Lagos — At a time reports insist that Nigeria now exports polio virus to neighbouring countries, another immunisation week for the eradication of the childhood killer disease in the country was concluded last week amidst boycotts and suspension of the exercise by some states over allegation that the vaccine contains other agents that are harmful. Roland Ogbonnaya and Godwin Haruna examine the contending issues

Over the last 20 years, the world has witnessed miraculous developments in child survival. First, smallpox was eradicated in 1979. Then during the 1980s, infant mortality fell by more than five per cent each year. This means that in one generation, the number of childhood deaths fell by half - an astounding achievement.

But 11 million children are still slipping through the safety net each year that many children die from preventable diseases or malnutrition. Today an estimated 1.2 million children are infected with HIV and 10 per cent of new infections occur in children under the age of five. Imagine the fear that a parent in sub-Saharan Africa lives with every day, knowing that their child has a one in 10 chance of dying before reaching their first birthday, and a one in five chance of not seeing their fifth birthday. Last weekend the National Programme on Immunisation (NPI) conducted fresh administration of Oral Polio Vaccines (OPV) aimed at eliminating wild poliovirus from the country. Many would have felt relieved that Nigeria was on its way to join the rest of the world to immunise 63 million children who are at the risk of infection of the wild poliovirus. But this drive may be at jeopardy following the controversy that has trailed the exercise in the country. The massive immunisation campaign effort was aimed at stemming the tide of polio outbreak spreading from Nigeria to neighbouring countries, which may put about 15 million children at risk of infection in five countries in West and Central Africa. The global campaign was launched simultaneously in Nigeria and nine other Central and West African countries of Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, Ivory Coast, Ghana, Niger and Togo.

Currently, Nigeria is the greatest risk to global eradication of polio. Reports from across the country said the latest global eradication took off in all designated centres except in Kano, Zamfara, Niger and Bauchi States where opposition has grown in recent months. It was gathered that while the drive was delayed in Bauchi, for logistics problems, it started off in Kastina and Kaduna States.

Recently, UNICEF said that the alarming spread of polio in West Africa was the biggest threat to global eradication of the disease. The agency's Executive Director, Carol Bellamy, told leaders of the Economic Community of West African States (ECOWAS) that two West African countries - Nigeria and Niger - now account for well over half the world's total polio caseload, quoting the records of the Global Polio Eradication Initiative (GPEI), a partnership including UNICEF, WHO, Rotary International and the US Centre for Disease Control and Prevention (CDC).

"This year, West Africans have put down their arms in Liberia and in Cote d'Ivoire, liberating millions of children from conflict," said Bellamy, speaking at the ECOWAS Heads of State Summit in Accra. "Now children urgently need the same vision and decisiveness from their leaders to stop polio, before the disease spreads out of control in the region."

It was also said that Nigeria is at the root of the recent surge of polio across West Africa. With more cases of the disease than any other nation, Nigeria has been identified as the source of recent polio importation into Ghana (9), Burkina Faso (6), Chad (3), Togo (1). Responding to these importation cost the world over $20 million in 2003. Much of this cost could have been avoided by improving countries' routine immunisation services, to protect children against polio and a whole host of other childhood diseases, said Bellamy said.

"Too many children in West Africa are absolutely defenceless against preventable childhood diseases, creating the perfect conditions for epidemics," she said. "With polio in Nigeria on the rise and spreading, West African nations have to make routine immunisation the backbone of their national polio defence. It's a case of balancing an investment in child health against the cost of responding to polio importation."

The Federal Government recently admitted the spread of a strain of polio disease prevalent in some parts of northern states to neighbouring countries. The WHO said the outbreak of the disease in parts of Central African Republic (CAR) might vitiate the target date of 2005 for the universal elimination of polio. Briefing journalists after the weekly meeting of the Federal Executive Council (FEC), health minister, Prof. Eyitayo Lambo said: "It may be true. What I can tell you for sure is that given what is happening in Nigeria, evidence has shown that some countries around us that were hitherto polio free for two years have been re-infected by the strains of polio virus from Nigeria, namely Cameroon, Niger, Burkina Faso, Ghana.

"What we are seeing is a re-spread of polio. All it takes is one outbreak in one area in Northern Nigeria. Now the disease is spreading all over West and Central Africa and every child in these areas is currently at risk of getting polio. We have to embark on a vigorous campaign to eradicate polio by visiting these countries. But really we have to go to the root of the problem and the root is in Northern Nigeria. That is where the virus has as home and continues to spread to other areas. This will continue to happen until it is eradicated there,".

The global fight to eradicate polio has been defined by the World Health Organisation as one of its two greatest public health challenges, the other being the AIDS pandemic. UN officials have warned that the virus now threatens areas that had been polio-free.

The controversy which is now scuttling the efforts in eradicating polio in Nigeria reared its ugly head when some Islamic clerics alleged that the polio vaccines were laced with chemicals designed to render African girls sterile, as part of a US-inspired plot to thin out populations in the developing world. The Federal Government debunked this allegation. Apart from going round the states in the northern part of the country where the allegation had its roots to meet religious and traditional leaders, Dr. Dere Awosika, the co-ordinator and chief executive officer of NPI also went to media houses in an attempt to dispel the allegation.

The health minister, while speaking to journalists in Abuja, on the allegation by the Jama'atu Nasril Islam (JNI) that the polio vaccine used in the immunisation campaign in the north had contaminants, said "I can assure you that we are in touch with JNI and we are putting in place some arrangements whereby over the next week or two, we will come together,undertake an assignment together for once and for all. And we believe that within the next two weeks, we will be able to come together and announce to Nigerians, that we have to move ahead with the polio campaign".

The Federal Government later set up a panel to look into the allegation to verify the safety of the oral polio vaccines. The panel had to delay the release of its report, which has since been ready to allow for the outcome of tests conducted in India.

WHO and UNICEF had hoped that the results would reassure Nigerians that the vaccines are safe, and avert failure of the just-concluded nation-wide immunisation. The deferment of the verification notwithstanding, the Jigawa State government has rescinded its decision to stop the immunisation in the state, saying the exercise would be conducted there this week. Bauchi State, among the states alleged to have suspended the immunisation, denied knowledge of the state government's suspension of the administration of oral polio vaccines. The governor, Alhaji Ahmad Adamu Mu'azu, said the news was new to him. He said those criticising the administration are trying to make politics out of nothing.

The first committee to look into the polio vaccines was set up by the Kano State Government and led by Dr. Lawan Hassan Bichi, a pharmacologist at the Bayero University, Kano. Testifying before the House of Representatives, Bichi said that "tests carried out on some randomly selected polio vaccine samples, showed that they contain elements not reflected on their label; and among these elements are those capable of impacting negatively on fertility and causative agent of AIDS."

According to a paper by Prof. Hussain Akande Abdul-Kareem of the Lagos State University Teaching Hospital, Ikeja titled 'Polio Vaccine: A Huge Virological Deception,' said the second committee was set up by Jama'atu Nasril Islam (JNI) and sent to India where they spent 28 days to conduct the investigation in New Delhi under the directive of WHO. The tests in India, he said, confirmed that the batches of OPV taken from Kaduna, Sokoto and Zamfra states contained "undeclared contaminants, "which" could cause malfunctions of the testes in males and cause infertility in women as well as toxic substances." Thus, the fears expressed about polio vaccines being distributed in Nigeria are genuine fears, he said. The question we should now ask is what will an infertility agent and AIDS causative agent be doing in a polio vaccine especially when these agents 'were not listed on the label of the polio vaccine vials?," the prefessor asked.

Chairman of the verification committee, Alhaji Kyari El-Kanemi, said in Abuja that the result of one of the tests conducted in India was being awaited. The committee visited India, Indonesia and South Africa.

"Although the results of the tests conducted have been received from University of Pretoria, South Africa, result of one of the tests out of the two conducted in India is still being awaited, as the procedure requires a minimum of 10 days for completion," he said. According to him, the results were expected before the end of February and will be submitted to the Federal Government.

Further delay will disappoint international health workers, who have already seen their attempts to immunise all Nigerian children at risk from a new polio outbreak thwarted by opposition from radical Muslims.

However, some people like the Kano State Governor Ibrahim Shekarau cannot be easily convinced that the vaccines are pollutant free. He also dismissed suggestions that the state's rejection of the on-going immunisation against polio has political undertone. Rather he said, the action was motivated by the genuine desire of government to protect the lives of innocent children. "What political benefit are we going to get by kicking against the administration of polio vaccine on innocent children if it is for their own good," he asked in a BBC Hausa interview.

Afterall, he said, the Federal Government or the ruling PDP neither produced the polio vaccines. "We only rely on the reports we got from the independent medical verification committee which we gave the mandate to verify the content of the vaccines, and they gave us their professional report that the vaccines contained some substances that can cause infertility, cancer and HIV virus," he alleged.

Shekarau reiterated that the report was not a secret, explaining that state government sent a copy of the independent medical verification committee to the Minister of Health, which the minister confirmed the receipt of the report when he visited the state recently. He said the state independent verification committee and the medical team from the Federal Ministry of Health agreed to work together to come out with an acceptable result, only for the federal ministry to start dodging the state team for reasons best known to them.

Shekarau alleged that the federal medical team misled the state independent verification about their joint trip to verify the vaccines in South Africa and India. The Federal Government, he said took off two hours before the agreed time.

"If you are in my position what would you think? So we concluded that they are hiding something from us because they have realised that we have discovered what they added to the vaccines, which is why we maintain our stand based on the verification report we have at hand." He invited anyone wishing to read the report of the state independent verification team, to come and do so.

Apparently worried by the controversy, the House of Representatives Sub-committee on Immunisation called for support for the country's immunisation agencies towards reversing the country's tainted polio immunisation record.

Speaking against the background of global disapproval of the transmission of the poliovirus from Nigeria to other West African countries, a medical doctor, Dr. Jeff Ojinika, regretted that internal controversies on the purity of the polio vaccine and poor statistical records had hindered the country's polio eradication programme. Despite establishing a specialised agency to promote the country's immunisation programme, Nigeria has suffered setbacks with latest reports showing that formerly polio-free West African countries had become infested with polio virus spread from Nigeria.

Arguing for support for the National Programme on Immunisation in surmounting the constraints facing the agency, Ojinika said: "Nigeria is a thickly populated country meaning that if there is still polio in this country and with the increased rate of migration it is possible to transmit this disease condition to other countries. So that is why we must make sure that ours is eradicated as other countries are eradicating, because if they eradicate and ours is still here, we can serve as a centre for infecting the whole world." People, Ojinika said, are just being mischievous with their intellect and some people are also trying to deceive their people.

Last week, the Pharmaceutical Society of Nigeria (PSN) commended Lambo and Awosika for an all inclusive approach on the issue of Oral Polio Vaccine (OPV) safety.

The society, in a statement after its quarterly meeting in Abuja, recently, called on all key players to put the past behind and move on with the polio eradication initiative (PEI) effort so that Nigeria could join the world free of poliomyelitis. The organisation's president, Chief U.N. Uwaga, reiterated that the vaccine is given orally, which gives a great indication of safety as it can be equated to food. Uwaga explained that the problem of oral administration could be easily detected and addressed accordingly. He therefore said that OPV is a better choice, safe, cost effective and easy to administer.

"Polio is a disease that cripples children. It has no cure. It is in this regard that PSN called on Nigerians to take advantage of the recent rounds of national Immunisation days, which ended last week," the PSN stressed.

It called on traditional rulers, religious institutions, Christians, Moslems, community leaders and leaders of thought to appreciate the immense benefits of immunisation for children and join forces with government and the NPI to inform the public properly in order to generate more understanding for the enduring health benefits to Nigerian children. The society assured Nigerians that of polio vaccines in use all over the world and especially Nigeria are safe. It urged Nigerians to discountenance the misinformation surrounding the polio vaccines in certain parts of the country.

Apart from the few states in the northern part of the country who did not participate, the just concluded WHO polio eradication programme recorded massive turn-outs in most parts of the country. The immunisation was simultaneous in Benin, Burkina Faso, Central African Republic, Chad, Ghana, Niger, Cote d'Ivoire and Togo. Some of the countries had commenced the vaccination of children since February 23 as part of the programme expected to end next month. This became necessary because of the trans-border transmission of the virus through immigration.

Bearing in mind the controversy the issue had generated in Nigeria in recent time, WHO, in a statement, announced that political, religious and traditional leaders would team up to launch the activities, and tens of thousands of vaccinators would go house-to-house over three days to administer the vaccine directly to every child.

However, in Kwara State, the National Immunisation Days (NID) was a resounding success owing to the spirited public enlightenment campaigns mounted by officials of the state ministry of health. The state commissioner of health, Dr. Bola Olaosebikan, who spoke at the launching of the first round of NID in Otte, Asa Local Government Area of the state, urged parents to participate in the programme actively. He advised them to welcome the vaccinators, who would move from house to house to immunise their children, adding that it was being done for their own benefit. Officials from the partner agencies witnessed the launching and spread out immediately to other parts of the state to continue the enlightenment programme for the success of the programme.

In the face of conflicting signals emanating from a few political and religious leaders, various leaders of the society have not relented in their efforts to make all Nigerian children benefit from the NIDs.

For instance, President of Rotary International, Jonathan Majiyagbe, appealed directly to communities to immunise their children. "Polio is our common enemy, but in some African communities, fear and misinformation about the polio vaccine has become as deadly as any disease. The polio vaccine is a safe and essential protection for children. We must not allow these unfounded rumours to come between our children and their health", Majiyagbe said in a statement.

The poliovirus is now circulating in only six countries, down from over 125 when the Global Polio Eradication Initiative was launched in 1988. The six countries with indigenous wild poliovirus are: Nigeria, India, Pakistan, Niger, Afghanistan and Egypt.

Dr. Bala Usman of the Ahmadu Bello University (ABU), Zaria, last week regretted that the various stakeholders had turned the OPV issues to politics. As he put it, "it is dangerous politics and sheer wickedness because these vaccines have been in existence since 1964 and millions of people have been vaccinated. All this brouhaha is to rubbish the President Olusegun Obasanjo government. We are not the only Muslims in the world, polio vaccination is world-wide and there are so many Muslim countries participating in the vaccination exercise," he said.

In Ilorin, where the population is predominantly Muslim, the NIDs went on smoothly, just like in other parts of Kwara devoid of controversies. In an interview with THISDAY at Otte, where the programme was launched, Mrs. Sailfat Adana, state supervisor in Asa Local Government Area, revealed that there was no incidence of poliomyelitis in the council just like in other parts of the state.

She said the current exercise in the area was merely preventive, adding: "Apart from this programme, we have routine immunisation programme in the health facilities scattered round the state. They give children from age 0-11 months five types of immunisation. We have BCG immunisation at birth, we give OPG as well. Then when the child is six weeks, we give BPT vaccines which is monthly for three consecutive months and it prevents tetanus, diphtheria and whooping cough. When the child is nine months old, the child is given measles immunisation. Everything I stated here are routinely given at the health facilities".

The health officer stated that the health facilities have designated days in the week when all these immunisations are done. She said that there was no area in the state that could be identified as being prone to poliovirus since the state was virtually free from the debilitating virus.

However, owing to movements of people in recent times and added to the fact that the state shared borders with a neighbouring country, she acknowledged that the few cases might have been imported. Adana disclosed that the one incident known to her in Ilorin was that of a child who came from Katsina State with his parents. She added that they have reverted to the "sweep" method last used in 2002 in the current exercise. The sweep method is one in which a group of vaccinators move into a neighbourhood and immunise children from house to house.

She said the method was very effective in ensuring that no child was left. The health officer added that the method was also less problematic for the mothers and guardians, who might not have to move out from their houses to have their children immunised.

Speaking to THISDAY in his office shortly after launching the programme in Otte, Olaosebikan said Kwara State had no problem of the wild polio virus infections. He said there had been no incident of the case this year and only one or two cases were recorded last year.

"When we talk of prevalence, it is really insignificant, we cannot say we have polio epidemic in this state. In Nigeria, we can be counted as one of the states that have no problem with poliomyelitis. You know that in Nigeria, the most infected state with the poliovirus is Kano with 84 cases, the second is Katsina State and the third most infected is Bauchi State. We are not even within the first 10 or 15. I know that 14 states in Nigeria are polio-free. We are doing our routine immunisation and I think we are okay", the commissioner explained.

He said the state was doing well in immunisation with or without the NIDs. He said the state used to come first in primary healthcare delivery system in the past and that the present government in the state was well prepared to maintain that position. He added that it was in furtherance of that objective that the state set up a committee on immunisation to effectively cater for the health needs of the people.

Olaosebikan explained that the programme have been well received in all the communities it has been taken to in the state. He said when the "campaign of calumny" against the vaccines started, he had already resumed work in the state and ensured that enough public enlightenment was done to make the people see the advantages of participating in the programme.

"I was here and became a barrier to false propaganda. I made the statement very loud and clear that polio vaccine is very safe", he stated. He added that he used his Healthcare magazine to reach many other people to counter the malicious propaganda that the vaccines were harmful to children.

"Here in Kwara, we are enjoying the cooperation of the people, the press and all segments of the society, who believe that polio vaccine is safe for the people and they are taking it. For those who are saying it is not safe, if I may ask them, what is the alternative? Wherever they are and they say don't take polio vaccine, what is the alternative, if their wives give birth today, what will they give to prevent paralysis? If their own children are not paralysed, why are they campaigning for other people's children to be paralysed knowing fully well that paralysis is irreversible?" the commissioner said.

He stated that once the nerve was damaged, it would be very difficult to reverse such a paralysis, adding, "Infection through poliomyelitis is not reversible. So, if their own children are already immunised and they are telling other people, who are young not to immunise their children, what alternative do they have"?

Olaosebikan argued that many health authorities across the world support the potency of polio vaccines. He said if it was not safe President Obasanjo would not allow it to come into the country, adding: "That was why he banned frozen chicken and fish, banned imported juice and so many other bad things that he feels are dangerous for us to eat. He has not banned polio vaccine. The Minister of Health, Prof. Lambo, also a WHO expert, supports it, WHO itself supports it, UNICEF supports it, NAFDAC supports it, NPI supports it, so what else are you going to believe if you don't believe your president, governor or minister and relevant authorities? Our governor here is a medical doctor of international repute, if it is not good, he will not tell us to use it".

Also speaking on the prevalence of poliomyelitis in the state, Dr. Abimbola Folorunso, director of healthcare and disease control in the ministry of health, who is in charge of immunisation, stated that there was only one known case in Koroafoju in Gan Lan Ward of Ilorin East Local Government Council. Folorunso told THISDAY in an interview that on close scrutiny, it was discovered that the family came from Katsina State.

She stated that the ministry used public enlightenment as a veritable tool to stop the propaganda on the veracity of the polio vaccines. "As soon as we got over this, people became eager to participate in the NID programme and we don't have problems with rejection in any part of the state. As you have seen for yourself from the areas you monitored, you saw women willingly bringing their children to be immunised because they know it will benefit them in the long run. As a department in this ministry, we take immunisation seriously, because it is a first step to preventing diseases", the director offered.

At Budo-Egba, a remote village in Asa Council Area, the health officer-in-charge of the Dr. Abubakar Olusola Saraki Cottage Hospital, Mr. Sadu Lasoju, stated that the NID sweep method was welcome. Lasoju told THISDAY that before the programme however, the cottage hospital had set aside every Tuesday of the week as a date for immunisation.

He said they have followed this regime since he resumed work there and many children have benefited from immunisation against many preventable diseases.