Nigeria Just Went A Year Without Polio For the First Time. (Here’s the Bad News.)
It’s been a year since Nigeria last reported a case of wild polio.
I’m taking a deep breath and writing that again: Nigeria has gone a whole year without a child being paralyzed by polio.
Ok, first the good news, which is pretty obvious: this is huge progress in the face of incredible odds.
This has never been done before. The entire African continent now has the chance to be polio-free for the first time. Nigeria is one of just three countries that has never stopped the virus; if it sustains this progress and ensures there are no cases over the next two years, our list of countries shrinks to two — Pakistan and Afghanistan.
It can be difficult to understand just how massive an effort polio eradication is unless you’ve seen it in action. In order to stop transmission of the virus, vaccination campaigns are run across vast areas of the country’s 924,000 sq. km — that’s roughly twice the size of the US state of California (with nearly 5X the population).
More than eight vaccination campaigns are conducted each year in northern Nigeria. That means eight times per year hundreds of thousands of local vaccinators go door-to-door to deliver millions of polio vaccine doses to every single child under the age of five. Over 20,000 traditional and religious leaders support the program by encouraging communities to participate. Polio survivors and local women’s groups are organized to educate families and dispel misconceptions about the vaccine.
On top of this mass mobilization effort, fresh thinking has played a big role in driving progress as well. For example, the program needed to find ways to reach the remote communities in Nigeria’s northern border regions where many children traditionally fall out of reach of health services, either due to difficult terrain or lack of health infrastructure. In 2013, 50% of polio cases reported in Nigeria came from these difficult to access border areas.
Recognizing this, Nigeria’s polio program systematically identified these communities and devised a special approach to reach these children. The program is known — fittingly — as the ‘hard-to-reach project’. Health workers have literally gone the extra mile to reach these remote communities and get childhood vaccinations to the children who need them. Along with polio vaccinations, they deliver other much-needed basic health services such as de-worming, malaria treatment, malnutrition screening, and care for pregnant women.
My first visit to Nigeria was in 2012. I was there to join hundreds of thousands of Nigerians working to kick polio out of the country. Since then, I’ve been back countless times. Last year, I spent about 120 days in northern Nigeria and traveled more than 80,000 miles between there and my home in Seattle.
Having such a huge milestone in sight is awe-inspiring, but it makes the stakes even higher. It would be a tragedy to miss this chance.
So often I’ve been humbled by the dedication of the people that have gotten us this far. In Kano state, the Governor himself is often seen going house-to-house during immunization campaigns to ensure success. In Sokoto state, I met a vaccination team supervisor who is a polio survivor herself and spends long days in communities despite her own severe paralysis. In Borno state, polio program staff face real risks in delivering polio vaccine to areas under threat by Boko Haram.
All of this — from country-wide progress to individual sacrifice and determination — is incredibly inspiring and worth celebrating.
But here’s the not-so-good part of the story: Nigeria’s 1-year milestone is nowhere near the end. There’s so much more work to do.
Nigeria must go two more years without any wild polio cases before it can be officially certified as polio-free. These next two years will be a test in addressing two big ongoing challenges: gaps in immunization coverage and the need for strong disease surveillance.
Many children still aren’t getting the vaccine doses they need to be protected. Coverage of routine childhood immunization in northern Nigeria remains far too low — well below 50% — to protect against the virus without continued campaigns. And in Nigeria’s volatile northeast — an area racked by poverty and insurgency — an estimated 62% of settlements remain inaccessible to vaccinators. When children remain vulnerable to polio, the door is left open for the virus to resurge. We must close these gaps.
Secondly, strong surveillance is critical to ensure polio is not silently circulating in the environment. The polio virus is transmitted through stool — between people as well as through sewage in the environment. It’s particularly prevalent in areas of poverty and open defecation. As a further challenge, the virus causes paralysis in less than 1% of those it infects meaning many people can be spreading the disease and have no idea they’re doing so. The global polio program has an extensive network of health workers and researchers dedicated to collecting and testing stool samples in order to stop polio outbreaks before they begin.
The importance of addressing these challenges can’t be overstated. Having such a huge milestone in sight is awe-inspiring, but it makes the stakes even higher. It would be a tragedy to miss this chance.
I hope you’ll join me in corking that champagne, skipping the hangover, and ensuring we finish the job we started.
