Nigeria's Polio Infrastructure Bolster COVID-19 Response

(File photo).

When the Nigerian Government announced the first confirmed novel coronavirus (COVID-19) case in the country on the morning of February 27th, Dr Rosemary Onyibe was ready to report for duty.

Dr Onyibe, who has worked with the Polio Eradication Initiative for more than 10 years, is the South West Nigeria Zonal Coordinator of the World Health Organization (WHO) Polio eradication programme that also supported response to Ebola Virus Disease outbreak in 2014.

"Once I heard the news, I instantly thought: duty is calling. My expertise is needed to serve my community," said Dr Onyibe.

Later that day, Dr Onyibe received an email from the WHO's acting Country Representative (WRai) inviting her and other colleagues to Abuja for a pre-deployment briefing to support the COVID-19 outbreak response.

Any disease outbreak in Africa's most populous country is never taken lightly and with the gravity of the global situation of the COVID-19 pandemic, the Nigerian Government had to move fast and mobilize all resources for the outbreak response. The polio programme was among their first calls for support for its human resources, technical expertise, disease surveillance and community networks, as well as its logistical capacity.

As of 01 April 2020, Nigeria has confirmed a total of 174 cases, 163 of which are currently receiving care, two are dead, and nine recovered and discharged. More than half of the cases contracted the virus after returning from high-risk countries, 10% of the cases are contacts of already confirmed cases, and the remaining 36% of the cases have incomplete epidemiological information. Affected States include Lagos, Ogun, Osun, Oyo, Edo, Rivers, Ekiti, Bauchi, Kaduna and the Federal Capital Territory.

"We immediately mobilized the existing polio personnel in the affected states to swing into action," said Dr Onyibe.

With the support of polio personnel, tracking a total of 6,655 contacts and conducting follow up visits is being facilitated. Polio staff also engage with the community and provide accurate, clear, and timely communications about the virus and how to limit its transmission. Technical officers also sensitized more than 11,700 religious and community leaders in all 36 States and FCT.

More than pinpricks

WHO's acting Country Representative in Nigeria, Dr Fiona Braka, noted that the support that the polio programme extends to other diseases goes beyond just vaccination.

"Polio workers perform critical functions to contain outbreaks. With the COVID-19 response, the polio staff are assisting with coordination, contact tracing, investigation of cases, risk communication, community engagement and disease surveillance. This support will be key as Nigeria enters the community transmission phase."

Activities supporting other diseases include data collection, analysis, reporting and archiving using mobile phones fashioned after the real-time tracking and reporting system that polio vaccination teams in northern Nigeria use.

These activities are all essential for vaccine preventable diseases like measles, Yellow fever and meningitis.

Adopting Polio Emergency Operations Centre model

Since the beginning of the outbreak, the Nigerian Ministry of Health activated Emergency Operations Centers (EOCs) in all of the affected states to coordinate the outbreak response activities. The EOC, which is a model first introduced to Nigeria by the polio programme, is organized under six functional units: Management and coordination, epidemiology and surveillance, case management, laboratory services, risk communication, and point of entry.

One of the EOCs' first priorities is to build the capacity of clinicians, port health officials, point of entry personnel, ship crews, military and para-military personnel and other relevant groups on infection prevention and control, decontamination, and contact tracing. With WHO's support, the government is rolling out similar training to key health workers from in other states.

Combined effort and continued vigilance

The polio programme has also put its innovative technology to support the response by adding disease surveillance questions on COVID-19 to the mobile application it devised for acute flaccid paralysis surveillance (AFP), a clinical symptom of poliomyelitis. The SMS-based application is called AVADAR, short for "auto-visual AFP detection and reporting" and it relies on a network of health workers and community volunteers in selected hard to reach areas to support disease surveillance through filling in a simple form after receiving a notification.

There is a total of 774 Disease Notification and Surveillance Officers spread across Nigeria working on COVID-19 contact tracing, in addition to 50,689 community informants for community sensitization and case reporting. These personnel are cardinal to active case search - a surveillance strategy that the polio programme trail-blazed to engage thousands of village volunteers to conduct searches for acute flaccid paralysis cases.

The polio infrastructure

With Nigeria passing the three-year mark with no wild poliovirus cases, the African Region is due to be certified to have eradicated wild polio virus. The independent Africa Regional Certification Commission is expected to make a final decision in the second half of 2020. Achieving this historic milestone will lead to implementation of a plan to ensure transition of polio workers to retain their knowledge and skills and keep the infrastructure in place.

Polio workers have been a stalwart of frontline support for outbreak response. For example, polio workers were essential to containing an Ebola virus outbreak in 2014.

The polio infrastructure was originally designed towards achieving the polio eradication goals," said Dr Braka. "Now, this polio infrastructure has incorporated new functions such as basic health services and response to outbreaks of other diseases, and is in the process of possible transition into the broader Nigerian health system."

On COVID-19 response, Dr Braka observed, "The polio infrastructure on ground, including health workers, traditional and religious leaders, community mobilizers, in the states, were crucial for mounting the response to the outbreak and continue to be WHO's frontline technical support to the Nigeria Centre for Disease Control (NCDC) and States respective incident Management teams."

Future of public health interventions assured

Significant investments by donors and partners have gone beyond polio eradication to saving lives and impacting positively on people's health. WHO and other partners are currently supporting the National transition plan to ensure these investments are sustained, and made available to support other National public health efforts and priorities.

"We must carefully consider how we transition many of the polio workers and the polio infrastructure to help with managing other health needs," Dr Braka said. "Future funding and partnerships will be a key part of this work."

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