The detection of two new polio cases in Nigeria has been a major disappointment for the global health community, derailing hopes that Africa’s most populous country could be officially certified “polio-free” in 2017. As an infectious disease specialist from Nigeria, I’ve watched the events unfold with apprehension.
Boko Haram, the violent Islamist group that kidnapped 200 schoolgirls in Chibok two years ago, has added another layer of complexity to Nigeria’s polio eradication campaign. As Nigerian officials and their international partners ponder the next steps against polio, it is imperative that the fight expand to take on Boko Haram.
Just four years ago, more than half of all polio cases worldwide occurred in Nigeria. When I lived in northern Nigeria, I saw firsthand how the disease crippled children and devastated families. The tide was largely turned due to methodical surveillance and vaccination programs that expanded across the country—only to hit the rocks in northeastern Borno state, where Boko Haram fighters have seized control of large areas.
Borno has seen a rise in malnutrition in camps of internally displaced people—a signal of broader distress—and officials concede that it was difficult to access communities to administer polio preventive vaccines from December 2013 into early 2016.
Nigeria now needs to ensure that the Ministry of Health and the national military work closely to ensure maximum protection of health workers and access to hard-to-reach communities. The armed forces could train military medics to administer vaccines, which is a fairly simple process. Another option would be to train health workers who can work specifically in crisis areas. This is exactly what Doctors Without Borders does, and this organization has experience working in similar areas like the Central African Republic. In addition to contributions from other foreign governments, the U.K. has donated over $1 billion to the fight against Boko Haram, but there have been reports that funds allocated are being used to persecute political foes instead. Nigeria simply cannot afford to mismanage funds at this critical time.
A more long-term plan in achieving polio eradication could be to focus on the health system and the health needs of the people of Borno state. The poor health system in Nigeria has played a role in the spread of polio infection; unfortunately, neglect of the health system by the government may also impede the eradication effort. Citizens in communities in Borno use noncompliance to vaccinations as a means to draw the government’s attention to the health and social services they require, such as providing malaria medication or making repairs to the roof of the local health clinic.
Government neglect was one of the reasons why Boko Haram became a reality in the first place. It is time the Nigerian government became more accountable and more dedicated to the role it was elected to perform.
When the World Health Organization declared the end of endemic polio in Nigeria in 2015, stakeholders at all levels of government became complacent and commitment waned. Although President Muhammadu Buhari pledged to continue to work toward polio eradication, the reality on ground was different.
This was obvious at all levels of government including state governors, the national assembly, and local government chairpersons. Borno state in particular always faced challenges with immunization, of which the governor was aware. State and local governments did not implement any adequate programs to fund the eradication of polio, which affected the quality of immunization and surveillance activities.
There has to be commitment from all stakeholders in the federal, state, and local governments, as well as from traditional and religious leaders, women’s organizations, and community leaders. All hands must be on deck. Additionally, the presidential task force on polio eradication must be convened immediately before the situation gets worse.
As recently as 2014, officials in Borno were congratulating themselves on the end of endemic polio—even though hundreds of communities in 20 local government areas were under the control of Boko Haram and effectively beyond the reach of health workers. Going forward, the Nigerian government needs to be transparent about programmatic methods and goals. By extension, the WHO has to be aware of these realities. The two new cases not only mean that Nigeria will have to start eradication efforts all over again, but also mean that polio was probably never interrupted in the first place.
Surveillance and immunization activities need to take place along the borders Borno shares with other countries like Chad, Cameroon, and Niger. The Nigerian government needs to work closely with the governments of neighboring countries to ensure that the virus isn’t moving in and out, as this would further complicate eradication efforts.
Nigeria can still become polio-free. But this major setback underscores that we can no longer afford to make unrealistic promises, nor celebrate premature victories. Like polio, the scourge of Boko Haram feeds upon regions with little support from outside forces and the central government. Let’s provide the resources to prevent both from spreading.
Ify Aniebo is a PhD candidate at Oxford University in clinical medicine and infectious tropic diseases and a 2016 Aspen New Voices Fellow.
[Photo courtesy of CDC Global Via Flickr]