AISHA got the virus when she was just two. Now at three, she cannot walk normally. The wild polio virus left not just the girl in agony; her parents are also devastated. For they had hoped she would bring them out of poverty when she got older and brgan to make money.
Aisha’s parents were apparently among parents who resisted the polio immunisation programme, believing that it was aimed at controlling the number of children one gives birth to. Muhammad Bello, Aisha’s grandfather was quoted as saying that before she got the virus, they never felt any need to take their children for routine immunization, but today, Bello has seen the need after his grandchild got knocked down by the virus. He said “we never felt the need to get our children immunized, but now, I will do my best to mobilize our community”. Her mother, Zainabu was also quoted as saying that “I do not really understand what happened. Aisha felt sick for weeks and got a high fever. Her legs have now started to get very weak and she has a hard time trying to stand up. The doctor said it was too late, she may get polio, but we needed to confirm. In the past, we always refused vaccination because some of our neighbours told us the oral polio vaccine could cause sterility. Now, we know that it is not true and we can see the consequences. From now on, I will commit myself to be part of the social mobilization team”. That was in May 2012 and two weeks later, the little girl was confirmed to be infested by the virus, thus becoming one of the 30 polio cases in Sokoto state as at May, 2012.
Today Aisha has joined the growing list of persons affected by the virus in a country regarded as one of the most entrenched reservoirs of wild poliovirus in the world. According to the World Health Organisation (WHO), Nigeria is the only country with ongoing transmission of all three serotypes of polio virus such as wild poliovirus type 1, wild poliovirus type 3, and circulating vaccine-derived poliovirus type 2. Interestingly, states in the northern part of the country are the main source of polio infections elsewhere in Nigeria and in neighbouring countries. For example, Nigeria or northern Nigeria is reported by international organisations as being the main source of polio in countries like Central African Republic, Chad, Cote d’Ivoire, Mali, Uganda, Kenya and other countries stretching from West to Central Africa and Horn of Africa. These countries have been classified as importation countries because they have stopped the transmission of indigenous wild poliovirus can be affected by importations of the virus. In addition, Nigeria is one of the three countries globally still considered as polio endemic nations, the others being Pakistan and Afghanistan. Incidentally, while Afghanistan and Pakistan are neigbours, Nigeria’s immediate neigbours have all eradicated cases of polio. Fresh cases of the disease in these countries have always been traced to states in northern Nigeria. But many states in the north have embraced polio, but it is generally agreed that a lot still need to be done if the disease is to be eradicated in the country. It is believed that the country is presently on the right track to stop fresh transmission of cases. But one thing that has been of concern to health workers and Nigerians is the fact that the same set of people seems to be immunized regularly, while several areas are ignored. So far, the country has recorded 52% drop in polio cases, 63% reduction in vaccine rejection while the number of states with ongoing circulation of the virus has reduced from 11 during the same time last year to nine. As at the last count, Borno, Yobe and Kano account for 72% of all polio cases in Nigeria so far this year while 3 percent of local government areas in the country have recorded polio virus so far this year. Similarly, there has been a reduction of the polio genetic clusters in Nigeria from 8 to 2 while no Wild Polio Virus Type 3 case has been detected in Nigeria so far this year, last case 11 months ago.
Be that as it may, The Nation gathered however that in some of the states of the north, principal officers of government and even key health officials have shown dislike for the polio eradication initiative. The Nation was told that in one of the states, the Director incharge of Primary health care is not positively disposed to the polio eradication initiative, while in another, the Secretary to Government is against the idea. It was also gathered that in some of the local government, refrigerators meant for the storage of the polio vaccine are taken away by highly placed local government officials. Available information had it that due top efforts of the state government, Kaduna recorded no case of polio for 30 months beginning from 2009 and when the government was beginning to beat its chest that the state was polio free, 10 new cases were reported in the state in 2012. Some officials of the state health ministry said that those fresh cases were traced to Zamfara state. But other believed that the set back was as a result of some children that were missed during the immunization exercise. But since the beginning of 2013, the state according to the officials has not recorded any case of polio. The state government has said it was determined to ensure that state is polio fr4ee and has deplored all machineries to ensuring success. This explain why the Deputy Governor, Ambassador Nuhu Bajoga had to abandon the comfort of his office in July to go in search of two children who reported missed out in the polio immunization exercise in Zangon Kataf local government area of the state and ensure that they were administered with the vaccination. James Swam Kazzah, Press Secretary to the Deputy Governor said that idea behind that visit was to determine whether the two children in the community who ‘missed out’ during the earlier immunization exercise had been recovered and rightly immunized to forestall any emergence of the dreaded polio virus in not only the local government but the entire state. He noted that like the Biblical analogy of leaving behind 99 sheep to search for one missing sheep, Ambassador Nuhu Bajoga left his comfort zone to trek long distance through bushy farmlands and muddy footpath to identify these two children for the sake of polio eradication in Kaduna state.
Late Governor Patrick Ibrahim Yakowa had, while launching the first quarter polio immunization in 2012 said that “If Nigeria is to join the rest of the world in becoming polio-free, we all must allow our children to be vaccinated, and the responsibility of such task, to a greater extend, rest on the shoulders of our Local Government chairmen, traditional and religious leaders. As such I am calling on all the Interim Local Government Chairmen, traditional and religious leaders, to have a stronger engagement with stakeholders through increased commitment and accountability to the fight against polio. I have also directed all Commissioners and Permanent Secretaries to henceforth join hands with their respective Local Government Chairmen in ensuring the success of vaccination campaigns”. This tends to have yielded result as no incident has been reported across the state in 2013. The government under Yakowa initiated an award for the best local government in polio eradication. The government, Yakowa had said “has made polio eradication initiative a top priority in the health sector”, adding that “in our fight against this disabling disease, the Kaduna State Government had spent huge resources in 2011 in the area of immunization, advocacy and control of the polio menace, with a view to retaining the polio-free status of the state. We are also committed to sustaining the state Task Force on Immunization meetings in order to ensure coordination of the polio eradication initiative. I have also directed all the Local Government Councils in the State to ensure regular meetings of the Local Government Task Force on Immunization and engagement of stakeholders, especially traditional and religious leaders in the campaign against polio in their respective areas. It is the combination of these efforts that made Kaduna State polio-free since 2009. The success achieved was a result of the commitment made, by both the Government and also by other stakeholders in the state, particularly our traditional and religious leaders. “In order to ensure that Kaduna State continues to be polio-free this year and beyond, the Kaduna State government has decided to identify and honour people who have positively influenced and advanced the polio eradication initiative in their respective domains. I will like to draw your attention to the fact that even though we have been free from polio since 2009, the fight against polio in Kaduna State is not yet over. This is because Kaduna State is surrounded by polio infected states. I have also been informed that there are still some children that have missed the routine polio immunization administered by both parents and caregivers. I therefore wish to charge those that are going to be decorated today as Polio Ambassadors to continue to support the polio eradication initiative in their respective constituencies, so that Kaduna State continuously remains a polio-free State and even assist in the eradication of polio in our neighbouring state”.
The world Health Organisation however believes that with concerted efforts by government and other stakeholders, Nigeria has the capacity to eradicate polio within nine months. WHO Country Director in Nigeria, Dr. David Okelo, was once quoted as saying that, “Nigeria has made a lot of progress in the fight against polio; we have done 95 percent of the work due to the efforts of traditional and religious leaders. We have just a fraction left so let us finish the job as quickly as possible. “Government should mobilize communities and leaders to finish the remaining part in the next six to nine months. We need to finish polio and move on to other problems such as cholera, high maternal mortality and other child killer diseases. We can do it and we should do it.” Many believe that the governors of the north have not shown serious commitment to the polio eradication campaign. But at one of the meeting of the Northern States Governors Forum, they resolved to strengthen the state task force on polio eradication in each of the states by making it more functional; sustain the quarterly interaction of governors with their traditional rulers and to prevail on Local Government Chairmen in the Northern States to continue to support Polio Programmes particularly through sustained enlightenment campaigns. Interestingly however, apart from the regularly National Immunisation Day exercises, there is little being done by the various states to ensure acceptability of the vaccine as fresh polio cases have been reported in a few states.
Even though there are few countries where people still carry the disease and in Nigeria where vaccine rejection has become common, there is still a global fight against the disease. As part of the global campaign, hundreds of scientists, doctors and other experts from around the world in May, 2013 launched the Scientific Declaration on Polio Eradication declaring that an end to the paralyzing disease is achievable and endorsing a comprehensive new strategy to secure a lasting polio-free world by 2018. At the launch, over 400 signatories urged governments, international organisations and civil society groups around the world to do their part and put an end to polio.
with the aim to protecting the world’s most vulnerable children and future generations from this preventable disease. They also call for full funding and implementation of the Polio Eradication and Endgame Strategic Plan 2013-2018, developed by the Global Polio Eradication Initiative (GPEI). However with polio cases at an all-time low and the disease remaining endemic in just three countries around the world, the Global Polio Eradication Initiative had estimated that ending the disease by 2018 can be achieved for a cost of approximately $5.5 billion. Dr. Walter Orenstein, professor and associate director of the Emory Vaccine Center at Emory University and former director of the U.S. Centers for Disease Control and Prevention’s National Immunization Program was quoted as saying that “we have the tools we need and a time-limited opening to defeat polio. The GPEI plan is the comprehensive roadmap that, if followed, will get us there”. On his part, Dr. Zulfiqar Bhutta, founding director of the Center of Excellence in Women and Child Health at Aga Khan University ad one of the doctors that has signed a declaration calling for the eradication of Polio by 2018 globally noted that “securing a lasting polio-free world goes hand in hand with strengthening routine immunization. We need all countries to prioritize investments in routine immunization”.
The declaration, part of which The Nation obtained online, emphasizes that achieving polio eradication requires efforts interrelated with strengthening routine immunization which is a new focus of the GPEI plan, pointing out that as the last cases of polio are contained, high levels of routine immunization will be critical. In the same vein, it noted that resources and learning from polio eradication efforts can be used to strengthen coverage of other life-saving vaccines, including for children who have never been reached with any health interventions before. Professor Helen Rees, executive director of the Wits Reproductive Health and HIV Institute at the University of the Witwatersrand in South Africa, who signed the declaration believe that as long as polio exists anywhere in the world, it threatens children everywhere. According to him, “by pursuing in parallel all of the steps needed to reach eradication, including the introduction of inactivated vaccines, countries have a complete path to eliminate polio’s threat.”
Investigations revealed that those who signed the declaration were drawn from 80 countries and is being promoted by more than 40 leading universities and schools of public health and medicine are promoting the declaration on their websites, including that of Nigeria’s Redeemer’s University. As at the time the declaration was signed in May, 2013, only 16 cases of polio had been reported globally with India, long-regarded as the most difficult place to eliminate polio, said not to have recorded a case in more than two years. This perhaps explains why Dr. David Heymann, head and senior fellow at the Chatham House Centre on Global Health Security and a signatory of the declaration believe that “eradicating polio is no longer a question of technical or scientific feasibility. Rather, getting the most effective vaccines to children at risk requires stronger political and societal commitment. Eliminating the last one percent of polio cases is an immense challenge, as is the eradication endgame after that. But by working together we can make history and leave the legacy of a polio-free world for future generations.”
However, polio survivors in Nigeria have joined the campaign against the virus. Karima Usman, a 38-year-old Nigerian mother of three, is one of such people who has decided to take up the task of convincing parents take their children for vaccination against polio. According to her, “no one used to go from house to house giving OPV [oral polio vaccine] when I was small. That is why I got polio. Now, OPV is available – but some parents are not letting their children take it.I got involved in this work three months ago and I will not rest till every parent agrees to get their child vaccinated. Most people get convinced easily when they see my condition and realize what poliovirus can do. But then there are some who are totally non-compliant due to spread of misinformation and myths and don’t even come to the door to talk to me. I don’t give up. I get off my tricycle and walk on my hands and go inside their houses to talk to them.”
Like Ms Usman, Auwal Bawa, Captain of the Katsina state Para-soccer team is another polio survivor who has d4ecided that it was time to join the campaign for the eradication of polio in Katsina state and in Nigeria. According to him, “I tell people that my ability lies in my mind. And it is the mind that they need to listen to and accept OPV and not false rumours”. Melisa Corkum of the UNICEF communication office in Nigeria said that “Polio survivors are recording a success rate of 70 per cent on an average over the last three polio immunization rounds. In other words, they are able to convince seven out of every 10 parents to accept OPV for their children which are remarkable. As the number of cases of polio has decreased over the years, the PSGs serve as a stark reminder of what the virus can do – and help in overcoming non-compliance.” In Sokoto, there is Fatima Aliyu, a mother of two and a polio survivor who has also joined in the campaign to ensure that every child in Sokoto is immunized. It is imperative to say that Sokoto is one of the states in the country struggling with non-compliance. In her words, “I call all men to support their wives to bring out their children for immunization. Would we have come out to support this programme if the vaccine had any side effects?”
