Daily Trust (Abuja)

Nigeria: Polio Eradication and Endgame

opinion

24th October was the World Polio Day which was established by Rotary International over a decade ago to commemorate the birth of Jonas Salk, who led the first team to develop a vaccine against poliomyelitis.

Use of this inactivated poliovirus vaccine and subsequent widespread use of the oral poliovirus, developed by Albert Sabin, led to the establishment of the Global Polio Eradication Initiative (GPEI) in 1988. Since then, GPEI has reduced polio worldwide by 99%.

However, in 2012, transmission of indigenous wild poliovirus continued in three countries: Nigeria, Afghanistan, and Pakistan. In April 2012, the World Health Assembly declared the completion of polio eradication a programmatic emergency for global public health. The World Polio Day this year was utilised to remind ourselves about a significant plan tagged 'Polio Eradication and Endgame Strategic Plan 2013-2018' which should not be only known, memorise but implement so that no child comes with Poliomyelitis again.

The Polio Eradication and Endgame Strategic Plan 2013-2018 is a comprehensive, long-term strategy that addresses what is needed to deliver a polio-free world by 2018. The plan was developed by the Global Polio Eradication Initiative (GPEI) in consultation with national health authorities, global health initiatives, scientific experts, donors and other stakeholders, in response to a directive of the World Health Assembly. The Polio Eradication and Endgame Strategic Plan 2013-2018 addresses the eradication of all polio disease, whether caused by wild poliovirus or circulating vaccine-derived poliovirus, while planning for the backbone of the polio effort to be used for delivering other health services to the world's most vulnerable children.

The End game document reiterated that since its launch at the World Health Assembly (WHA) in 1988, the Global Polio Eradication Initiative (GPEI) has reduced the global incidence of polio by more than 99% and the number of countries with endemic polio from 125 to 3. More than 10 million people are walking today who otherwise would have been paralysed.

On 26 May 2012, the World Health Assembly declared ending polio a "programmatic emergency for global public health". Noting India's success using available tools and technology, the threat to the global community of ongoing poliovirus transmission in the last three endemic countries Afghanistan, Nigeria and Pakistan - and the growing knowledge about and risk of circulating vaccine-derived polioviruses (cVDPVs), which can cause outbreaks of paralytic disease, the WHA called on the World Health Organization Director-General to develop and finalize a comprehensive polio endgame strategy.

Progress made against polio in 2012

The End game document observed that the year 2012 saw tremendous advances for the programme, setting up the possibility to end polio for good. Among the most significant advances is India which, in February 2012, celebrated a full year without a child paralysed by indigenous wild poliovirus (WPV). India was arguably the most technically challenging place to eliminate polio. The country's success was due to the ability of the programme to repeatedly reach all children; the use of a new bivalent oral polio vaccine (bOPV); sustained political commitment and accountability; societal support; and the availability of resources needed to complete the job. The country remains polio-free today.

In September 2012, government leaders in the endemic and donor countries and the Secretary-General of the United Nations declared that ending polio is a top priority. This signalled the political commitment needed to effectively implement national Emergency Action Plans and capitalize on the progress to date. In addition to declining cases in Afghanistan and Pakistan, evidence demonstrates that these countries and Nigeria showed marked improvement in increasing vaccination coverage in 2012, putting them on a trajectory to interrupt transmission by the end of 2014.

In Afghanistan, by the end of 2012, approximately 15 000 children remained unreachable, down from 80 000 in 2011, thanks to a combination of strategies, such as permanent polio teams operating in the key high-risk areas and intense outreach efforts with community leaders. In Nigeria, although overall cases increased in 2012, case numbers had stabilized by the last quarter of the year due to revised micro-plans, better vaccination team selection, improved monitoring and strong oversight at the national and state levels. The proportion of very high-risk local government areas in which vaccine coverage reached the target threshold increased from 10% in February 2012 to 70% in February 2013.

The Polio Eradication and Endgame Strategic Plan 2013-2018.

The plan was created to address past failures in programme implementation, with the following in mind:

1. One size does not fit all: While the core principles of eradication are global the tactics needed in the remaining countries must be carefully tailored to adapt to a range of local factors.

2. Technological innovation cannot overcome gaps in programme management and community engagement.

3. A combination of innovations tailored to the country context can deliver success in even the most challenging conditions.

On 25 January 2013, the WHO Executive Board reviewed and strongly endorsed the Plan's goal, objectives and timelines.

The 4 main objectives are as follows:

1. Stop all WPV transmission by the end of 2014 and new cVDPV outbreaks within 120 days of confirmation of the first case

2. Hasten the interruption of all poliovirus transmission and help strengthen immunization systems

3. Certify all regions of the world polio-free and ensure that all polio-virus stocks are safely contained

4. Ensure that a polio-free world is permanent and that the investment in polio eradication provides public health dividends for years to come

As Nigeria is among the 3 endemic counties, this plan represents a hope to be implemented, so that no child in Nigeria suffers Poliomyelitis again.

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