By Francis Awowole-Brown
Penultimate week, Aliko Dangote, African top business mogul, and his American counterpart, Bill Gates, embarked on campaign trips to ensure Nigeria is polio free. To the Africa’s richest man, “it is quite embarrassing that Nigeria is one of the only three countries in the world that are yet to be certified polio free.” The other two countries are Pakistan and Afghanistan.
Therefore, for the whole week, Dangote Foundation and the Bill and Melinda Gates Foundation, which have been at the fore front of the campaign to eliminate polio, went on assessment of the situation in the areas earlier affected by the disease and the neighboring Chad Republic, where the two business moguls and their teams met with President Idris Deby in Ndjamena.
Polio is a crippling and potentially fatal infectious disease. It is an infectious viral disease that affects the central nervous system and can cause temporary or permanent paralysis, most especially in the leg. Children not older than 5 years are more likely to contract the virus than any other group, therefore the epidemic inflicts economic loss of colossal dimension on a nation as youths, the future generation, which forms a plank of the productive population are affected.
Polio is caused by a highly contagious virus specific to humans. The virus usually enters the environment in the feces of someone who is infected. In areas with poor sanitation, the virus easily spreads through the fecal-oral route, via contaminated water or food. In addition, direct contact with a person infected with the virus can cause polio. The infection with poliovirus and direct contact with persons increase the risk.
According to World Health Organisation (WHO), a country is regarded as polio free if no cases have been detected for a year. However, no cases of the virus have been reported in the last sixteen months in Nigeria but it is feared that it is still possible polio circulates under some prevailing circumstances as was the case, where a particular strain of virus resurfaced after five years in 2016 which professionals adduced to inadequate surveillance and under-vaccinated populations. Even a single case is considered an epidemic.
Over the years, Dangote Foundation has been involved in causes that guarantee healthy life for the Nigerian child and reduce extreme poverty among the vulnerable especially women. It was in this spirit that he had deployed his resources, for critical interventions, among which are issues bordering on nutrition, routine immunization and commitment to eradicate polio.
The Centre for Strategic and International Studies (CSIS) described as multiple factors hampering eradication of the virus especially in the North. Many of the factors, it stated in one of its report on Polio eradication, are embedded in the country’s broad social-political dynamics and enduring chasm between the governed and the government and a decentralized governmental system that often neglect service delivery to marginalized communities.
Some of the obstacles to polio eradication in Nigeria as in many other countries are the lack of basic health infrastructure, which limits vaccine distribution and delivery, the crippling effects of internal strife occasioned by insurgents’ activities which has turned some areas in the North-East as hard-reach.
The visit to Chad was necessitated by the fact that Chad is next to Nigeria from North East axis where immunization penetration has been very difficult. Any movement of the virus across the border might put Chad into jeopardy hence the need to intensify immunization in the country especially in the islands close to the insurgents’ enclave.
Besides Chad is said to be spending less than before on vaccines and routine immunization operational costs – both in absolute terms as well as a proportion of total expenditures. Therefore, both Dangote and Gates were able to obtain commitment from Deby to personally track the ability of the polio program to access and actually go to all 800 Chadian islands in the lake Convince with a promise to step up his political and financial support for routine immunization.
The Chadian President then signed a declaration, committing to increase immunization rates in Chad and end polio in the region. Though Chad has not seen a case of wild polio since 2012, a 2016 polio outbreak in Nigeria placed those in neighbouring countries at risk, particularly children who live on the hard-to-reach islands of Lake Chad.
Déby reaffirmed his support for the region-wide effort to stop polio. “Improving the health of Chad’s children is critical. I am committed to working with neighbouring governments to end polio for good in Africa, and to protecting more of our country’s children with vaccines against other deadly diseases”, he told his visitors.
After the signing, Dangote said all countries in West Africa—including Chad—share a responsibility to protect every child with polio vaccine. Until this happens, the risk of wild polio cases spreading remains.
Said he: “We are close to stopping polio on the continent – but we are not done yet. We want to save the lives of 250, 000 children with the application of right vaccines. Unless we protect all children in Africa with the polio vaccine, the risk of the virus spreading will remain. That is why the Dangote Foundation is determined to continue working with Nigeria’s neighbours including Chad, to improve immunization rates and end polio for good.”
He stated that polio eradication is a must because it is a disease that causes paralysis and in some instances, death. 30 years ago, it paralyzed an estimated 350,000 people – last year there were just 22 cases confined to Afghanistan and Pakistan, a record low. But, the fight against polio is not over until there are no cases anywhere in the world for at least three years.
“As a Nigerian, I feel that I have a special responsibility to make sure that Africa is free from polio since my country has been the one exporting the virus for so many years”, the African richest man said.
“The polio outbreak in Borno a year and a half ago was a big setback. And a lot of work has been done to get it under control. But I’m concerned especially about the risks that still remain. Nigeria cannot reach thousands of settlements, and its islands in Lake Chad because of Boko Haram. And until we do, you will need to be super vigilant on your side.
“One of the risks I see is the islands on your side in Lake Chad. As Bill mentioned, they are difficult to reach, and they have not been visited on a regular basis by the polio program. I think it would be very helpful if you gave instructions to the military to help transport vaccinators to each of the islands we’ve been talking about – so that they are all visited at least 3-5 times this year. With logistics and planning support from the military, I think you can take the final steps to ensure Chad remains polio-free.
“If you personally lead a public review of the program every six months – with the Ministers of Health, Interior, Finance and Communication – along with the Governors and administration, traditional and religious leaders, it would send a clear signal that it is not business as usual. I would be happy to come back for your first review, if you conduct it mid-year.
“Like Nigeria, Chad needs to spend more of its own money on routine immunization. If we cannot immunize our own children to protect them from disease, they have failed them. My recommendation is that you establish a clear budget line for routine immunization in the annual budget at least 40%. That would get you back to the level of commitment the government was making in 2012. Bill and I will work hard with the global partners to try to secure the rest.
From Chad, the team arrived Sokoto where they met with the Sultan, Alhaji Saad Abubakar, and the community heads as well six governors from the Northern region on renewed commitment to intensify immunization to ward of the polio virus and take Nigeria off the list of polio countries.
While thanking the Sultan for his commitment in ensuring that Nigeria is polio free, Dangote lamented that despite all efforts made to ensure the immunization reached majority of the targeted populace, not much ground has been covered. In his own state of Kano, for instance, routine immunization coverage is 16 per cent while that of Sokoto is less than five per cent.
And whereas vaccines, staff and funding are available, the coverage is not moving and has been abysmally low. “It’s both a demand and poor service quality problem. We cannot make progress on the demand side without traditional leaders”, he said. The challenge, according to him, is to get all settlement heads (mai-angwas) to enlist and identify all eligible children, and meet monthly with the local health facility to determine who is and who is not coming for immunization.
“Our biggest challenge in rolling out this strategy is that settlement heads expect to get paid”. Dangote told the Sultan to come in forcefully to let the settlement heads know that asking for money before mobilizing their children for immunization would only compound the problem and not in keeping with the traditional role of settlement heads. If the Sultan can take a very public stand that all settlement heads must support routine immunization and meet monthly with health staff without remuneration.
“But we know that the fight is not yet won, and I would like to reiterate Bill’s point that you and the Emirs in all six states request a joint meeting with your Governors, LGA Chairmen and District Heads this month to review the state of preparations for the April and May national polio campaigns. Every detail counts in preparation and execution.
“With our current very low rates of immunization, we know that most of our dear young children remain unprotected from vaccine preventable disease such as measles, yellow fever, whooping cough, and more. We need your help in changing this.”
At the Sokoto Government House, the governors of Kaduna, Borno, Yobe, Sokoto, Bauchi and Kano signed a Memorandum of Understanding extending their commitment to counterpart responsibilities including funding to deepening coverage of immunization in their respective states.
However before signing the MoU, the Minister of Health, Prof. Isaac Adewole gave a presentation on the immunization coverage in the areas.
Dangote urged the governors not to be distracted by the coming electioneering but to keep focus on the polio endgame. “That means we should keep the counter-part funding commitments; that we ensure the April and May campaigns are done well, and that LGA Chairmen and District Heads are involved in preparations and implementation of the campaigns”, he said.
“I am delighted to be here to sign these extensions and a letter of intent. It signals that we are taking a development mindset to keep building our routine immunization programs as we begin to focus on broader primary health care. It means that Your Excellences, our Traditional Fathers, Honorable Commissioners, Development Partners, we are all in this together, through thick and thin. Bill and I have seen amazing things happen in Nigeria with turning polio around—when people said it couldn’t be done. We know that the routine immunization and Primary Health Care work is much different, much more complex, and requires long term dedication. It also requires us to keep our passion and motivation high. It requires a sense of urgency to overtake a most dangerous and infectious disease.