June 9, 2009

Polio eradication: How Nigeria faced the world at World Health Assembly

By Sola Ogundipe, who was in Geneva
WHEN the 62nd World Health Assembly opened at the Palais de Nations in Geneva Switzerland on May 18, 2009, one of the major  health concerns of international interest, besides  the (then) looming H1N1 influenza (swine flu) pandemic, was the race towards  global target for eradication of poliomyelitis.

Minister of Health,  Prof. Babatunde Osotimehin immunising Baby Mandela with the Oral polio Vaccine at the Mother Children's Home in Gwarinpa  Abuja, last week during a visit to the Home. With him are the Proprietress Mother Theresa Home, Yeye Bolanle Dare and the Immunisation Officer.

Minister of Health, Prof. Babatunde Osotimehin immunising Baby Mandela with the Oral polio Vaccine at the Mother Children's Home in Gwarinpa Abuja, last week during a visit to the Home. With him are the Proprietress Mother Theresa Home, Yeye Bolanle Dare and the Immunisation Officer.

Still plagued by the ghosts of the October 2003 controversy surrounding the immunisation programme against polio in which three states in northern Nigeria (Kano, Katsina and Jigawa) boycotted the polio immunisation campaign, it was not surprising that Nigeria has remained squarely in the eye of the storm about polio eradication.

At the time of the boycott, the Global Polio Eradication Initiative  had launched what was hoped to be the final onslaught against polio, with a plan to immunise more than 15 million children in West and Central Africa.

There had been particular concerns about the high prevalence of polio cases in Nigeria, and the World Health Organisation (WHO) had it on record that the nation accounted for about 45 per  cent  of polio cases worldwide and 80 per cent of cases reported from the African region in 2003. The high prevalence was attributed to poor vaccine coverage during the previous control campaigns. No thanks to the boycott, the nation is now  one of the four nations (alongside…..) on the yet to interrupt the wild poliovirus transmission.

In 2008, during the 61st WHA, one of the resolutions adopted at the end of the meeting was that Nigeria should strive to “reduce the risk of international spread of poliovirus.”

Expectedly, this particular resolution was  primal on the agenda which the Nigerian delegation to the meeting had committed to address along with issues concerning maternal and child health, malaria control, pandemic influenza prevention and control, non communicable disease prevention and control, and national legislation on health, among others.

So as the 62nd WHA got under way, the world was all ears to know just how far the country had progressed.  No one was better placed to tell the story than Nigeria’s own Minister of Health, Prof. Babatunde Osotimehin, who led the 28-man delegation to the event.

Mounting the rostrum, Osotimehin delved into the series of activities and events the nation had undertaken to meet the WHA mandate as far as polio was concerned.

Noting that Nigeria did make appreciable  progress in polio eradication from 1998-2002 but suffered a major set-back in 2003-2004 as a result of controversy over the safety of the Oral Polio Vaccine (OPV), he said: “That setback ensured that Nigeria is one of only four countries yet to interrupt the wild poliovirus transmission in the World. Following this, polio eradication efforts were intensified. These include new innovations aimed at improving effectiveness of polio eradication activities, utilization of the more effective monovalent Oral Polio Vaccine (mOPVs), and mOPV3 with an integrated approach, and adoption of the Immunization Plus Days (IPDs+).

During IPDs, a broad range of child survival interventions resulted in marked improvement of the quality of vaccinations and a significant decline in incidence of wild polio transmission. However progress could not be sustained resulting in a major resurgence of wild polio virus transmission in 2008 such

The Minister elaborated on how the nation placed emphasis on the importance of vaccination is a crucial tool for preventing and controlling the disease.

Already, in line with the resolution adopted at the 61st World Health Assembly urging Nigeria to “reduce the risk of international spread of poliovirus”, Osotimehin said the nation had  quickly stepped up efforts aimed at stopping the polio outbreak in northern Nigeria through intensified eradication activities that ensured vaccination of  all children  with the oral polio vaccine.

The  62nd WHA was assured that since the 61st WHA one year ago, Nigeria has put in place important measures and have also recorded commendable outcomes. Delegates heared that Nigeria has implemented six rounds of enhanced Supplemental Immunisation Activities (SIAs), three of which have been national campaigns. He said the quality of these campaigns show a steady improvement and the number of Local Government Areas (LGAs) achieving 90 per cent coverage of polio increased to 627 during the March 2009 SIAs. As a result of the steady improvement in quality of the SIAs, the number of unvaccinated children during campaigns declined significantly.

On the revitalising the routine immunisation, the Minister said efforts to improve routine immunisation performance are bearing modest dividends and national routine OPV3 coverage increased from 47 per cent at the beginning of 2008 to 63 per cent in the first quarter in 2009; a 75 per cent increase within 12 months.

Other pointers he gave include  Acute Flaccid Paralysis Surveillance.  “In this regard, certification standard (AFP) performance was maintained at national level and in all but one state in 2008. At LGA level, 73 per cent of all LGAs in the country met the two main AFP surveillance performance indicators.  Both national polio laboratories in the country located at Ibadan and Maiduguri  maintained WHO accreditation in 2008.”

On population immunity, the Minister recalled: “The improved quality of immunisation activities has impacted positively on population immunity. The proportion of non-polio AFP cases aged 6-35 months reported never to have received a single dose of OPV declined from 15 per cent in 2006 to less than 5 per cent by the first quarter of 2009.

“Similarly, the proportion of non-polio AFP cases aged 6-35 months that were reported to have received at least three dose of OPV increased from 62 per cent in 2006 to 78 per cent by the first quarter of 2009. The most dramatic improvement in population immunity was registered in Kano , where for the first time ever, the children never vaccinated, reduced to less than 20 per cent.”