an accessible, credible and dependable programme of routine immunisation. Availability of vaccines is essential. So is the gathering and evaluation of actual time knowledge to tell motion. This may be achieved in common operation centres, not simply centres arrange for emergencies.
Nigeria should additionally harness politics, faith and tradition and actively contain communities and particular person residents in illness management and prevention.
A model of this text was printed by Nigeria Health Watch