Tackling the polio challenge

By UCHE ANUNNE

Poliomyelitis, polio for short, is a communicable disease caused by a viral infection.
It can lead to temporary paralysis, and in more severe cases, permanent paralysis.
Polio has 22 medical symptoms, among which are headache, fever, muscle aches and abdominal pains.
It is very often contracted through person-to-person contact via infected secretions from the nose or mouth or by contact with infected faces.
If policy pronouncement, seminars, workshops and conferences were solutions to problem of polio, the disease would have long been forgotten in Nigeria.
At different fora, the polio eradication campaign in Nigeria has continued to receive commitments both from the high and the low.
Besides top government functionaries and NGO, traditional and religious leaders have also been in forefront of the campaigns.
On many occasions, such highly placed and respected individuals have directly participated in the immunization of children.
As part of efforts to rid Nigerian children of the menace, the country has committed itself to the Polio Eradication Initiative, a global agenda set more than 20 years ago.
But for analysts the persistence of the menace in spite of such efforts remains confounding.
“It is just bad; the more Nigeria tries to eliminate polio, the more the virus re-dedicates itself to humiliating the country in the country of nations,” Miss Grace Atama, a Nursing Sister, remarked recently.
According to statistics from Global Polio eradication Initiative, Nigeria, with 736 confirmed cases, is leading in polio endemic countries index.
The closest country to it is India, which has 496 cases.
Pakistan and Afghanistan make up the list of the four polio-endemic countries with 87 and 22 cases respectively.
According to the National Primary Health Care Development Agency (NPHCDA), cases of Wild Polio Virus (WPV) increased from 233 in 2007 to 732 in October this year, while the Wild Polio Virus Type 1 cases increased from 80 in 2007 to 674 in October this year.
The figures represent an eight-fold increase.
The agency also estimates that 130 million dollars is required to tackle polio globally this year.
It also estimates that 229 million dollars is required for the campaign against the menace in 2009.
For Nigeria, it says that about N15 billion is required to wage the war against polio this year, while N12 billion will be needed for the same campaign in 2009.
Already, the campaign is facing a funding deficit of 355 million dollars, the agency says.
For many observers of the situation in Nigeria, the controversy over Oral Polio Vaccine (OPV) at the beginning of this decade is responsible for its continued presence.
Between 2001 and 2003 specifically, Nigeria was enmeshed in a controversy surrounding the safety of the Oral Polio Vaccine (OPV), the polio preventive vaccine administered on children under five years.
Some elements in the north of Nigeria, who opposed the OPV, alleged that the vaccine had been adulterated with anti-fertility substances.
They say that it was part of a conspiracy to impose birth control on the populace and reduce the population of Nigerians, especially those in the north.
The controversy led to the outright rejection of the vaccine.
To force a change of heart, international organization and other Non-Government Organisations (NGOs) began spirited efforts to correct the misinformation.
Several tests were carried out on the vaccine internally as well as in South Africa and Malaysia.
All the tests proved that it was safe ad unadulterated.
But before Nigeria could recover from the controversy, the little that had been achieved in the anti-polio campaigns began to erode, leading to massive re-infection in many states especially Kano, Katsina, Jigawa, Zamfara and isolated cases in Anambra.
To recover lost grounds, some initiatives were taken by the Federal Government.
Those initiatives included the introduction of “Immunisation Plus Days”, which included the inclusion of such child saving antigens such as measles vaccines and insecticide treated mosquito bed nets into the polio immunization campaign.
The move was to discourage what participants described as “campaign fatigue resulting from repeated rounds of polio immunization.”
Nigeria also embarked on synchronized immunization campaign with some of its neighbours such as Niger and Benin Republics to checkmate a cross border transmission of the virus.
In 2006, the Federal Government decided to merge the National Programme on Immunisation (NPI) with the NPHCDA as a way of institutionalising immunization so as to achieve efficiency in routine immunization.
But in spite of these efforts, not much can be said to have been achieved.
Perhaps, it was in recognition of that situation that the World Health Organisation shifted the deadline for polio eradication from 2008 to March 2009.
The Acting Minister of Health, Dr. Hassan Lawal says Nigeria will work hard to meet the international deadline.
He, however, says that routine immunization will continue.
“There is no substitute to routine immunization in the fight against Wild Polio Virus.
“Routine immunization, if properly packaged and implemented, will wipe out the virus.
“It is a shame that new cases of polio are still being reported in Nigeria. This has gone to show the failure of the NPHCDA.
“The agency lost focus and derailed the nation’s immunization agenda thereby dragging us behind,” he said.
But for Alhaji Aminu Hammayo, the Commissioner for Health, Bauchi State, the campaign against polio can only be successful if the people are carried along in the designing and implementation of polio immunization campaign.
“We are looking at a situation whereby the people can identify with the exercise and embrace it. We want them to make their input into the campaign,” he says.
According David Tikon, the Taraba Commissioner for Health, the state governments need adequate logistic support to confront the burden of polio.
“In my state, we are facing the challenge of inadequate support for routine imunisation activities, poor management of funds at the local governments, inadequate infrastructure and poor management of cold rooms.”
Dr. Isa Vatsa, his colleague from Niger State, says polio eradication can be achieved in the country if all stakeholders play their roles well.
“In my state, we have strengthened existing structures by widening the membership list of the polio eradication team.
“We have also directed the Local Government Councils to free more resources for routine immunization,” Vatsa says.
He, however, says that a second look should be given to the nation’s database to ensure that every child is captured during immunization campaigns.
According to him, investigations have revealed that many children were not immunized during some of the campaigns, even when vaccinators claimed to have recorded more than 100 per cent coverage rate.
“In some cases, you hear of 100 per cent coverage rate. Yet you later discover that many children were not immunized. This raises a lot of question. It means that the estimated number of children for immunization is not correct,” he says.
Dr. Abdulsalami Nasidi, Director, Public Health, Federal Ministry of Health, says that the Federal Government’s target is to “drastically reduce the number of new polio infections by December.”
Dr. Nasidi, who is also the Chairman, Presidential Task Force on Polio Eradication and Routine Immunisation, while acknowledging an upsurge in the number of new cases in June and July this year, is still optimistic that the crisis is not irredeemable.
“We have changed how we were reaching out to the communities, we have introduced innovations on how vaccines are given. We are mobilizing both political and traditional leadership to be part of the campaign,” he says.
He also says that efforts are being made to streamline the interventions from development partners in the polio eradication campaign through the “common basket initiative.”
……. Include UNICEF, WHO, European Union partnership for Immunisation Efficiency (EU-PRIME), and Japanese International Cooperation Agency (JICA).
“The move is to ensure that there is no duplication of efforts which may lead to wastage of resources. We want to have all interventions streamlined so that we will know who is doing what and where,” he says.
He says that changes in policy implementation and leadership in implementing agencies will not affect the success of the campaign as the task force he heads is meant to accelerate the eradication process rather than usurp any agency’s mandates.
Dr. Emmanuel Abanida, an official of PHCDA, says that programme ownership must be strengthened by ensuring full involvement of political leaders if the war against polio is to succeed.
He called for full community participation in all aspects of the programme, from planning, implementation, monitoring to evaluation.
With less than five months to the March 2009 deadline for polio eradication, observers say a lot still needs to be done if Nigeria, the leading host of the menace, is to meet that deadline.