As one of the few remaining countries in the world still battling polio, Nigeria has made significant strides in reducing the threat of the disease in recent years. According to the World Health Organisation (WHO), the primary areas of focus in the global fight against polio eradication are indeed just northern Nigeria and the border of Afghanistan and Pakistan. Slight increases in the number of reported polio cases over the past 18 months have resulted in the government once again revamping efforts to completely eradicate the disease by 2013.

WHO strategy for halting the transmission of wild poliovirus in affected areas include: high infant immunisation coverage with four doses of oral poliovirus vaccine (OPV) in the first year of life; supplementary doses of OPV to all children under five years of age; surveillance for wild poliovirus through reporting and laboratory testing of all acute flaccid paralysis cases among children under 15 years of age; and targeted “mop-up” campaigns once wild poliovirus transmission is limited to a specific focal area.

Furthermore, before any region can be certified “polio-free”, it must satisfy three conditions: there are at least three years of zero polio cases due to wild poliovirus; disease surveillance efforts in country meet international standards; and each country must illustrate the capacity to detect, report and respond to “imported” polio cases.

RENEWED FOCUS: The ongoing efforts to eradicate polio in Nigeria experienced a dramatic success in 2010 when, according to the WHO, the 21 confirmed cases of the disease represented a 95% decline over confirmed cases in 2009. However, the country faced a setback in 2011 when 62 cases of the highly infectious disease were confirmed, concentrated primarily in the rural northern region. This recent rise has been blamed by a drop-off in participation in the country’s vaccination programme. Oral dosing is the primary method of vaccination, which requires regular doses for several years. Ensuring regular access to polio vaccines for nearly 60m Nigerian children has become a prime focus of the federal government.

The primary reasons for non-compliance in immunisation cited were: “felt no need” (25%), “no reason” (24%), “no caregiver consent” (15%), “religious belief” (10%) and “too many rounds” (7%). As the disease becomes less common, a degree of complacency has set in some areas. There have been calls from local officials in affected states to make polio vaccination compulsory by law, essentially making it criminal for any parent to prevent vaccination in their child. Though improbable, the appeal aptly portrays the gravity of a preventable situation.

GAPS: An independent report released by the Global Polio Eradication Initiative (GPEI) has indicated that over 1.8m children in Nigeria have never been immunised against the disease, roughly two-thirds of the total of 2.7m children in Africa who have yet to receive immunisation. The GPEI is a public-private partnership led by national governments and spearheaded by the WHO, Rotary International, the US Centres for Disease Control and Prevention (CDC), and the UN Children’s Fund (UNICEF). According to the GPEI, Nigeria is the only country to have reported all three serotypes of the polio virus: wild poliovirus type one, wild poliovirus type three, and circulating vaccine-derived poliovirus type two.

Meanwhile, according to a press statement made by UNICEF in June 2012, Nigeria reported 45 cases of wild polio in the first six months of the year. The statement also estimated that Nigeria contributes 90% to the polio burden in Africa and more than 50% of this year’s cases worldwide are from Nigeria. Cases were reported in 10 northern states: Niger, Jigawa, Kaduna, Kano, Katsina, Sokoto, Zamfara, Borno, Yobe and Bauchi. By August 2012 the GPEI reported the total had increased to 70 cases for the year.

PROGRESS: Even with the recent uptick in cases, Nigeria has made great progress in reducing the incidence of polio in a relatively short period of time. In 2003 some 4000 cases were reported. It was that year when the World Bank began supporting the country’s polio eradication initiatives (PEIs) up through the present day, including the allocation of a $60m credit to the federal government to support new PEIs. This is the third credit provided since 2003 by the World Bank, which in 2011 financed the procurement of more than 400m oral vaccine doses.

The government had drafted a Polio Emergency Eradication Plan in 2011 in an attempt to step up PEIs, but the realisation of its core aims was hampered by limited financial and human resources. Considering that polio is more prevalent in northern rural areas, the plan was also inhibited by logistical issues. Additionally, it became clear that implementing the plan was of secondary importance for many state governments. The government hopes to address these shortcomings with its eradication emergency plan for 2012, which was developed after collaborating closely with state and local officials, as well as with a number of global polio eradication initiative organisations. The 2012 plan takes a bottom-up approach, by which state and local governments can tailor polio eradication plans to suit the particular needs of their jurisdictions, while still receiving substantial support from the government.

TASK AT HAND: Furthermore, in 2012 President Goodluck Jonathan established the Presidential Taskforce on the Eradication of Polio, and pledged to increase funding for PEIs. Addressing the taskforce in Abuja in February 2012, he said, “My commitment to the people of this country is that between now and 2015, when my term of office is expected to end, we will work day and night to make sure we eradicate polio. For that reason, we have also increased the amount of money we bring into polio eradication from $17m to $30m, and if we have challenges, we will look for more money.” Jonathan has called the persistence of polio an embarrassment.

In addition to assistance from the World Bank, Nigeria is receiving help from the CDC, which is providing technical support to the Federal Ministry of Health. The CDC has established an office in Abuja to help the country combat polio, malaria, HIV/AIDS and other infectious diseases, and contributed $22m to the purchase of oral polio vaccines.

The federal, state and local authorities plan to eradicate polio using a multifaceted approach, including increasing the volume of supplementary immunisation activities; intensifying advocacy, awareness, and mobilisation; accelerating routine immunisation delivery; and increasing surveillance and tracking of poliovirus cases. The 2012 plan also has a number of provisions that will better document those children who miss doses, particularly in states with nomadic populations. The government plans to identify and map nomadic routes, as well as target those areas for vaccine distribution and administration.