Polio

Nigeria’s documentation to be declared polio free was on Thursday, June 18, 2020, accepted by the African Regional Commission for the Certification of Poliomyelitis Eradication (ARCC). The implication of this is that Nigeria has gone through the final process of Wild Polio Virus (WPV) eradication and certification and will officially be declared WPV free by the World Health Organisation (WHO) in August 2020.

Indeed, Nigeria recorded this breakthrough in polio elimination despite the activities of Boko Haram and the significant increase in Wild Polio Virus type one (WPV1) cases globally in 2019.

The feat is significant in the face of many challenges including the poor access to children in some parts of the country due to insecurity, poor health seeking behaviour of Nigerians, vaccine hesitancy, malnutrition, poor sanitation, and inadequate funding for Primary Health Care (PHC), especially at State and Local Government Area (LGA) levels.

Nigeria made history on August 21, 2019, when she achieved three years without a case of WPV. The last WPV case was isolated in a child in Borno State on August 21, 2016.

The polio-free certification was after careful assessment of the risk of missed transmission in inaccessible areas of Borno, and other countries in the region where there is lack of confidence in surveillance.

The WHO, for the first time on September 25, 2015, delisted Nigeria from the polio-endemic list after interrupting transmission for 12 months beginning from July 24, 2014. Unfortunately, 25 months later, on August 21, 2016, another case of WPV was discovered.

“The ARCC during a virtual meeting on Thursday declared Nigeria polio free. This calls for celebration,” Chairman Expert Review Committee on Polio Eradication, Prof. Oyewale Tomori, had told The Guardian.

Tomori, who is also a virologist and WHO consultant, said: “If you are talking about achievements in healthcare, please help me name one. Oh yes at least we have finally eradicated polio as the last nation in Africa to do so….”

President, Pharmaceutical Society of Nigeria (PSN), Mazi Sam Ohuabunwa, said: “One major success I think Nigeria has scored in recent times, is the eradication of wild polio virus.”

To the President, National Association of Resident Doctors (NARD), Dr. Aliyu Sokombo, “We have recorded quite a few successes in healthcare delivery in Nigeria. Eradication of polio is commendable and improvement of the National Primary Health Care Development Agency (NPHCDA) capacity.”

A polio free Nigeria was achieved by NPHCDA under the leadership of Dr. Faisal Shuaib, a medical doctor and public health specialist. Before Shuaib’s appointment as the Executive Director (ED)/Chief Executive Officer (CEO) of NPHCDA, he was a Senior Programme Officer (Africa) for the Bill and Melinda Gates Foundation (BMGF) at Seattle, United States of America (USA). He was responsible for developing and implementing strategies on polio outbreak response activities in Africa. Prior to joining the foundation, Shuaib coordinated Nigeria’s successful response to the outbreak of Ebola Virus Disease (EVD) as the Incident Manager of the Ebola Emergency Operations Centre in 2014. He was also a member of the six-man panel established to assess the response of the WHO to the global Ebola outbreak in 2014 and provided technical advice to the Federal Ministry of Health (FMoH) and NPHCDA in areas of immunisation and polio eradication activities between 2012 and 2015. Shuaib had in the past also worked as a research associate at the University of Alabama at Birmingham, United Kingdom (UK).

Shuaib in an exclusive interview with The Guardian among other things said the strategies used and structures established to achieve polio eradication could be adopted to contain the Coronavirus disease (COVID-19).

What does it mean to be polio free? Does it mean that there is no circulating vaccine derived polio virus (cVDPV2) in Nigeria? Shuaib said: “This means that the most virulent and lethal forms of polio viruses which we call WPV has been eradicated in all sections of our country, the cVDPVs are still there, the last case was in January 2020. This challenge results from the fact that children who have been vaccinated with Monovalent Oral Polio Vaccine Type 2 shed the viral particles in the environment, which then interacts with other pathogens and becomes virulent especially among children that have not completed their Routine immunization. These are not part of the process for WPV certification and the Government of Nigeria with our partners is taking all the necessary steps required to stop the circulation of cVDPVs.”

Shuaib said: “Routine immunizations (RI) and polio vaccination activities will continue in Nigeria in order for us to continue to build the required herd immunity against polio and other Vaccine Preventable Diseases (VPDs) to be able to prevent a WPV resurgence and maintain our polio free status.

Also note that as long as some countries in the world are still having WPV such as Afghanistan and Pakistan who remain the only polio endemic countries in the East Mediterranean Region, we will continue to retain our Oral Polio Vaccines (OPV) stockpiles. And while we continue with our routine immunization services, we will ensure the vaccines are available for regular mass immunization to forestall the spread of any importation of viruses. Nigeria will continue to have reserves of these vaccines until all countries are certified polio free.”

The NPHCDA boss said the feat is an opportunity to unlock a lot of resources, as Nigeria will not be implementing polio mass campaigns at the same frequency and intensity that was done pre-certification. He said such resources will be channeled through what is called a polio transition plan to address other challenging health needs of the country especially, primary health care. Shuaib said the country’s ten-year agreement (2018 – 2028) with the Gavi Alliance is on course and President Muhammadu Buhari has remained committed to providing the resources contained in the Nigeria Strategy for Strengthening Immunisation and PHC Systems (NSSIPS) document, which we signed, with the Alliance. In other words, we have been fulfilling our obligations.

On the significance of this feat by Nigeria in the global efforts to eliminate polio, the public health physician said:  “It is very significant for Nigeria because at the end of the process, Nigeria would be removed from the list of countries with circulating WPV. That is a thing of pride for our country. It also means that the resources jointly committed to the fight against polio from our development partners have not been in vain.”


Shuaib said he feels fulfilled as citizen of this great country, as a public health professional and as the Executive Director of the NPHCDA. “One of the four-point agenda our team had in 2017 was to build on what previous leaders had done, and with additional strategic innovations, bring an end to polio. It is a thing of joy that we have achieved this feat, and this could only have been done through a multi-sectoral collaborative effort,” he said.

What did Nigeria do right to eliminate polio at last or rather how was polio eliminated from Nigeria? The NPHCDA CEO said: “We got the right resources from Government and development partners; we got the right support from Mr. President, the Honorable Minister of Health and Nigerians. We got the full alignment and support of our traditional leaders especially the Northern Traditional Leaders Committee on Polio Eradication Initiative, Routine Immunization and Primary Healthcare (PEI/RI/PHC) led by His Eminence the Sultan of Sokoto, Alhaji Muhammad Saad Abubakar.

“We got the right support from state governors, donors, and partners, and as well as our Security agencies. We also got the right people at the NPHCDA being in the right places at the right time. We have very hardworking, passionate, determined, and sacrificial health workers, vaccinators, and volunteers in the frontline, who were committed in the fight against polio, and some paid the ultimate price in the line of duty.”

Why is it that the WHO could only declare Nigeria free of polio in August? “The COVID-19 pandemic is perhaps the main reason why the declaration was rescheduled to the month of August 2020, which would occur at the Hon Ministers of Health of the African Region meeting. The declaration and presentation of a polio free certificate was earlier scheduled for June at the 25th meeting of the ARCC immediately after our documentation would have been accepted. As you are aware, COVID-19 has brought a lot of changes in global health systems and this is what is responsible for the delay,” Shuaib said.

What is the role of ARCC? Shuaib said the ARCC is a sixteen-member independent body of experts who have distinguished themselves in the global public health space from around the world including Nigeria. He said the committee was established by the Regional Director of the African regional office of the WHO to independently assess countries’ claims of a polio free status through an evidence based assessment of each country after submission of the completed Polio Eradication Initiative (PEI) documentation. Additionally, he said, the committee reviews several other PEI data sources in the African Region and verifies a country’s claims through field visits.

How can the country translate the experience of polio elimination to contain COVID-19 and other infectious diseases? Shuaib said: “We have already begun deploying the polio eradication experiences and lessons learnt and other resources to address routine immunisation challenges. We are also applying the lessons learnt to the Integrated Diseases Surveillance and Response (IDSR) strategy to improve the prevention, detection, and control of outbreak-prone-diseases. Currently we are deploying the expertise from our agency and partners at National Emergency Polio Operation Center (NEOC) in the fight against COVID-19 and this is yielding positive result in our quest to stop community transmission.”

President Muhammadu Buhari has congratulated fellow citizens on the joyous and historic occasion as Nigeria becomes Wild Polio Virus Free.

Mr Buhari also appreciated all partners, local and international, for their relentless efforts in ensuring the clean health bill.

The president made his feelings known in a statement released by his Senior Special Assistant on Media and Publicity, Garba Shehu, in Abuja an Sunday.

According to the president, this achievement reflects the resilient spirit of Nigerians, particularly the capacity of hardworking men and women in the health industry, who drew resources and support from multiple sectors to deal a final blow to the deadly virus.

He said: “This achievement is not only one of the great successes of this generation of Nigerians but also one of the obvious dividends of this administration, which is consistent with our progressive investment in the health of our people since 2015.

“This landmark achievement is also a promise kept to all Nigerians. As you will recall that in August 2015, barely three months after we assumed office, I promised Nigerians that: ‘My government shall provide the necessary resources and commitment required to strengthen the health system, routine immunisation and ensure the country is certified Polio free.”

The president noted that in 2016, the country suffered a major setback in the polio eradication efforts with the outbreak of the Wild Polio Virus in Borno, after about two years without any case.

Mr Buhari recalled that he promptly directed the immediate release of N9.8 billion to the National Primary Health Care Development Agency (NPHCDA) to contain the outbreak.

“Subsequently, we have been meeting all our financial obligations to bilateral and multilateral agreements, and also provided the moral support and leadership required at all levels to motivate the men and women in the frontline of polio eradication.

“In addition, we sincerely appreciate our donors and development partners who stood by the country during those trying times,” he added.

According to him, this achievement is a hard-won battle spanning over three decades of hard work and dedication by the Global Polio Eradication Initiative (GPEI).

He also lauded the Federal, States and Local Governments, polio eradication team at all levels, the nation donors and development partners, both local and international for their contributions in achieving this feat.

“As we recall, the polio eradication structures were used when Nigeria successfully eradicated Ebola Virus Disease within the shortest possible time in 2014.

“I am glad that these same human, material and technological resources have been deployed to steadily increase Routine Immunisation coverage and are being organised to implement the fight against community transmission of the COVID-19 pandemic.

“This big battle would not have been won without the support of our donors and development partners.

“These include Bill and Melinda Gates Foundation, Aliko Dangote Foundation, Rotary International, United States Centre for Disease Control and Prevention, USAID, Sir Emeka Offor Foundation, Japan International Cooperation Agency (JICA) and European Union.”

The president also acknowledged the contributions of the Global Health Canada, German Development Bank (KfW), WHO, UNICEF, Nigeria Governor’s Forum, Polio Survivors Group, the media, faith-based and other non-governmental organisations.

Besides, he noted the immense contribution of traditional and religious leaders who mobilised communities to accept immunisation and other government programmes.

“The final theatre of the polio eradication fight was particularly championed by the Northern Traditional Leaders Committee on Polio Eradication and Primary Health Care (NTLC) under the guidance of His Highness, Sultan of Sokoto, Muhammad Saad Abubakar, and strategic leadership of late Shehu of Bama, Alhaji Kyari Ibn Umar El-Kanemi.

“We thank you all for the leadership and partnership over the years,” the president said.

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Dr Osagie Ehanire, Minister of Health, has said that Nigeria was still struggling with high numbers of unimmunised children, with its maternal and under-five mortality rates worsening.

Ehanire made this disclosure at the Expanded Inter-Agency Coordination Committee (ICC), to review Nigeria Strategy on Immunisation and Primary Health Care System Strengthening, (NSIPSS), on Tuesday, in Abuja.

He said that the numbers of children not immunised were unacceptably high, with about two-third not accessing vaccines for preventable diseases like pneumonia, diarrhoea and measles.

The News Agency of Nigeria(NAN), reports that the meeting was the first high-level meeting led by GAVI Board and Alliance Gavi, since the NSIPPS accountability framework was put in place.

The minister recognised immunisation as a highly cost-effective way of reducing child mortality, adding that partnership with GAVI had critically scaled up coverage, to 80 per cent by 2018, to improve health indices and achieve SDG goals in the country.

He said that these targets may seem ambitious but were achievable, working with partners, including GAVI.

“In the past few years, immunisation and strengthening PHCs have been prioritised.

“The National Primary Health Care Development Agency (NPHCDA), established the National Emergency Routine Immunisation Coordination Committee (NERICC), with focus on 18 low-performing states and their local governments, as a platform for timely resolution of RI gaps and execution of innovative support strategies.

“NERICC support has recently been extended, even to medium and high performing states, to ensure that countrywide gains are sustained,” he said.

According to him, the results of 2018 SMART survey and National Demographic Health Survey were released this year.

“I am delighted to share with you that immunisation coverage, measured by Penta three coverage, has increased across the country,” he said.

Ehanire said that it was an increased coverage for the first time in many years, with some of the largest gains achieved in northern states of the country.

According to him, though coverage is still unacceptably low in few states, government is pleased with the documented increases and positive trend in coverage in most states.

The minister said that the government was also beginning to see increase in demand and improvements in access to immunisation services in communities.

He, however, said that it was only possible because of the engagement of traditional, religious and community leaders, to drive demand for immunisation and PHC services.

“Engaging the leaders is yielding results in increased confidence and patronage of PHC system.

“The high turnout of eligible children recorded at the introduction of Meningitis A and Measles second dose vaccine, as well as the ongoing integrated Measles and Meningitis A campaigns, is indicative of a positive trajectory in immunisation uptake.

“Nigeria’s health spending has increased from 4.5 per cent in 2018 to 5 per cent in 2019.

“There are highly competing national and energy security challenges, but the effect has been ameliorated by the launch of the Basic Health Care Provision Fund of 1 per cent of Federal Consolidated Revenue to further strengthen PHCs.

“Key to vaccine procurement assurance in years ahead, is the inclusion, by government, of vaccine funding in the Service Wide Votes of the budget; in the Medium-Term Expenditure Framework (MTEF),” he said.

He disclosed that all of the funds budgeted for vaccine procurement in 2019 had been paid to NPHCDA and would be transferred to United Nation International Children Emergency Fund, (UNICEF), shortly.

Ehanire assured Nigerians that the budgetary commitment had the support of the National Assembly, as demonstrated by the smooth passage of the health budget.

“Discussion is currently ongoing between the Federal Ministries of Health, Finance, Budget and National Planning, NPHCDA and the Gates Foundation.

“The additional funding support of $75 million over the next five years is one of the options that could be applied for vaccines financing in line with NSIPSS implementation plan,” he said.

The minister said that the Accountability Framework (AF), was important to sharing understanding of achievements, challenges and progress, adding that it provided an annual review that would hold all stakeholders into account at all levels.

According to him, although the AF was finalised and signed just in May this year, government is resolute in its commitments and has already met a good number of its indicators.

“With the cooperation of GAVI and other partners, we plan to achieve, even surpass by Year 2020, the milestones set in the AF,” he said.

Chief Executive Officer of GAVI, Dr Seth Berkley, appreciated the Nigerian government for receiving the GAVI high level team, to discuss how vaccines would work for all Nigerians.

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Bill-Gates
Bill-Gates

The co-founder of Bill and Melinda Gates Foundation, Bill Gates, has said Nigeria is one of the most difficult places to wipe out polio in the world.

Speaking at the joint forum of the Commonwealth Head of Government Meeting in Westminster yesterday, Gates said India, Nigeria and Pakistan has proven to be the most difficult places to wipe out the disease, adding that it was difficult but achievable.

Gates, who is the second richest man in the world, said the Commonwealth has to learn from itself in solving its own problems, stating examples of what Nigeria learnt from India in the eradication of the dangerous disease.

The philanthropist, according to The Cable, said: “If you want to do something better, find out who is already doing better than anyone else in the world, and adopt what they are doing, to your own challenges. The Commonwealth is ideal for this and you have positive outliers in almost every area of expertise, and you meet regularly to learn from one another.

“Polio eradication is a great example of this. For different reasons, India, Nigeria, Pakistan, are three of the places it has been most difficult to wipe out this disease. But India was declared Polio-free in 2014.

“The lessons learnt from there have helped Nigeria get to zero cases in 2017. And now Pakistan, which still has few cases, very few, is taking those experiences, particularly at the challenges of dealing with insecurity, and they have their cases down to the lowest areas ever.

“So, this success really goes back to the substantial commitments made in part at the Commonwealth meetings. Collectively, Commonwealth nations are experts in far more than just polio eradication.

“Nobody else is better in the world at education than Singapore. Bangladesh and Sri Lanka have built very high quality primary healthcare systems, staffed primarily by women healthcare workers.”

Gates was in Nigeria in March to discuss the need to invest more in health and education for the future of Nigeria.

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The District Governor, Rotary International District 9110, Mr. Patrick Ikheola, has said that the club identifies with the effort of the Federal Government to eradicate poliomyelitis in the country.

Ikheola expressed the hope that the club’s efforts, in the areas of public enlightenment and funding, would assist in restoring the country to its status of a polio-free one.

He said this on Monday when he paid a courtesy visit to the Rotary Club of Ogudu GRA, Lagos.

The visit was part of the district governor’s annual duties in the 2016/2017 Rotary year to familiarise himself with the club and to provide support and mentoring.

Ikheola said, “Our focus and concern is to eradicate polio. Two years ago, the country was declared polio-free; but just of recent, we had three cases in the North as a result of the Sambisa forest that had not been accessed in the past.

“We are hopeful that what we are doing now, enlightening parents on the need to immunise their children and funding, will go a long way in restoring the country to its status as a polio-free country.”

Ikheola, on behalf of the Rotary Club of Ogudu GRA, disbursed cheques worth N1m to beneficiaries of the club’s micro credit scheme.

 PUNCH.  

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The federal government at the weekend said it was already rolling out plans to eradicate Wild Polio Virus (WPV) from Nigeria once and for all.

While addressing a Press Conference to update the media on the government’s response to the recent Polio outbreak in the Northeast, the Acting Executive Director of National Primary Health Care Development Agency, Dr. Emmanuel Odu said the bulk of the fund needed for the intervention has been released.

He said the government budgeted and released a total of N9.8 billion for Polio eradication and immunization this year.

It would be recalled that after being free from Polio for two years, Nigeria recorded three new cases of the virus between July and August this year in Borno State.

But Dr. Odu said: “In the immediate response Mop-up targeting 5 local government areas, 820, 000 eligible children were vaccinated.”

He added that the first round, involving five contiguous and very high risk states, achieved the vaccination of 5.9 million eligible children.

Dr. Odu also said response campaign was implemented in 18 States in the Northern Nigeria including the FCT in the second outbreak response strategy.

“This round targets 31.54 million eligible children for which a total of 38.4 million doses of Polio Vaccines were deployed to the states”, he said.

According to him, 28,757,161 children under the age of five years were vaccinated in the exercise which took place between 17-20 September, 2016.

He said apart from efforts being made by Nigeria, all other members of the Lake Chad Basin involving; Chad, Niger, Cameroon and Central Africa Republic were also carrying out a synchronized implementation of Polio campaigns in response to the Nigeria outbreak.

The third outbreak response, fourth and fifth Immunization Responses will take place on 15-18 October, 29 October- 01November and 19-22 November respectively.

While expressing optimism that when fully implemented, the campaign will finally eradicate the Polio Virus in the country, Dr. Odu said there were still some areas not accessible in the Northeast.