In 2020, Nigeria celebrated a hard-won victory over polio after years of determined efforts according to a report by WHO.
Seventeen Years before then five northern Nigeria states had avoided the vaccine due non-availability of education and orientation. But despite the critical state of things a 90-year-old erudite scholar Professor Umaru Shehu took it upon himself and other health practitioners and make children in those states fully prevented by the menace(polio).
The country was declared free from wild poliovirus, an achievement lauded as a triumph for global health. However, this victory is under threat as a new strain of the poliovirus, the type 2 variant, reemerges, prompting renewed efforts to tackle the outbreak. With over 50 cases of poliovirus type 2 reported between January and May 2024, Nigeria faces a critical moment in its fight against the virus.
On Wednesday, top health authorities, global partners, and traditional leaders gathered in Abuja to strategize on how to combat the latest outbreak. The meeting, which included Bill Gates, co-chair of the Bill & Melinda Gates Foundation, highlighted the urgent need to intensify immunization campaigns and surveillance efforts, particularly in under-immunized regions in northern Nigeria.
The Resurgence of Type 2 Poliovirus
Poliovirus type 2, also known as circulating vaccine-derived poliovirus type 2 (cVDPV2), is a mutation of the weakened virus originally used in oral polio vaccines. Despite its origins, this strain can be just as dangerous as the wild poliovirus, causing paralysis or even death in unvaccinated children. According to Bill Gates, this strain represents a significant challenge to the global effort to eradicate polio. “We do have this circulating variant, poliovirus type 2… Unfortunately, it’s equally bad as the wild poliovirus. It can paralyze or even kill children, and we still have work to do to get rid of this,” Gates remarked during the Abuja meeting.
The reappearance of cVDPV2 is a troubling development, particularly in Nigeria, where years of immunization campaigns had seemingly brought the country to the brink of eliminating polio. Between 2016 and 2020, Nigeria made tremendous strides in reducing polio cases, largely due to the extensive efforts of government agencies, international health organizations, and local community leaders. However, setbacks, including the ongoing spread of cVDPV2, signal that the fight is far from over.
Immunization Gaps and Community Resistance
One of the main challenges to eradicating polio in Nigeria has been reluctance among certain communities to participate in vaccination campaigns. This resistance is often driven by religious and traditional beliefs, particularly in the northern regions. Misinformation and fear surrounding vaccines have long hampered efforts to reach full immunization coverage, putting countless children at risk.
However, traditional leaders in northern Nigeria have not played crucial role but have been an essential medium in bridging this gap. Their influence and outreach efforts have significantly improved vaccination rates in hard-to-reach areas. The executive director of the Nigerian Primary Healthcare Development Agency, Muyi Aina, praised the efforts of these leaders, saying, “The results we’re getting are due largely to the commitment received from our revered traditional leaders. For example, we had a 57% reduction in pending noncompliance from the April campaign, and we were able to vaccinate an additional 117,000 zero-plus children across 14 states with the help of the traditional leaders.”
Progress Amid Setbacks
Despite the challenges posed by the reemergence of poliovirus type 2, Nigeria has made commendable progress in its vaccination campaigns. The country’s efforts to expand routine immunization, including for diseases like human papillomavirus (HPV), have been widely recognized. Yet, the resurgence of cVDPV2 serves as a stark reminder that sustained efforts are necessary to protect vulnerable populations, particularly in regions with limited access to healthcare services.
The World Health Organization (WHO) has also expressed concerns about the recent setbacks in Nigeria’s polio eradication campaign. Walter Kazadi Mulombo, the WHO’s representative in Nigeria, emphasized the importance of maintaining vigilance. “We are facing the challenge of interrupting transmission of significant variant poliovirus type 2,” Mulombo said. “We nearly got there several months ago, but then we experienced some setbacks.”
The setback refers to a combination of factors, including the disruption of health services during the COVID-19 pandemic, which limited routine immunization efforts. Additionally, challenges related to logistics, vaccine supply, and public trust in health authorities have contributed to the persistence of the virus in certain regions.
Strengthening Surveillance and Collaboration
To combat the resurgence of poliovirus type 2, health authorities are ramping up surveillance efforts and expanding vaccination campaigns. Cristian Munduate, UNICEF’s country representative, stressed the need for collaboration between all stakeholders to ensure that no child is left behind. “We need to accelerate with polio, but we also need to accelerate in line with all these effects to link more routine immunization to reach those children,” Munduate said. “To work and strengthen primary healthcare, we are very committed to at least having one primary healthcare worker fully equipped per ward.”
Improving surveillance is critical to identifying and addressing new cases of cVDPV2 before they can spread. Enhanced monitoring efforts, combined with expanded vaccination coverage, will help ensure that outbreaks are quickly contained and that progress towards eradication is not derailed.
The place of Traditional Leaders in Curbing Polio
Traditional leaders in northern Nigeria have been at the forefront of the polio eradication campaign for years. Their role in educating communities, dispelling myths about vaccines, and encouraging participation in immunization campaigns has been invaluable. At a meeting held in Abuja, Muhammadu Sa’ad Abubakar, the Sultan of Sokoto, had reaffirmed the commitment and continuous support of northern traditional rulers towards vaccination efforts. “We are more concerned with the welfare of our people, so whoever is going to help us to help our people is part and parcel of us and is always welcomed,” he said.
The involvement of traditional leaders has been a key factor in the success of past immunization campaigns, and their continued support will be essential in overcoming the current resurgence of cVDPV2.
Treading the path to Eradication
Despite the reemergence of poliovirus type 2, Nigeria remains committed to eradicating the disease once and for all. The Abuja meeting concluded with a renewed call for stronger efforts, better surveillance, and continued collaboration between health authorities, global partners, and traditional leaders. While the road to eradication may be long, the progress made so far offers hope that Nigeria can overcome this latest challenge and secure a future free from polio.
The fight against polio has always been a collective effort, and as Nigeria faces this new threat, the unity and determination of all stakeholders will be crucial to ensuring that the country’s victory over polio is not undone.
