Ebola outbreak in Nigeria and how it was managed

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Title The Impact of the Polio Eradication Programme on the Nigerian Healthcare System Course Title: Comparative Health Systems( SLSM005-SUM) Word Count (5000 +/- 10%) 5250

Table of Content

1.0. Introduction 2

What is Poliomyelitis? 2

History of Poliomyelitis in Nigeria 2

2.0. Overview of the Nigerian Healthcare System and the Polio Eradication Efforts in Nigeria 4

2.1. The Nigerian Healthcare System 4

2.2. The National Response through Nigerian Polio Emergency Operations (EOC) 9

2.3. The International Response and regional collaborative efforts 11

3.0 Politics, Religion and Polio Eradication Programmes in Nigeria 13

3.1. Political and Religious Interference in Primary Healthcare

delivery in Nigeria 13

3.2 Polio Resurgence in Northern Nigeria 15

3.3 The Current Status of Polio in Nigeria 16

4.0 Conclusion 16

References 17

Abbreviations 21

1.0 Introduction

1.1 What is Poliomyelitis?

Poliomyelitis, commonly known as polio is a highly infectious viral disease caused by the polio virus (WHO, 2018). This enterovirus from the picornavirus family, can damage the digestive tract and attack the central nervous system, invading the brain and spinal cord of the patient and can cause paralysis in some cases shortly after infection (Osazuwa-Peters, 2011; Renne, 2012; CDC, 2017 and WHO, 2018). Although polio is seen as a paralytic disease, about 70 % of infections can be asymptomatic and may not result in paralysis. However, infected individuals without visible symptoms can still pass the virus to others and make them gravely ill (CDC, 2017). The polio virus mostly affects children under 5 years of age and about 0.5% of infections leads to permanent paralysis resulting in about less than 10% fatalities when the breathing muscles of infected persons become immobilized (WHO, 2018). Some of the symptoms for non-paralytic polio infection are generic and only last for a few days. They include; fever, common cold, fatigue, headache, vomiting, stiffness of the neck and pain in the limbs appearing like a mild meningitis with stiffness lasting for up to 10 days (Ochmann and Roser, 2017).Transmission is from person to person through oral contact with infected persons faeces likely through unwashed hands after using the toilet or children playing with toys contaminated with faeces which ends up in their mouth ( WHO, 2018; CDC, 2017). The poliovirus resides in the gullet and intestines of an infected person and can spread also through sprays from a sneeze or cough, but this is very rare (CDC, 2017). There is no known cure for polio now, but polio vaccination can provide lifelong protection for children especially when given multiple times (WHO, 2018). Polio viral infection thrives in overcrowded and filthy environments, so observing basic hygiene of proper washing of hands after toilet use and good sewage disposal will help contain the spread.

1.2 History of Poliomyelitis in Nigeria

Polio dates to thousands of years ago going by some ancient relics and historical records. It was recorded for instance, that the poet Sir Walter Scott in 1773 was infected with polio aged eighteen months which paralyzed his right leg from infancy (Smallman-Raynor et al, 2006) and an Egyptian stele showing a man with polio as shown in fig.1 below.

Fig 1. Ancient Evidence of polio infection (1580-1350 BC)

http://polioeradication.org/wp-content/uploads/2016/07/1580-–-1350-BC-e1471346715147.jpg

An Egyptian stele showing a priest with a withered leg proving the existence of polio for thousands of years.

Source: GPEI website (2018)

Poliomyelitis was one of the most feared diseases around the 20th century in the now developed countries paralysing and disfiguring a lot of children every year (Polio Global Eradication Initiative (GPEI), 2018.). However when the polio vaccine was introduced in the 1950s developed by Dr Jonas Salle, it hindered the spread and the number of infections reduced considerably (Ochmann and Roser, 2017; GPEI,2018). Later in the early 60s a new live oral polio vaccine (OPV) was developed by Dr Albert Sabin. This later vaccine became very popular and became the global choice of most national immunization programmes (GPEI,2018).

Polio was well known in Nigeria before the introduction of the anti-polio vaccine. Although polio was endemic during the colonial era, vaccination was concentrated on the expatriates and their families not the indigenous Nigerians until 1974 when the WHO carried out a brief polio vaccination program in Ibadan resulting in a decline in the number of polio cases in the city and its environs (Renne, 2012). According to Renne (2012, p.498) the positive outcomes of the earliest vaccination exercise in Nigeria by WHO resulted in some influential Nigerians advocating for regular vaccination of every Nigerian child. The call to vaccinate Nigerian children for polio was only embraced nationally in 1988 when the Nigerian government was assisted by UNICEF to implement the Expanded Programme on Immunisation (EPI). This programme according to the author was targeted at vaccinating children against six early childhood diseases including polio. Primary health care centres were opened across the country to implement the mass vaccination programme. These primary health care centres played a major role in the success of the EPI programme nationwide. The launching of the Global Polio Eradication Initiative (GPEI) in 1988 was the spring board for this immunisation programme in Nigeria with USA investing above UD$11 billion worldwide through the GPEI undertaking (GPEI, 2018).

However, due to lack of maintenance culture as well as corruption and unstable political and economic climate in Nigeria things changed after 1990. The Nigerian federal government according to Renne (2011, p.498) decided to transfer the management and funding of the EPI programme and primary health care operations to states governments. This unfortunate decision the author believes, resulted in a sharp decline in immunization levels with levels as low as 26% to 30% coverage reported in some states. This was the initial level before the Nigerian government got involved in the programme to eradicate polio worldwide (Renne, 2012). In 2007 according to Mohammad (2015, p.1) the National Programme on Immunisation was re-organised, and some progress was recorded in the fight against polio for about two years (2009- 2010). This progress stalled again raising concerns in the global community who at this point saw Nigeria as holding back the complete eradication of polio worldwide (Mohammad, 2015). The wild polio which has three strains (strains 1,2 and3) has been the culprit in all the infections in Nigeria except for recent detection of vaccine derived poliovirus strain in 2016 in Borno state in the northeast of Nigeria (WHO, 2016). Two out of these three strains of wild polio virus are now extinct. The type 2 strain was eradicated in 1999 and the last reported case of strain 3 was in 2012 in Nigeria.

2.0. Overview of the Nigerian Healthcare System and the Polio Eradication Efforts in Nigeria

2.1. The Nigerian Healthcare System

The Federal Republic of Nigeria is the most populous country in Africa with an estimated population of 195 million (World Population Review, 2018). As at 2016 however WHO estimated Nigerian population to be around 185 million people (WHO,2018) with an observed life expectancy at 66.4 for females and 63.7 for males.

Table1. Life expectancy, 1990-2016

1990

2016

1990

2016

Females

61.8

69.2

55.8

66.4

Males

59.0

64.6

54.0

63.7

Source: GBD compare (IHME, 2017)

In Nigeria Malaria is believed to be the leading killer in view of 192,284 deaths from malaria in 2015 (Obinna, 2016). The other major killers according to the author include diarrhoeal diseases and HIV/AIDS taking more than 143,000 and 131,000 lives respectively. Going by CDC (2018) country profile report on Nigeria the following diseases are the 10 top killer diseases in Nigeria.

Top 10 Causes of Death

1. Diarrheal Diseases

2. Neglected Tropical Diseases (NTDs) &  Malaria

3. Neonatal Disorders

4. HIV/AIDS  & Tuberculosis (TB)

5. Cardiovascular Diseases

6. Neoplasms

7. Diabetes/Urological/Blood/ Endocrine Disorders

8. Unintentional Injuries

9. Other Non-communicable Diseases

10. Nutritional Deficiencies

Source: GBD Compare (2018)

Although polio is not on the list, it is still considered a deadly disease due to Nigeria’s proximity to other countries in the sub- Saharan West African coast that are susceptible to the polio virus making global spread possible. One child infected can cause global spread because Polio according to Fatiregun (2005, p.20) “does not respect national borders or continental boundaries”. Nigeria shares borders with Niger and Chad in the north, Benin in the west and Cameroon in the east with the Gulf of Guinea and the Atlantic Oceans covering the southern borders of Nigeria. Infectious diseases like polio can easily cross the borders to the neighbouring countries due to poor border control, weak and in some cases, non-existent surveillance operations in these poor developing African countries to track spread of infectious diseases in the region.

Historical

Nigeria, a former colony of Great Britain has 36 states with Abuja as the federal capital city, serving as the seat of government. The first contact Nigeria had with scientific medicine was during the enforcement of the abolition of slave trade which brought the Royal Navy to West Africa and they had Naval surgeons on board and later some Army medical officers arrived too (Schram, 1971). In 1845 according to Schram (1971,p.1), those who had no contact with the European coastal stations in Nigeria had their first encounter with western medical treatment through the arrival of missionaries whose first point of call was in Badagary, Lagos. The prior explorations of Mungo Park and Richard Lander were seriously fraught by disease. In the expedition of 1854, Dr Baikie introduced the use of quinine, which greatly decreased mortality and morbidity among the explorers who had contacted malaria (Scott-Emuakpor, 2010). This discovery was contentious because some believed that Dr Baikie borrowed the idea from his traditional herbalists associates during his expeditions. The first missionary hospital was eventually founded in 1886 at Abeokuta. Later two more modern missionary hospitals were opened, one in Ilesha in the west and the other in Uburu in the east in 1912 and 1915 respectively as recorded by Schram (1971, p.2). Prior to this period Nigerians depended wholly on traditional herbal or ritualistic health care. This is how modern medical services started and evolved in Nigeria until her independence on October 1st, 1960.

Structure

Nigeria operates a pluralistic health system whereby health facilities are owned by the public sector, that is the government as well as by private providers who could be private for profit and private not for profit concerns (Skolnik, 2012,p.90). Orthodox medicine, alternative and traditional ritualistic health care delivery as well as faith healing operate alongside each other in Nigeria forming the health care system in operation. The Nigerian healthcare administration is organized in to three (3) tiers of government namely; the Federal government, the State government and the Local government areas. Health care is administered through these three tiers. The federal government over sees the tertiary health structures like the university teaching hospitals and the specialist hospitals through the Federal Ministry of Health. The secondary health structures like general hospitals are administered by the state government through the State Ministry of Health while the primary health care facilities are run and maintained by the local government areas through its health department and then of course the Private health care providers (Federal Republic of Nigeria/ Federal Ministry of Health (FRN/FMOH), 2000; Akplagah, 2015). In recent years however, the federal government has managed, funded and supervised infectious outbreaks like polio, HIV/AIDs and Ebola considered as national emergencies. When such is the case the state government health facilities and the primary health care centres under the local government authority’s jurisdiction are taken over by emergency operations teams deployed by the federal government to monitor case incidents and provide surveillance and contact tracings. This arrangement has worked well in the fight against polio and the Ebola outbreak in 2014 in collaboration with many international health agencies like WHO, CDC, UNICEF and a few others (Desmarais, 2016). Figure 2 below shows the Nigerian Health Service structure.

Fig.2. Organizational Pyramid of the Nigerian Health Services Structure

CABINET National Advisory Council on Health Inter Sectoral Collaboration Federal Ministry of Health Private sector, NGOs, ...

Source: Akplagah (2015) Health Systems in Nigeria.

Funding

Health care in Nigeria is funded by a combination of revenue from different sources including; budgetary allocation from the federal government, out of pocket payments for treatment by citizens, funding from international bodies and donor agencies as well as health insurance contributions (Akplagah, 2015 and Uzochukwu et al , 2015 ).

The out of pocket source contributes more than 70% of total health expenditure and this can be in the forms of hospital bill payments to private healthcare providers at the time of service delivery and payments for medical supplies like medications (Uzochukwu et al, 2015; Okpi, 2018). Despite these health financing options in Nigeria, the finances are still fairly shared across the health system with evident area inequality in healthcare disbursements. Hence, reaching effective health care funding system continues to be tricky in Nigeria (Uzochukwu et al , 2015). Another contributing factor is the issue of corruption and a culture that neglects accountability. Funds allocated to project are often mismanaged and no one is held accountable. Moreover the private health sector do not want a functional government funded health service because they are profiteering through the collapse. Lack of regulatory role by the federal government in fees charged for private medical treatments, standardising pharmaceutical products, drugs administration and the quality of service have left the population defrauded financially and given substandard medical treatment and diagnosis. Most doctors who work in the government health establishments have their own private practice so when there is a strike, which is quite regular, they fall back on their private practice most times helping to prolong the strike actions. In fact, Mcfubara (2015, p.62), stated that the continuous strikes have become impurity in the Nigerian health system. This impunity he believes is fuelled by greed, self-interest and nepotism. According to WHO “Protecting people against the financial consequences of ill-health” (WHO,2010) is one of the functions of a good health system, this clearly is not happening in Nigeria. A significant percentage of drugs in circulation in Nigeria are substandard and some downright fake (National Agency for Food Drugs Administration and Control (NAFDAC), 2003). The drugs administration and control agency is not well funded to regulate the industry, even when well-funded the issue of corruption comes to play.

Moreover, a considerable number of the population, more than 50% live in the rural areas and below the poverty line of less than $1 per day and so cannot afford the high cost of health care in the country (Omoruan et al, 2009; Welcome, 2011). There is also the issue of poor referral system between the three tiers of the Nigerian health service structures which reflects on the poor administrative functions of the health care delivery system as a whole. (Welcome, 2011).

Resources

Nigeria has one of the largest number of human resources for health (HRH) in Africa but, like the other 57 HRH crisis countries identified by the world health report in 2006, has concentrations of health care professionals including; doctors, nurses and midwives that are still too low to efficiently deliver vital health services (1.95 per 1,000) (WHO, 2018). In recent years mass migration to foreign countries has reduced and the primary challenge for Nigeria is insufficient production and unfair distribution of health workers. Majority of health care professionals are concentrated in urban tertiary health care services particularly in Lagos, Port Harcourt and Abuja at the expense of the rural or semi-urban health centres. In 2011 Welcome (2011, p.470) reported that the number of health institutions in Nigeria stood at 33,303 general hospitals, 20,278 primary health centres and posts, and 59 teaching hospital and federal medical centres, even so, health care institution continues to suffer shortage in health work force. Adebayo et al (2016) in their study estimated the number of doctors in Nigeria health service in 2016 as ranging between 31,413 to 50,120 while nurses are estimated to range from 83,548 to 137,859. In their view, if no effort is made to upscale the current supply there will be a significant short fall in health workers in Nigeria making the desired objective of achieving effective health care delivery and solving the heavy disease burden in Nigeria unattainable. Over the years the federal government allocation to health has steadily increased. In 2014 the budget allocation for health was NGN279.2 billion which increased significantly from NGN154.6 billion in 2009 (Uzochukwu et al, 2015). The health budget has increased further in 2018 to N340.5 billion but this huge amount represents only about 3.9% of the total budget (Okpi, 2018). The African Union’s Abuja Declaration 2001, signed in Nigeria, encouraged member nations to earmark at least 15% of their annual budgets to health (WHO,2011). Comparing this spending on health with other countries will show huge disparities. In America the spending on health is more than 17% of the total budget, in the United Kingdom(UK) it is more than 9%. Even South Africa with a lot less population than Nigeria spends 13.5% of her GDP on health. The average for most countries, however is 10% ( Sawyer and Cox ,2018; UNICEF, 2017). This low spending on health explains the myriads of healthcare challenges facing the nation and the very often negative health indicators associated with Nigeria including the resurgence of the polio virus recently.

2.2. The National Response through Polio Emergency Operations Centres (EOC)

In 2012, Polio was a serious public health issue requiring urgent response in Nigeria. Nigeria was the only remaining polio prevalent country in Africa with a lot of new cases reported eventually reaching 122 confirmed wild polio virus cases (Desmarais, 2016). This resulted in Nigeria being regarded as the worst performing of all polio-endemic countries, with the poorest global record of wild poliovirus cases. This situation in Nigeria was considered a threat to the dream of total eradication of polio worldwide (Osazuwa-Peters, 2011). A lot of things were responsible including low levels of immunization coverage especially in the northern part of the country, poor community mobilization and engagement, mismanagement of resources, lack of accountability and weak coordinated approach between Nigeria and her international partners working toward polio eradication. Worse still is the challenging security conditions because of Islamic militant’s insurgence especially the Gboko Haram sect within and around the states in the northeast of Nigeria believed to be the highest risk area of poliovirus infection. May and Semerenskaya, (2017,p. 248) believe that the security issue in the north is discouraging volunteers from going to those polio endemic areas to fish out the consistently missing children in the north to administer oral polio vaccine to them. These missed out children are the reservoirs of the flash polio resurgence repeatedly occurring in the north east of Nigeria.

Eventually the then President and Commander in Chief of Federal Republic of Nigeria, President Goodluck Jonathan, decided to take on the fight against polio as a national emergency (Muhammad, 2015). The President Good inaugurated a Presidential Task Force on Polio Eradication (PTFoPE). Many National Polio Emergency Operations Centres (EOC s) were set up immediately by the Presidential Task Force on Polio Eradication (PTFoPE) and took polio virus head on. In his report Mohammad (2015) in his report stated that the president confronted polio with vigour by setting up the presidential task force on polio eradication to oversee the activities of the State and LGA Task Forces as well as providing regular real time progress report to the President personally. The Expanded Programme on Immunization (EPI) was accelerated by the PTFoPE under the leadership of the National Primary Health Care Development Agency (NPHCDA) who equally set up EOCs in all the critical states by galvanising varied and critical expertise from the government and the GPEI partners, on diverse workings of Polio Eradication Initiative. This could be seen as the turning point in Nigeria’s polio eradication efforts. Innovative campaigns were introduced to increase take up of the oral polio vaccines (OPV). Accountability according to Muhammad (2015) was enforced and the federal government supported the campaigns with additional funding every year. The collaborative efforts and tenacity of the NPHCDA, PTFoPE , GPEI partners and the EOCs started yielding fruits by 2013. The identified polio cases reduced from 122 in 2012 to 53 cases by the end of 2013. Rapid response to reported outbreaks, community mobilization, routine immunization and consistent surveillance played major roles in the success recorded. This momentum was sustained in 2014 reducing polio cases further to only 6. No case was recorded in 2015, 4 cases were reported in 2016 and non-in 2017 as shown in figure 3 below (May and Semerenskaya, 2017; NPHCDA, 2018)

Figure 3: Confirmed Wild Polio Virus (WPV) cases in Nigeria, 2005‐2017

Source: NPHCDA (2018)

Nigeria is capable of eradicating polio. This can only be realised when politicians in authority see polio eradication as a matter of national health emergency like the former president and provide funding that will be properly utilized and accounted for. Community participation is vital as well as expert collaborative efforts among intentional and proactive agencies to rid Nigeria and other two remaining polio endemic countries, Pakistan and Afghanistan of polio once and for all.

2.3 The International Response and Regional Collaborative Efforts.

International health agencies have been at the forefront of polio eradication programmes in Nigeria especially the World Health Organisation (WHO) even before the launching of the Global Polio Eradication Initiative (GPEI) in 1988 by the World Health Assembly. In 1974 WHO intervened in the riotous spread of polio in Ibadan by initiating a short-lived polio vaccination program resulting in the number of polio cases in the city and its environs declining (Renne, 2012). With the launching of the GPEI in 1988 the WHO presence and other international health agencies became even more pronounced and visible. The Presidential Task Force on Polio Eradication (PTFoPE) was set up to lead the country’s targeted response to eradicate polio from Nigeria (Muhammad, 2015). The task forces’ collaborations with international health agencies and organisations to win the fight against polio was part of the plan. Some of the organisations and agencies that were part of this sustained collaborative effort in eradicating wild polio in Nigeria include; WHO, United Nations Children’s Fund (UNICEF), Centre for Disease Control and Prevention (CDC), Rotary International and Bill and Melinda Gates Foundation. The Nigerian federal Ministry of Health and the National Primary Health Care Development Agency (NPHCDA) were part of the team to improve coordination and to closely monitor and manage the whole performance of the polio eradication process.

The Bill & Melinda Gates Foundation till date has invested about US$1.6 billion in Nigeria to help fund healthcare pilot projects, agriculture and financial inclusion. This is their biggest investment in Africa in addition to payment of $76 million of Nigeria's indebtedness to Japan to help eradicate polio ( Sampathkumar, 2018). Alhaji Aliko Dangote, Africa’s richest man, who is a Nigerian, has earlier worked with Mr Gates to help interrupt the spread of the poliovirus in Nigeria and has also helped fund other health programmes and projects in Nigeria (ReliefWeb, 2018). The taskforce through the Ministry of health established Emergency operation centres (EOCs) in all the high-risk areas of the country to focus on the highest -priority interventions with the national polio EOC located in Abuja the federal capital territory. This was where eradication and immediate response strategies and vaccination campaigns were planned. The EOCs worked as centralized command-and-control units responsible for disaster preparation and management (Desmarais, 2016). It is reported that each of the core organizations contributed people to help with data collection, analysis and reporting of eradication triumphs while the NPHCDA supplied indigenous staff who were adequately trained to gather figures from Local Government Areas (LGAs), districts, and settlements in poliovirus high-risk states. Epidemiologists operating at the EOCs were placed by CDC and WHO to ensure that the house to house vaccination programmes did not miss out any child especially the hard to reach ones. Desmarais (2016) described the operations of the EOCs as a war room approach stating that even experts from UNICEF were on ground to handle the communication challenge helping with community mobilization, engaging with traditional, religious and opinion leaders to diffuse any misconceptions regarding vaccination. Desmarais continued that WHO positioned specialists and thousands of vaccination tents as well as immunization specialists, vaccination-program supervisors, coaches, and polio-surveillance professionals. The power house of the polio eradication programme which is the national EOC data team had representatives from all the EOC partners. The team adopted fast tracked analytics and regular synthesis to monitor progress. All campaigns were evaluated during and immediately after the intervention to assess success and to device new strategies to reduce the number of missed children. The success rate was unprecedented as shown in figure 4 below. This reflected the massive progress made in the levels of vaccination coverage in the high-risk states especially in the north-eastern states of Nigeria.

Fig. 4. Shows how levels of vaccination coverage increased by six folds between 2012 -2015 with the EOCs war room approach to vaccination in the high-risk areas.Nigeria increased the number of high-risk state LGAs reaching target immunity coverage more than sixfold.

Source: Desmarais (2016) McKinsey & Company

These 5 core partners that lead the operations of GPEI alongside 200 national governments have invested around $14 Billion globally in the GPEI’s effort to eradicate polio worldwide(GPEI,2018).

3.0. Politics, Religion and Polio Eradication Programmes in Nigeria

3.1. Political and Religious Interference in Primary Healthcare delivery in Nigeria.

Wassilak, and Orenstein (2010, p.447) stated that since 1988, which marked the launching of the GPEI, global polio incidence has reduced by more than 99%, from about 350,000 cases to 1606 established cases in 2009 in 125 countries. It plummeted even further to 572 cases in 11 countries( Altman, 2003) by the end of that year. According to the authors, significant progress was made before 2000 but it gradually slowed down in the years that followed. This stagnation and even reversal of gained grounds against polio were the fallout from two major episodes of international spread of WPV which occurred during 2003–2009, originating from India and Nigeria re-infecting countries that were once polio free. Wild Polio virus has been endemic to Nigeria despite all the efforts made towards eradication of polio in Nigeria. Mid 2003 witnessed a disagreement regarding the safety of the oral polio vaccine. This disagreement positioned the five states affected against the federal government, WHO and UNICEF (Obadare, 2005)

It was rumoured that the oral polio vaccine was causing infertility, HIV/AIDS, cancer and a ploy by western world to depopulate the Islamic world ( Skolnik, 2012; Osazuwa-Peter, 2011; Jegede, 2007 ). This resulted in vaccination boycott by about five northern states instigated by certain traditional, political and religious Islamic leaders in northern Nigeria. This boycott led to the resurgence of wild polio in Nigeria and subsequent spread to neighbouring West African countries as shown in figure below jeopardizing the World Health Organization strategy to eliminate polio worldwide by the end of 2005 (Altman, 2003)

Fig. 5 Showing re-infection of neighbouring countries with wild poliovirus strain from Nigeria.

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Source: Osazuwa-Peters (2011).

These rumors gained ground predominantly because of the religious cultural values of the people as well as high levels of illiteracy. Northern Nigeria is strongly fashioned by religion. So the collective value system is a religious one alluding great authority and unconditional allegiance to their political and religious leaders at the expense of the federal government commands (Renne, 2010). Muslims in northern Nigeria became suspicious of western drugs and wary of vaccination campaigns initiated by the federal government since 1996, when families in Kano state blamed New York-based pharmaceutical giant, Pfizer for using an experimental meningitis drug Trovan on their children during the 1996 meningitis epidemic in Nigeria without ethical approval, informed consent and fully informing them of the risks (McKenzie, 2004). Pfizer was not penalised as the affected families expected so this strengthened their resolve to boycott the immunization exercise which affected about five states in total. The states affected were Niger, Bauchi, Kano, Zamfara and Kaduna states (McKenzie, 2004). They felt that their children were used as guinea pigs with the approval of the federal government via the federal ministry of health and some United Nations agencies (Yahaya, 2005). It was also assumed that the war in Iraq then aggravated the situation because if America is fighting people in the Middle East the conclusion is that they are fighting all Muslims (Murphy, 2004). The polio vaccines could be another form of America trying to harm Muslims. In July, 2004 the conflict was eventually resolved through dialogue, with religious leaders playing a major role in the process ( Jegede, 2007). Unfortunately, a lot of harm had been done before the resolution. It was discovered that Polio strains from Nigeria were responsible for about 80% of global polio cases at the time of the polio vaccine boycott in northern Nigeria (Kaufmann and Feldbaum, 2009)

3.2 Polio Resurgence in Northern Nigeria

Nigeria was at the verge of celebrating more than two years without any wild poliovirus infection and was even removed from the list of polio endemic countries by WHO only for wild polio and vaccine derived polio cases to resurface in Borno mid 2016 (Desmarais , 2016; WHO, 2016). This was a devastating blow to the Country who saw the past two years of no polio infection case as a milestone for the country and for the global polio eradication initiative (Desmarais, 2016). WHO (2016) confirmed that there was a link between the new detected wild polio cases to a strain detected in Borno State in 2011 meaning that this particular strain has been circulating unnoticed since then. WHO reported that strengthened disease surveillance is in operation in the area. Specimens from healthy household contacts are tested to avoid a repeat of the 2011 Borno oversight. Through these tests a vaccine – derived polio virus has been detected in one of the specimens (WHO, 2016). A regional outbreak response involving neighbouring countries is in place as a response to the detected wild and vaccine derived polio virus in north-east Nigeria. In order to prevent an international spread Nigeria and all neighbouring countries of the Lake Chad Basin during the 66th session of the World Health Organization Regional Committee for the African Region, were asked as a matter of the utmost urgency to fully implement a coordinated outbreak response in order to quickly interrupt this outbreak before the end of 2016 (GPEI, 2016).

3.3 The Current Status of Polio in Nigeria

Since the announcement of the outbreak of poliovirus in Nigeria again after being polio free for about two years the concern has been the possibility of cross boarder transmission because of the large movement of people across Nigeria and her neighbouring countries in the Lake Chad are a (GPEI, 2016). According to Fatiregun (2005, p.20) poliovirus disease does not respect national or international boarders or boundaries. The GPEI spokesperson revealed that many rapid and high-quality vaccination campaigns were urgently executed in the area so as to minimise further transmissions.

The outbreak highlights the risk of transmission throughout the Lake Chad region which spans notably Chad (Lake Chad area), northern Cameroon, southern Niger and neighbouring parts of the Central African Republic. There are large movements of people across and within these countries as a result of an ongoing humanitarian situation. He expressed optimism that there is hope for a rapid end to the outbreak. The only snag he sees is the insecurity common within and around the countries in Lake Chad area. This insecurity has been responsible for the missing children who are cut off from repeated immunization campaigns because they cannot be reached. He believes that conducting several vaccination campaigns that can reach nearly every child will knock out the polio virus once and for all from the face of the earth (GPEI,2016).

4.0 Conclusion

Nigeria is endowed in many ways, but the main issue is lack of efficient management of resources and lack of maintenance culture. Corruption is another problem. There is no gainsaying the fact that Nigeria has the capacity to eradicate polio as no polio case has been reported in southern Nigeria for five years now (WHO, 2015). This North-South disparity is so pronounced that any report about polio in Nigeria would refer to Northern Nigeria, as the South is considered free of the polio virus but the possibility of re-infection of southern population remains (Osazuwa-Peters, 2011). The 29th Expert Review Committee on Polio Eradication and Routine Immunization (ERC) rightly concluded in 2015, that Nigeria is well positioned to interrupt the transmission of wild polio virus (WHO, 2015). This is a possibility if the illiteracy and health disparity between the northern and southern parts of Nigeria is bridged. The primary healthcare structure needs rejuvenation and properly funded. This is the easiest route to achieve mass vaccination especially in the rural arrears. Security situation in the north east of Nigeria should be addressed to reduce to the barest minimum the issue of missing children because the only way to stop polio in its track is to make sure every child in Nigeria is repeatedly vaccinated against polio.

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Abbreviations

CDC - Centre for Disease Control and prevention

WHO - World Health Organization

IHME - Institute for Health Metrics and Evaluation

UNICEF - United Nations Children’s Fund

LGA - Local Government Area

FMOH - Federal Ministry of Health

GPEI - Global Polio Eradication Initiative

PEI - Polio Eradication Initiative

EOCs - Emergency Operations Centres

FCT - Federal Capital Territory

PTFoPE - Presidential Task Force on Polio Eradication

NAFDAC - Eradication National Agency for Food Drugs Administration and Control

OPV- Oral Polio Vaccine

CIA - Central Intelligence Agency

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