At long last, Africa is now free of Wild Polio Virus(WPV). Nigeria was the last house harbouring the virus on the continent until it was given a clean bill of health by the World Health Organisation(WHO) on Tuesday.
A journey that started 25 years ago, Africa’s race to polio eradication was quite a slow, bumpy, tortuous and lengthy one. There were setbacks and challenges here and there mostly occasioned by insurgency, superstition, mutual suspicion and lack of financial and political will.
However, it was worth the wait. Success was achieved at last. On Tuesday, following approval from the Independent Africa Regional Certification Commission (ARCC), the continent was certified polio-free.
The milestone was achieved after Nigeria, which accounted for more than half of all global cases less than a decade ago, received its polio-free certificate from the World Health Organisation (WHO).
In a statement made available to PREMIUM TIMES, ARCC Chairperson, Rose Gana, said the decision to declare the region polio-free comes after meeting the certification criteria.
“Today is a historic day for Africa. The African Regional Certification Commission for Polio eradication (ARCC) is pleased to announce that the Region has successfully met the certification criteria for wild polio eradication, with no cases of the wild poliovirus reported in the Region for four years.
“The ARCC’s decision comes after an exhaustive, decades-long process of documentation and analysis of polio surveillance, immunisation and laboratory capacity of the region’s 47 member states, which included conducting field verification visits to each country,” she said.
The poliovirus, which causes paralysis by attacking the nervous system, is spread from person to person mostly through contaminated water.
Disease eradication, according to Devex, means the total stopping of the transmission of infectious disease, reducing the prevalence of the disease to zero. To date, only one disease — smallpox — has been successfully eradicated in 1980.
With Africa’s eradication of polio, the world is now inching closer to ending yet another viral disease as only Afghanistan and Pakistan are the only countries yet to be certified polio-free.
Global efforts to eradicate the poliovirus date back to 1988, when the World Health Assembly passed a resolution to eradicate the disease globally by the year 2000 and launched the Global Polio Eradication Initiative.
Since then, polio eradication has enjoyed remarkable success which brought about the reduction of scourge by over 99 per cent since 1988, from an estimated 350 000 cases then, to 33 reported cases in 2018, according to WHO data.
The first breakthrough came in 1994 when the American continent was declared polio-free. Eight years later, the whole of Europe received a clean bill of health in 2002, when all 53 countries in the WHO’s designated European region were declared free of the virus.
India, one of the major strongholds of the contagion, eradicated the virus in 2014 after a massive polio campaign that kicked off in 1997.
Africa’s Long Road
In Africa, the race to defeat polio dates back to 1996. Then, every country on the continent was affected by polio. More than 75,000 children became paralysed each year, and health efforts on the continent were focused elsewhere, the WHO fact sheet showed.
It was not until the late renowned South African leader, Nelson Mandela, launched the Kick Polio Out of Africa campaign same year that efforts of governments, health workers, and international funders were brought under one roof — the Global Polio Eradication Initiative (GPEI).
PREMIUM TIMES had reported on Tuesday that the task of eradicating polio meant overcoming immense logistical challenges. GPEI, a public-private partnership launched in 1988 with a goal of ending polio worldwide, was most pivotal in bridging funding and technical gaps in the continent.
It was driven by five partners – the WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF) and the Bill & Melinda Gates Foundation.
Billions of dollars were invested with the support of donors and partners including the Dangote Foundation, European Union, Rotary, GAVI, JICA, the World Bank and the Governments of Canada, Germany, Japan, among others.
In 2000, the first synchronised campaigns began in 17 countries, with 76 million children being vaccinated by tens of thousands of volunteers. The radical campaign was followed by a heavy push from 2008 to 2010, when an outbreak in 24 countries in western and central Africa was met by a large-scale, multi-national vaccination of 85 million children.
Despite its intensity, the campaign was met with drawbacks which dragged polio eradication in Africa to nearly 25 years.
A vast sprawl of hard-to-reach village populations; long distances to urban hospitals, poor infrastructure such as inadequate roads and unreliable “cold chains”–refrigerated transport networks to keep vaccines viable–was always going to present special challenges.
Many countries on the continent had little cold storage for vaccines with many remote communities having high levels of illiteracy and lack of awareness.
Chief among the challenges was violence and insurgency. The most afflicted regions are those where the government’s reach is weakest and the presence of Islamic militants is strongest as earlier reported by PREMIUM TIMES.
Just as Nigeria has contended with the Boko-haram insurgency for more than a decade, the remaining two countries battling the contagion – Pakistan and Afghanistan – are also at war with terrorist groups.
Nigeria would have been certified polio-free in July 2017 and subsequently removed from the list of polio-endemic countries if not for the cases involving two children in Jejere and Gwoza Local Government Areas of Borno State in August 2016.
At the time, it was a frustrating set-back as the country had made huge progress and had gone two years without any cases being identified.
Asides Nigeria, the last time infections were found on the continent was in 2014 in Somalia, a crisis-prone region.
“Nigeria has been embroiled in a huge humanitarian emergency occasioned by the Boko Haram insurgency, the fallout of which called for the biggest crisis management operations since the civil war of over fifty years ago,” says the Human Rights Writers Association of Nigeria(HURIWA), a development that, no doubt, slowed down polio eradication program in the country.
The United Nations High Commission for Refugee (UNHCR) estimated that violent attacks by non-state armed groups in parts of the North-East have displaced over two million Nigerians, with Borno State being the most affected.
It was the resilience of a network of nearly 20 000 UNICEF-trained community mobilisers, influencers and communication experts deployed across 14 northern “high risk” that heralded the final push to end polio in the last three years, PREMIUM TIMES had reported.
These community mobilisers, mostly women, managed to navigate areas of conflict like Lake Chad by boat and deliver vaccines to remote communities.
Widespread rumours and misinformation about the vaccine also slowed down immunisation efforts.
Despite billions of foreign aid pumped into polio eradication, bridging the barrier of suspicion and acceptance of immunisation programs, especially in rural Northern Nigeria was a major problem.
In 2003, Kano, Zamfara, and Kaduna States halted immunisations following reports by Muslim religious leaders that the vaccine was contaminated with an anti-fertility agent as part of the Western plot to make Muslim women infertile.
Laboratory tests by Nigerian scientists dismissed the accusations but then, the boycott, which lasted for 13 months, was a major setback to polio eradication in Nigeria, with long-lasting repercussions in and outside the country.
Since then, anything that has to do with western medicine and vaccination is often treated with suspicion in those parts. Advocacy, however, found success with the aforementioned 20, 000 mediators.
They were able to penetrate because they were mostly from the communities. They served as the link between interventions and the people.
While commending efforts that helped to eradicate polio in Africa, Nigeria’s president Muhammadu Buhari in a press statement by his spokesperson, Femi Adesina, on Tuesday as reported by PREMIUM TIMES, assured the global community that Nigeria will sustain the momentum and leverage on the lessons learnt from polio eradication to strengthen her health system, especially primary health care, and prioritise health security.
He said Nigeria used data systems, community engagement and innovative technology to monitor and predict the occurrence of polio outbreaks, adding that these same skills and tools are being used to fight COVID-19 and the multi-country outbreaks of Circulating Vaccine Derived Polio Viruses.
But while the trumpets of jubilation are still being blown, health experts are urging countries on the continent to tread with caution as all strains of the contagion are yet to be fully eliminated.
Two out of the three strains of wild poliovirus have been eradicated worldwide and on Tuesday, Africa became free of the last remaining strain – wild poliovirus.
But vaccine-derived poliovirus still exists in Africa with 177 cases being identified this year, the World Health Organization (WHO) reported.
This is a rare form of the virus that mutates from the oral polio vaccine and can then spread to under-immunised communities.
WHO identified a number of these cases in Nigeria, the Democratic Republic of the Congo, Central African Republic and Angola.