August 25th, 2020, will be well remembered for Africa’s collective victory over the wild poliovirus by its commendable eradication. The World Health Organization (WHO), Africa Region officially declared the region free of the wild poliovirus. According to the Director-General of the World Health Organization, who declared in a live streaming media briefing, “today we come together to rejoice over a historic public health success, the certification of wild poliovirus eradication in the African region.”
This is a morale booster coming at a time when health systems in Africa buckle under the pressure of responding to COVID-19. Like the COVID-19 virus, polio virus’s notoriety has been the vulnerability of children under-five to this infection as well as consequent paralysis, disability, and death. In 1988, polio was responsible for about 350,000 global infections. Of which, 1 out of 200 resulted in irreversible paralysis and risk of death. Today, it is eradicated in all but two countries of the world.
Much can be learned from the success of wild polio eradication and applied not just to the current pandemic but also to the other lingering vaccine-preventable diseases. At global, regional, and national level partnerships and collaboration underlie this success.
The Global Polio Eradication Initiative, launched to achieve the eradication of polio in 1988, harnessed not just technical health capacities of national governments, WHO, and the United Nations Children’s Fund (UNICEF) but also the innovation and financial capabilities of NGOs, the private sector and GAVI (the vaccine alliance set up to increase vaccine access). Further, regional political momentum was galvanized as African leaders similarly showed commitment to polio eradication in 1996. While these initiatives have culminated in this result, the greatest victory is unarguably Nigeria’s.
Nigeria closed the gap. As the last cases of wild poliovirus in the Africa region were reported in Borno State, North-East Nigeria. This follows the dedicated service of health workers, who faced an insurgency in addition to reaching remote children with life-saving vaccines, gave all. Indeed, some paid for this victory with their lives. While many such deaths may have gone unreported, in 2013 nine health workers reportedly lost their lives while on immunization activities in the region.
Furthermore, communities and their leaders promoted immunization benefits to increase demand. Whether in advocating for immunization or by addressing immunization at the level of ward development committees, individual communities committed to amplifying local needs resulting in a more responsive and effective program. Noteworthy is the fact that donors such as GAVI and UNICEF supported this community empowerment with the overall effect we celebrate today.
Finally, innovation utilizing geographic information systems powered by mobile technology improved access. By these means, supported by the Bill and Melinda Gates Foundation, health workers at communities (remote or otherwise) could easily report and link cases to prompt care. Clearly, advancing with technology presents opportunities to explore and support a reduction in community transmission.
Overall, these prove public health success is possible, within the confines of political and technical determination, dedication, financing, and community engagement. Nevertheless, this is not the end of the wild poliovirus. There is a risk of re-introduction as according to the WHO, transmission remains to be interrupted in Afghanistan and Pakistan. Referencing COVID-19, ease of movement particularly air travel potentiated its spread globally. With these remaining hotbed of wild poliovirus transmission, this potential threat is very real and requires continuing surveillance and maintenance of routine immunization efforts nationally.
Highlighting Nigeria’s routine immunization program, a worrying contradiction and questions on the sustainability of these gains persist. According to the recent 2018 Nigeria Demographic and Health Survey, only 31.3% of children reportedly received full immunization. The factors influencing this are wide-ranging from low maternal education and low socioeconomic status to low financing for immunization as a component of Nigeria’s low budgetary allocation for health. It is clear sustaining this success may present a challenge. Therefore, while international efforts shift to tackle polio in the two remaining countries, Nigeria must not rest on its oars. Instead, gear up with the lesson learned and apply these to other vaccine-preventable diseases.
Communities should see this victory as evidence that public health measures work. Accordingly, then contribute by supporting existing measures in mitigating different burdensome diseases. The government on one hand should recognize and engage the different sections of the community for buy-in and mutual trust for programs and measures designed to tackle these diseases. On the other hand, commitment to improving the health system particularly funding for the primary health care system on which the routine immunization program rides is pivotal. Finally, collectively we must remember this victory as being founded on collaboration. Hence this must be promoted at all levels, recognizing eradicating diseases as a component of securing health is a public good. This is especially relevant as COVID-19 is currently the focus of national and international public health control efforts.