By Onyinye Oranezi and Thelma Chioma Abeku (Lead Writers)
The launch of the Global Polio Eradication Initiative (GPEI) a little over three decades ago, which birthed the drive for a polio free world has resulted in significant health advances. Indeed, before the COVID-19 pandemic, polio eradication hinted at what the world could accomplish by working together to build surveillance systems that involved community engagement and participation, protecting the health of children.
Nigeria was one of the last African countries to eradicate wild poliovirus (WPV) and was certified WPV-free in August 2020, thanks to the tireless efforts of the government of Nigeria and development partners. The country must now endeavour, in every way, to maintain its wild poliovirus-free status, despite the sporadic transmission of circulating vaccine-derived polio virus type 2 (cVDPV2). Weekly country updates showed that in Nigeria, there have been a total of 16 reported cases of cVDPV2 in 2022.
Cases of Circulating vaccine-derived polioviruses (cVDPVs) sometimes emerge in populations where vaccination rates are sub-optimal, missing out children who now become under-vaccinated and vulnerable. The only way to prevent cVDPVs remains the live-attenuated oral polio virus (OPV) to eradicate and prevent the spread of any polio variant.
Malawi lived without any form of wild polio for 30 years, however in February 2022, the country recorded one case of wild poliovirus type 1 (WPV1). During the 38th Expert Review Committee (ERC) Meeting on polio eradication and routine immunisation which took place in March 2022, Executive Director, National Primary Health Care Development Agency (NPHCDA), Dr Faisal Shuaibu said, “the report from Malawi indicates that we must strengthen our system in order to avoid an outbreak of WPV in Nigeria.” He also said that the circulating variant poliovirus Type 2 (cVPV2) which has spread to 29 states and the Federal Capital Territory (FCT), is a major concern and the greatest challenge the country has faced in the Polio programme.
Wild poliovirus-free but still under threat
When a person on a weight loss journey attains their goal, the next stage is to maintain their efforts. This is the stage where the person does their utmost to maintain their ideal weight and retain their hard-won success. The possibility remains for wild poliovirus to be imported into wild poliovirus-free countries and spread among under-vaccinated populations, therefore heightening the need for purposeful action to sustain routine immunisation programmes and ensuring that zero-dose children and communities are also covered.
Professor Marycelin Baba, Director, National Polio Laboratory, World Health Organization (WHO), University of Maiduguri Teaching Hospital, stated that ‘’stopping the outbreak of circulating vaccine-derived poliovirus requires active and adequate surveillance, and immunisation activities especially routine immunisation. These are key activities that will sustain our polio-free status’’.
Long life for all
As an important step forward in the global eradication of polio, on Tuesday, April 26, GEPI announced that it is seeking new commitments to fund its 2022–2026 strategy, which, if fully funded, will see the immunisation of 370 million children annually for the next five years and the continuation of global surveillance activities for polio and other diseases in 50 countries. The strategy centres on integrating polio activities with other essential health programs in affected countries, better reaching children in the highest risk communities who have received zero-doses and strengthening engagement with local leaders and influencers to build trust and vaccine acceptance. Funding is critical to reach under-served communities and strengthen initiatives to improve global health systems.
Mainstreaming gender equality efforts is one of the keys to this new strategy as highlighted in the report titled “Investment Case 2022–2026: investing in the promise of a polio-free world”, Gender equality is a powerful driver for better health outcomes. Women comprise almost 80% of vaccinators in Nigeria and Somalia, and over 60% in Pakistan. They have been critical in reaching children that otherwise may have been missed and are an integral part of reaching every child with vaccines.
World Immunisation Week is celebrated in the last week of April and the 2022 theme is ‘Long Life for All’. It highlights the collective action needed to promote the use of vaccines to protect people of all ages against disease. It is critical for Nigeria to ensure that no child dies of vaccine-preventable disease or is crippled because of Polio. For Nigeria to achieve the desired 80% national coverage with all scheduled routine antigens by 2028, surveillance gaps at state and local government levels must be filled, significant improvements must be made to routine immunisation to ensure that the entire population is accessible, and issues with accountability, funding and political commitment must be addressed.
Strengthening primary health care to sustain routine immunisation
Strengthening the health system in Nigeria would also make achieving and maintaining high levels of immunisation coverage a priority. The Nigeria Strategy for Immunisation and PHC System Strengthening [NSIPSS] 2018–2028 is a 10-year strategy designed to contribute to the reduction of mortality by preventing vaccine preventable deaths. Its goal is to achieve at least 80% equitable, sustained national coverage with all scheduled routine antigens by 2028.
Robust outbreak response plans need to be put in place to intercept any resurgence. This requires state-level commitment and leadership, supported by sustained funding. Given that 2 countries (Pakistan and Afghanistan) have not yet eradicated wild poliovirus, Nigeria must work to maintain constant surveillance in all states and boarder communities to ensure that any potential outbreaks are contained. This will be accomplished by collaborating with the National Primary Health Care Department (NPHCDA), Nigeria Centre for Disease Control (NCDC), the Federal and state ministries of health, as well as state epidemiologists to maintain surveillance and ensure that an emergency response is timely and effective.
According to the NPHCDA implementation of the strategies and interventions detailed in the NSIPSS is primarily the responsibility of state governments, local governments and frontline health workers, with support from partner agencies working at the respective levels.