Twenty-four years after African Heads of State committed to eradicating polio during the 32nd Ordinary Session of the Organisation of African Unity (now African Union) in Yaoundé, Cameroon, the dream finally became a reality on August 25, 2020 when the Independent Africa Regional Certification Commission certified Africa free of the wild poliovirus.
Indeed, Africa has come a long way by eradicating a disease, which as of 1996 was paralysing an estimated 75,000 children annually on the continent. According to the World Health Organisation, concerted efforts at polio eradication have prevented up to 1.8 million children from crippling life-long paralysis and saved approximately 180,000 lives.
Amid the celebrations, however, there remain legitimate concerns and challenges that must be addressed if Nigeria and by extension, Africa, is to remain polio-free. Nigeria, the supposed Giant of Africa, was the last African country among the 47 countries in the WHO African region to be certified polio-free having recorded four cases of the dreaded disease in the war-ravaged Borno State in 2016. This development delayed Africa’s polio-free certification by three years.
It was estimated that in 2016, health officials lacked access to 500,000 children due to the activities of insurgents in the North-East. Some officials who were brave enough to go into the terrorist territory paid the supreme price. In 2013, a roadside bombing killed polio vaccinators in the North. Two terrorists reportedly used a four-year-old child as a decoy to track down and kill volunteers, one of whom was a mother of eight. According to reports, some courageous vaccinators had to disguise their vaccine carriers or hide them under their hijab, while soldiers had to personally immunise children in some extreme circumstances. Despite these heroic efforts, however, 10,000 children still lack access to routine immunisation in Borno State, according to the WHO. This is therefore not the time to be complacent.
Worthy of note is that the two Middle East countries – Afghanistan and Pakistan – that remain the only two countries with confirmed cases of polio, have also witnessed terrorist activities disrupting routine immunisation, which sometimes leads to the death of vaccinators. Peace remains a conditio sine qua non for the health sector to thrive. The Federal Government should therefore speedily crush the Boko Haram insurgency, which has lingered for 10 years.
Also, the existence of polio in any country remains a threat to the rest of the world. As Nelson Mandela stated at the launch of the ‘Kick Polio Out of Africa’ campaign in August 1996, “Children that have not been immunised will remain susceptible to the disease, even in areas where cases of polio have not been seen for some time.” It was therefore not surprising when an outbreak between 2003 and 2006 in northern Nigeria led to national and international spread of the disease, re-infecting and causing 1,475 cases in 20 previously polio-free countries including faraway Indonesia and Yemen.
As the Director-General of the WHO, Tedros Ghebreyesus, rightly stated during the certification ceremony of Africa’s polio-free status, “The end of wild polio in Africa is a great day. But as we all know, it’s not the end of polio. Sixteen countries still face outbreaks of vaccine-derived poliovirus, and we have a hard road ahead to eradicate wild poliovirus from Afghanistan and Pakistan. As long as polio persists anywhere, it’s a threat everywhere.”
So, while the disease may have been eradicated from Africa, it remains a threat. Vigilance and surveillance remain essential. Indeed, the current outbreak of vaccine-derived polio in Nigeria and 15 other countries stems from the oral polio vaccine used in lower income countries because it is cheap and easy to administer. This could undermine the gains of the eradication of the wild poliovirus. Although it is not as deadly as the eradicated polio, experts say in rare cases, vaccine-derived polio could lead to paralysis, especially in places with poor sanitation and large numbers of unvaccinated children.
If some oral polio vaccines are infecting children, then this development could dissuade an already sceptical and highly-illiterate people from taking their children for the routine immunisation thereby opening a floodgate of new infections.
But there are more matters of concern. The COVID-19 pandemic – which has upended our way of life – has also interrupted routine immunisation in several African countries. Henrietta Fore, the Executive Director of UNICEF, called COVID-19 a “global health emergency that not only threatens people’s lives, it also threatens to interrupt our work to deliver the polio vaccine and so many other lifesaving interventions in Africa.” The government must therefore avoid the temptation of cutting budgets for immunisation in favour of the COVID-19 response. Rather, such health services should be integrated with the COVID-19 surveillance, killing two birds with one stone.
Education and sensitisation must also continue in order to counter deadly narratives. The vaccine boycott in northern Nigeria, which lasted from 2003 to 2004, was caused by jejune conspiracy theories that the vaccines were designed to make children sterile or had been infected with HIV to kill and reduce the North’s population. This rumour, which was propagated by community leaders, politicians and clerics, frustrated the country’s response to the deadly disease and by 2008, Nigeria alone accounted for 86 per cent of all the polio cases on the continent, according to experts.
Nigerians have continued to suffer the effects of poor leadership and a crippling and underfunded health sector with universal health coverage at a paltry 5.0 per cent as of 2018 and the current federal health budget at just 4.0 per cent of the total budget. The country has had to depend largely on foreign governments and donors like the Bill and Melinda Gates Foundation and GAVI, the Vaccine Alliance. They invested billions of dollars to make Nigeria polio-free. This is an unsustainable model for the development of the health sector of any country.
Nigeria has continued to witness periodic outbreaks of cholera, hepatitis, monkeypox, Lassa fever, meningitis and yellow fever, which are preventable. Nigeria still accounts for 25 per cent of the world’s malaria burden. The victory over polio, therefore, should strengthen the resolve of Nigerians to improve the health sector. It should not be a reason to return to complacency like Nigeria did after defeating Ebola. The victory over polio should be the impetus for tackling other diseases and ensuring a better health sector.
