Polio Eradication: Nigeria Must Keep its Eye on the Prize
July 25, 2015
July 24 marks a significant milestone in the global effort to eradicate polio: Nigeria, one of the countries where wild poliovirus has proven hardest to extinguish, has reported no cases of the disease for a year. While the success should be celebrated, it also should be viewed with a note of caution. The country’s polio program needs continued political attention and sufficient resources to achieve official polio-free certification, a determination made formally by the World Health Organization only after three full years with no cases.
Nigeria has been near success before. In 2010, the country reported a record low 21 cases of wild poliovirus. But the program faltered and case numbers ballooned to 122 in 2012. “There was so much jubilation, we got carried away,” said Andrew Etsano chief medical officer for Nigeria’s national polio Emergency Operations Center. With the end potentially in sight, country leaders lost focus. “Political support is the engine that drives the process. Once you lose that, you can’t move,” Etsano said.
To maintain momentum, the polio initiative is now emphasizing that the year mark is simply a step toward the ultimate goal of certified disease elimination. “Now that we are making progress, we don’t want to make the same mistake we made in the past which is complacency, giving the false impression the job has been done,” Etsano said.
The message is essential not only for political leaders, but donors, some of which have been supporting global polio eradication for a marathon 26 years and might take Nigeria’s progress as a sign they can move on to other issues. But continued resources and focus are essential. The Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative cautions that Nigeria has several areas where disease surveillance is subpar and that in northeast Nigeria, as many as 62 percent of settlements remain inaccessible to vaccinators.
The message to stay the course is being advanced at the highest levels. Oyewale Tomori, President of the Nigerian Academy of Science, recently urged newly elected Nigerian President Muhammadu Buhari to push continued U.S. support for polio eradication at his July 20 meeting with President Obama. “Bringing peace and stability to the northeast and instituting economic and political reforms are clearly key priorities, but it would be a mistake to overlook what could be one of President Buhari’s greatest achievements: the eradication of polio in Nigeria,” Tomori wrote.
While its commitment to polio eradication and polio program performance has been spotty over the years, Nigeria is now in its best position ever. Concerted program improvements include the establishment of national and state level polio emergency operations centers to better coordinate and track vaccination efforts. The program also instituted health camps to provide health services beyond polio drops, is paying special attention to vaccination along transient border areas, and is active in refugee camps. Improving surveillance also is a priority.
Nigeria is working toward the political will and polio program quality it needs to officially become polio free. But country officials and program leadership at the state and global level need to implement the improvements necessary to ensure continued progress. “Nigeria is not yet safe,” the IMB cautioned in its May 2015 report. “Nigeria must build further resilience and…move its programme from good to great.” Only then can the real celebration begin.