Despite Mistrust and Numerous Setbacks, Nigeria is Officially Free of Wild Polio
By: Julian Mok
National Stop Transmission of Polio | Nigeria
Lexington — June 2020 marks the month that Nigeria has been officially declared wild polio free by the Africa Regional Certification Commission (ARCC) for wild poliomyelitis eradication. Wild polio, the strain of virus that exists endemically, has not been detected in the country since 2016. Nigeria was the last remaining African country where wild polio existed, making this achievement a major milestone for the health of all Africans.
Since 1988, The Global Polio Eradication Initiative (GPEI) has collaborated with the World Health Organization, UNICEF, US Center for Disease Control and Prevention, the Gates Foundation and Rotary International with the goal of immunizing every child around the world. This initiative was extremely successful in eradicating cases of polio, halving polio cases by the year 2000. However, in 2003, a combination of misinformation and distrust allowed the virus to peak in Nigeria.
Ibrahim Shekarau, the then-governor of Kano, banned the polio vaccine campaign from his state because rumors had spread that the oral vaccine was a ploy by Westerners to sterilize Muslims and decrease their populations. As Kano became an epicenter of the disease, by 2012 the country accounted for more than half of all polio cases in the world.
Children paid the biggest price for the misinformed policy. Children under the age of five are more susceptible to the polio virus which invades their nervous system and causes total paralysis in a matter of hours. 5-10% of those paralyzed suffocate due to the immobilization of muscles that control breathing. There was no choice but to push for healthcare workers to bridge the gap of trust and stop the highly infectious disease from wreaking further havoc.
Healthcare workers implemented a program working in conjunction with a wide array of health advocates, engaging with traditional and religious leaders and deploying a network of 20,000 women who delivered vaccines door-to-door. These were members of the community that Nigerian parents trusted. Leaders spoke to their communities about the benefits of immunization, with one leader administering an oral vaccine to himself in front of a crowd. Women are entrusted to administer the vaccine to children in their communities five times a year. By rebuilding trust through a network of local advocates, Nigeria has managed to eradicate wild polio.
However, vaccine-derived Type 2 polio, or cVDPV2, still circulates in Nigeria. Wild polio is a strain that occurs naturally and exists endemically in the environment. Type 2 polio is a strain that develops when the weakened version of the live virus that exists in vaccines mutates back to the harmful variant. This can happen when vaccines are not consistently administered, and people have compromised immune systems.
Despite ridding the country of wild polio, Nigerian officials know that there is no place for complacency. They will have to comply to the guidelines of the ARCC, which requires the country to maintain a high immunization for oral polio vaccine, have a robust national polio outbreak preparedness and response plan, and have a functioning national polio certification committee. World health agencies will also have to fight for sustained compliance with immunization schedules and continue working with community leaders to reach the people.
Being free of wild polio is a major milestone for a country that was wracked with polio outbreaks just years ago. The GPEI can now shift some attention towards Afghanistan and Pakistan, the only two countries in the world where wild polio still exists.