The most populous country in Africa, Nigeria, was once the epicenter of wild polio; in 2012, it accounted for almost all cases of polio worldwide. Many factors contribute to this, including the density of the population, poor sanitation, and the lack of access to health care.
The World Health Organization (WHO) describes poliomyelitis, commonly known as polio, as a highly infectious viral disease that primarily affects children under five, leading to irreversible paralysis and, in severe cases, death.
Nigeria has made significant strides toward eradication, but regions like Sokoto State, located on the northwest side of Nigeria, face unique challenges due to insecurity and conflict, which hinder vaccination campaigns and threaten progress.
Aishat Hashim, a registered nurse, midwife, and public health specialist from Sokoto State, said that having worked on polio eradication projects for over 15 years, she believes eradication is possible but will require a collective effort and addressing the root causes of the challenges related to insecurity and climate change before eradication can be achieved.
"While the country has made significant progress in reducing polio cases, there are still challenges to overcome, particularly in the northern region, including Sokoto State. The World Health Organization and other partners are working closely with the government on vaccination efforts and improved surveillance," said Hashim.
Several international organizations have been instrumental in combating polio in Sokoto State, Nigeria, through collaborations with the Nigerian government, local health authorities, and community leaders to ensure the success of polio eradication efforts. These include UNICEF, the Bill and Melinda Gates Foundation, and the WHO, which have contributed billions of dollars to immunization campaigns, disease surveillance, and public health infrastructure.
Despite all these efforts, Sokoto is battling the circulating vaccine-derived poliovirus (cVDPV), caused by gaps in immunization coverage and other public health challenges.
Negative Effects of Conflict in Polio Eradication Efforts
Insecurity poses a significant challenge to polio eradication in Sokoto State by limiting access, disrupting services, and increasing mistrust. Armed banditry and the displacement of communities due to insecurity make it difficult for health workers to reach populations, monitor their patients, and deliver lifesaving vaccines to children. However, through community engagement, innovative delivery methods, and coordinated security efforts, progress can still be made in safeguarding children against the poliovirus.
"Polio has had a devastating effect on individuals and communities in hard-to-reach and affected areas, as many children have already been paralyzed or disabled, and families have been torn apart by polio. The economic burden of polio is also significant because many families struggle to access healthcare and rehabilitation services," said Hashim.
Vaccination Campaigns
"Vaccination campaigns play a crucial role in preventing polio, especially the OPV oral polio vaccine, which is the most commonly used vaccine in Nigeria and has been effective in reducing polio cases," she said. "However, in areas with low vaccination coverage, the risk of derived poliovirus is increasing, and new cases are emerging."
Hashim said that there are some challenges in delivering vaccines, such as insecurity, poor infrastructure, and misinformation.
Militia groups such as Boko Haram and communal conflict have led to instability, making certain areas inaccessible to health workers. This insecurity hampers the consistent delivery of vaccines to all children, leaving pockets of unvaccinated populations vulnerable to polio outbreaks.
Hashim said health workers like herself navigate security risks by working closely with local authorities and community leaders.
"We also use innovative strategies like outreach services and mobile vaccination teams to reach these vulnerable populations and ensure coverage," she said.
Remote and hard-to-reach communities, coupled with inadequate infrastructure, also pose significant challenges in transporting vaccines, maintaining cold chain systems, and ensuring timely immunization.
"Misinformation and vaccine hesitancy are significant challenges; some communities are skeptical about the safety and efficacy of the vaccine, which makes them hesitant to take it, leading to low vaccine coverage," said Hashim.
She stressed the importance of community and religious leaders in dispelling misinformation.
"Community leaders help promote vaccine acceptance, remove misconceptions, and address any hesitancy about the safety and effectiveness of the vaccine. They also mobilize communities for vaccination campaigns, ensuring community involvement and providing support to health workers," she said.
While Nigeria remains wild polio-free, other countries in Africa are still seeing resurging cases. Mozambique reported a resurgence of wild poliovirus in 2022, marking the first detection in the country since 1992. The outbreak occurred in Tete Province, with cases linked to the neighboring Malawi outbreak. This resurgence has brought renewed urgency to immunization campaigns and public health interventions. The Democratic Republic of Congo (DRC) and Somalia have also reported new polio cases, raising public health concerns amid ongoing challenges like insecurity.
Climate Change
Cyclones, floods, and other natural disasters frequently disrupt health services, including immunization campaigns.
Nigeria faces significant climate challenges, including rising temperatures, erratic rainfall patterns, desertification, and increased frequency of floods and droughts. These environmental changes affect access to healthcare, the spread of diseases, and the sustainability of vaccination programs critical to polio eradication.
Like Nigeria, Mozambique, a low-income country in Southern Africa, is one of the most climate-vulnerable nations in the world.
The country faces frequent and intense climate-related disasters, including cyclones, floods, and droughts. Mozambique also faces insecurity in the Northern part of the country which further hinders effective vaccination administration.
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These challenges exacerbate existing social and economic vulnerabilities, creating significant hurdles for public health, food security, and sustainable development.
Displaced populations in disaster-affected areas are at increased risk of missing routine vaccinations. In 2019, the country was hit by Cyclones Idai and Kenneth, causing widespread destruction. These events displaced millions, destroyed infrastructure, and disrupted essential services such as healthcare, education, and electricity supply.
"Eradicating polio in Nigeria requires a sustained and collective effort. We must continue to support vaccination efforts, promote community engagement and involvement throughout the campaign, and address the root causes of insecurity and misinformation because together we can achieve a polio-free Nigeria and a safer, healthier world for all," said Hashim.
The vulnerability of Africa to climate change underscores the urgent need for comprehensive adaptation and mitigation strategies. There is a need for governments, international organizations, and local communities to work together to address the impacts of extreme weather events, water scarcity, and public health challenges.
Investments in climate resilience and effective public health systems can help Africa reduce the devastating effects of climate change, alleviate disease burdens, and build a sustainable future for its population.
