Health

How Nigeria (Africa) got WHO’s polio free certification

By Akanimo Sampson

By July 2015, it was a year since Nigeria recorded any case of polio.  For over 17 years before 2015, the disease was on rampage in the country, especially in the northern axis.

Nigeria, Africa’s most populous country and the giant of the continent accounted for almost 50 per cent of global and 80 per cent of African polio cases.  Sadly, Nigeria was the face of the disease.

That unenviable status did not go down well with Chibuike Amaechi, the incumbent Transportation Minister. When he took over as Chairman of the Governors’ Forum in May 2011, health was on top of his agenda. As the then governor of Rivers State, the oil and gas capital of Nigeria, Amaechi had a robust plan for primary, secondary and tertiary levels of the health sector in the big oil state.

But, he was greatly disturbed by the heavy toll polio was inflicting on the country, especially in the North.

Sometime in May 2014, the then Director-General of the Governors’ Forum, Asishana Okauru, was asked about how Amaechi went about his anti-polio war. He was reportedly speechless, and when he eventually got his voice back, he exploded, ‘’I have never seen anything like it.’’

Continuing, he said, ‘’Ameachi made polio a permanent part of our agenda for at least 18 months. At every single meeting it was discussed. So, when you see that polio is being well managed today, it is because of his effort.  

‘’And, I can tell you that it is that same spirit that helped the country with the outbreak of Ebola. With that state of mind, every time there is a challenge that should be handled at the sub-national level with a common governance template, you see all of them (the governors) moving in the same direction because of that mentality.

‘’So, when you have something consistently on your agenda for 18 months, there is just no way you would not make progress.’’

According to the World Health Organisation (WHO), polio is a highly infectious disease caused by a virus that invades the nervous system, and can cause total paralysis in a matter of hours. The virus is transmitted by person-to-person spread mainly through the faecal-oral route or, less frequently, by a common vehicle (for example, contaminated water or food) and multiplies in the intestine.

WHO says initial symptoms are fever, fatigue, headache, vomiting, stiffness of the neck and pain in the limbs. ‘’One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilised’’, the global health agency says.

Polio mainly affects children under five years of age. According to WHO, ‘’there is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.’’

Interestingly, wild poliovirus cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 33 reported cases in 2018.

Of the three strains of wild poliovirus (type 1, type 2, and type 3), wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type 3 has been found since the last reported case in Nigeria in November 2012.

WHO Response

In 1988, the 41st World Health Assembly adopted a resolution for the worldwide eradication of polio. It marked the launch of the Global Polio Eradication Initiative (GPEI), spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, and later joined by additional key partners including the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

This followed the certification of the eradication of smallpox in 1980, progress during the 1980s towards elimination of the poliovirus in the Americas, and Rotary International’s commitment to raise funds to protect all children from the disease.

Overall, since the GPEI was launched, the number of cases has fallen by over 99%.

In 1994, the WHO Region of the Americas was certified polio-free, followed by the WHO Western Pacific Region in 2000 and the WHO European Region in June 2002. On March 27, 2014, the WHO South-East Asia Region was certified polio-free, meaning that transmission of wild poliovirus has been interrupted in this bloc of 11 countries stretching from Indonesia to India.

This achievement marks a significant leap forward in global eradication, with 80% of the world’s population now living in certified polio-free regions.

More than 18 million people are able to walk today, who would otherwise have been paralysed. An estimated 1.5 million childhood deaths have been prevented, through the systematic administration of vitamin A during polio immunisation activities.

With the benefit of hindsight it appears Amaechi knew that the strategies for polio eradication work when they are fully implemented. This is clearly demonstrated by the governors’ forum under his watch hammering on it for 18 months consistently.

That is also true of India’s success in stopping polio in January 2011, in arguably the most technically-challenging place, and polio-free certification of the entire South-East Asia Region of WHO occurred in March 2014.

Those who know better say, failure to implement strategic approaches, leads to ongoing transmission of the virus. Endemic transmission of wild poliovirus is continuing to cause cases in border areas of Afghanistan and Pakistan.

Failure to stop polio in these last remaining areas could result in as many as 200 000 new cases every year, within 10 years, all over the world. That is why it is critical to ensure polio is eradicated completely, once and for all.

Future benefits of polio eradication

Consistently, WHO has been saying that once polio is eradicated, the world can celebrate the delivery of a major global public good that will benefit all people equally, no matter where they live. Economic modeling has found that the eradication of polio will save at least $40–50 billion, mostly in low-income countries.

Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.

However, on June 18, WHO certified Nigeria a polio free country, after three consecutive years of no record of outbreak of the disease.  

The process of certification which commenced few months ago culminated in the complete documentation by officials of the National Primary Healthcare Development Agency (NPHCDA), and was accepted by the WHO team.

WHO Nigeria Country office, had in a tweet, confirmed that Nigeria’s complete documentation for wild polio virus free status was accepted by the Africa Regional Certification Commission for polio eradication (ARCC).

Chairman of Nigeria National Polioplus, Dr. Tunji Funsho, in a reaction to the development congratulated the citizenry and the Federal Government for the feat. He, however, said the fight was not over as more effort was required to ensure more people have access to vaccination which will permanently put an end to polio in Nigeria.

He lauded efforts of local and international partners, particularly the National Primary Health Care Development Agency, Bill and Melinda Gate, UNICEF, WHO and several others for their financial and logistics contributions to the success of the programme.

In the mean time, following the launch the global polio eradication initiative in 1988, with the goal of eradicating the disease by the year 2000, WHO by 1996 realised that the eradication initiative was not going as planned in terms of reducing the outbreak and spread of the disease.

A massive booster immunisation initiative Kick Out Polio was launched. The initiative was indeed ground breaking as vaccination was taken to the door steps of millions of children across the world, especially in vulnerable regions, and Nigeria was again, the poster child of the campaign.

For Maryam Yahya, an anthropological researcher, everything was going on well until July 2003, when Kano, Zamfara and Kaduna States, halted the campaign on the ground   that “the vaccines were deliberately contaminated with anti-fertility agents and the HIV virus”.

There were also some cultural and political angles to the boycott.

The botched Trovan trial on 200 children against meningitis by Pfizer in 1996, which led to the death of at least five of them, provided another strong reason for the popularity of the call for boycott of the polio immunisation.

The boycott was costly in both economic and human terms as more northern states joined. Most of those who managed to survive polio attack became severely and irreversibly deformed. Largely due to the foresight of Amaechi, all that tragic past is history today in Nigeria.

As an added boost, the Africa Regional Certification Commission on Tuesday certified the WHO African Region as wild polio-free after four years without a case. With this historic milestone, five of the six WHO regions – representing over 90% of the world’s population – are now free of the wild poliovirus, moving the world closer to achieving global polio eradication. 

Only two countries worldwide continue to see wild poliovirus transmission: Pakistan and Afghanistan. 

GPEI congratulates the national governments of the 47 countries in the WHO African Region for the Tuesday achievement. 

WHO Director-General, Dr Tedros Adhanom Ghebreyesus, says ‘’ending wild polio virus in Africa is one of the greatest public health achievements of our time and provides powerful inspiration for all of us to finish the job of eradicating polio globally.

‘’I thank and congratulate the governments, health workers, community volunteers, traditional and religious leaders and parents across the region who have worked together to kick wild polio out of Africa.”

Strong leadership and innovation were instrumental in stopping the wild poliovirus in the region. Countries successfully coordinated their efforts to overcome major challenges to immunising children, such as high levels of population movement, conflict and insecurity restricting access to health services, and the virus’s ability to spread quickly and travel across borders. 

In addition, WHO said, ‘’the continued generosity and shared commitment of donors – including governments, the private sector, multilateral institutions and philanthropic organisations – to achieving a polio-free world helped build the infrastructure that enabled the African region to reach more children than ever before with polio vaccines and defeat wild polio.’’  

Rotary International President, Holger Knaack, says ‘’during a challenging year for global health, the certification of the African region as wild poliovirus-free is a sign of hope and progress that shows what can be accomplished through collaboration and perseverance.

‘’Since 1996, when Nelson Mandela joined with Rotary, the Global Polio Eradication Initiative, and governments of the African region we’ve achieved something remarkable. Today’s milestone tells us that polio eradication is possible, as long as the world remains committed to finishing the job. Let us work together to harness our collective energies to overcome the remaining challenges and fulfil our promise of a polio-free world.”

Without the doubt, the resources and expertise used to eliminate wild polio have significantly contributed to Africa’s public health and outbreak response systems.

The polio programme provides far-reaching health benefits to local communities, from supporting the African region’s response to COVID-19 to bolstering routine immunisation against other vaccine-preventable diseases. 

While this is a remarkable milestone, ‘’we must not become complacent. Continued commitment to strengthening immunisation and health systems in the African region is essential to protect progress against wild polio and to tackle the spread of type 2 circulating vaccine-derived poliovirus (cVDPV2), which is present in 16 countries in the region.

‘’Pockets of low immunity mean such strains continue to pose a threat and the risk is magnified by interruptions in vaccination due to COVID-19, which have left communities more vulnerable to cVDPV2 outbreaks’’, WHO said.

GPEI is however, calling on countries and donors to remain vigilant against all forms of polio. Until every strain is eradicated worldwide, the incredible progress made against polio globally will be at risk. 

The WHO African Region’s success against wild polio has shown the world that progress against some of the biggest global health challenges is possible. GPEI is grateful for every person, partner, donor and country who helped bring about this incredible achievement.