“Come July 24th 2015 encomiums will begin to flow into Nigeria if no Polio case is recorded before the date, National Primary Health Care Development Agency’s Executive Director, Dr. Ado Muhammad told Ndidi Chukwu of Health Reporters that the true heroes were the 16 vaccinators who were murdered while saving lives, describes it as the most challenging in the fight against Polio in Nigeria.”
Nigeria will be celebrating one year of polio interruption by July 24th how has the journey been for you?
Let me start by appreciating Nigerians and journalists for the support which has taken us this far. There is no doubt that Nigeria has made a lot of progress with regards to polio eradication. If you look at where we are now, you will know that we have made a lot of progress with regard to polio eradication. It is 12 months now without a case of Wild Polio Virus, the last case of Wild polio Virus was reported in Kano at Sumaila Local Government Area precisely on the 24th of July 2014, which is a year, today July 24th 2015 Nigeria is one year without a Wild Polio Virus. It is a journey one can say was difficult, along rocky path way, because there were a lot of challenges which we surmounted before reaching where we are now. It is important for us to understand how far we have come, I was appointed late 2011 and I assumed office early 2012 then we had 123 cases of Wild Polio Virus by the end of 2012. By 2013 we brought it down to 53 cases of Wild Polio Virus in 2014 only 6 cases of WPV was reported and between July 2014 and to date no single WPV has been reported. No child has been paralysed with WPV. This did not just happen, we brought in a lot of innovations into the programme in terms of seeing that any case of WPV is an emergency and we also have entrenched accountability, within the programme where people will be sanctioned for not doing the right thing and people will also be rewarded for doing the correct thing and I also brought in the GIS marking, in such a way that for vaccinators if we assign you to a particular location and you don’t go we will be able to detect and we ensure that children in those places are vaccinated. We coordinated a very good relationship with our traditional rulers, the royal fathers where if there are cases of refusal and rejection of vaccines they go in to help us resolve those issues. There are anti-polio campaigners all over the country and we have been able to engage them to clearly show the communities that the polio vaccine is not harmful, it is not meant to de-populate any part of the country but it is only meant for preventing Nigerian children from getting paralysed and that message was received well, because of that the resistance against vaccination was highly minimised.
What is the plan to sustain this milestone till the time, it is totally eradicated?
Having made this progress we need to sustain it, today we have interrupted WPV for the first time. It has never happened in the history of this country, the global polio campaign started from 1988, from 1988 till now, we have an opportunity to interrupt polio for the first time, and we never did before. This is the very first time this is happening and it is the best history that polio eradication have had in terms of performance, so we need to sustain that gain and for us to sustain the gain, there are a number of things we need to do, first, we still have campaigns, and we have to strengthen our routine immunisation already coverage has also improved significantly. Now coverage is at 91% when you compare it to the 51% it was about 4 years ago, but sustainability is very important particularly for Oral Polio Vaccine (OPV) coverage. We also need to create demand for routine immunisation in all the Local Governments across the country so that women will be bringing their children for vaccination, thirdly we are also going to enhance surveillance in such a way that if there is any suspected case anywhere in this country we will pick it so that it will not be as if we are zero because we couldn’t pick cases. Our surveillance system now is about 85 percent active. This will help us pick any case of WPV in any part of the country. Detect it and it will be reported, we need to enhance and further improve on our surveillance system. Proactively what we have done is to activate additional source of information in terms of using patent medicine vendors because we notice that caregivers of parents always take their children to patent medicine vendors so we have trained them to report polio cases. We have also activated a source of information with bone setters because some will take children to bone setters when they notice children with weakness of the limb, now the bone setters will be reporting to us. We have trained doctors and traditional birth attendants to report to us. That is to ensure that we have a good surveillance system in place. These are things that we need to continue to ensure that we sustain the gain. We have also tried to educate our leaders at the Local Governments not to relax because interruption is only a step, the main thing is eradication and until we have it eradicated we are not resting; between interruption and eradication is two years.
What will you consider the most challenging time for you, and partners towards interrupting polio?
As I said at the beginning the road was rocky and the terrain was rough, for me the most challenging period was when on a single day 13 vaccinators were killed in Kano, that was in February 2013, 13 innocent vaccinators were wasted, that was 10 innocent females and 3 males and the same day another 3 vaccinators were killed in Maiduguri, so losing 16 vaccinators in a day was the most challenging, these were health workers working hard to defeat polio and save our children, trying to prevent paralysis, trying to ensure that we have a productive population that will contribute to the economy of the country and they were fell down by gun men. That was the most trying period for me because it took us almost six months before we resumed immunisation again in Kano, we had to reassure vaccinators and health workers of the security. We had to talk to security agencies to guarantee their safety and to plan and work with security agencies in such a way that no harm will come on any health worker in the cause of their duties. There were other periods that were also trying for us, the Nyanya Bomb blast, we lost vaccinators too, and they had gone to collect vaccines and were on their way to vaccinate children and caught up with it. We also had pockets of challenges in the journey to zero polio, we had anti polio campaigners that were sending wrong messages that polio vaccine was used to de-populate some part of the country, and they were for family planning and that resulted into rejection in some number of locations in this country, we had to go in and involved religious and traditional leaders to carry out interpersonal communication to resolve some of these issues. We also had elites refusing, when you have elites sending misinformation about polio that will constitute a major stumbling block that was why we experienced huge refusal for immunisation. We had to sit with them and explain to them the benefits and the content of the vaccine to make them see reason that Nigeria cannot lag behind in interruption. So far with combination of interventions and using even polio victims as advocates we were able to address some of these concerns.
How significant is this Polio interruption to reduction of U-5 mortality in Nigeria?
We have seen reduction in infant mortality in the country and that is not only because of polio campaign, because also of the use of polio campaign to administer some lifesaving commodities for infants, as part of the polio campaign. We have strengthened routine immunisation all over the country, with the structure of routine immunisation we are seeing much more improvement in coverage and less number of children being missed. We see less vaccine preventable diseases being reported and in addition we also have introduced new vaccines. We brought in pentavalent vaccine which is the five in one antigen and we also brought in pneumococcal conjugate vaccine, which is used to reduce burden due to pneumonia. Simple introduction of PCV in the country is resulting to averting about 240,000 deaths which is a huge number. We have also brought in live saving commodities and we are administering that in a number of locations, ORS and Zinc sulphate is also being used. So a lot interventions have resulted into reduction in child mortality.
What is the plan for future investment in vaccine purchase and production for Nigeria?
For future investment for vaccine and immunisation in Nigeria, I will look at it from two directions, two angles, first I want to look at it in terms of the actual production of vaccine. Nigeria is a huge market, and in the West Africa Sub-region it has a huge market, annually we make provision to cater for vaccine for about 7.2 million eligible children every year. That is huge number and it also taking cognisance of joining countries like Niger, Chad, Cameroon and the rest. If Nigeria is to produce vaccines we should be able to service the region. The advantage of that is that we will be conserving scares foreign exchange secondly we will also be creating job opportunities for our teaming youths. So far what we have done is that we have constituted a small team to work on local production of vaccine, and a number of outfits have indicated interest like May and Baker which is working towards having an agreement with the federal Government of Nigeria to commence local production and we are also discussing with them and also encouraging other entrepreneurs to invest in local production of vaccine, that is the way to go because if we have a local production in Nigeria we will be boosting the economy. We also have to look at sustainable financing; the cost of fully immunising a child is getting much more expensive because we are bringing in new vaccines every day. Before now pentavalent was not on our purchase schedule, PCV, Injectable Polio Vaccine, and Rota Virus Vaccine to address the issue of pneumonia, there is also Human Papilloma Vaccine for cervical cancer, so the financial schedule is getting loaded all these were not on the schedule before and it is getting very expensive and government alone cannot provide resources to fully immunise a child. We have to look at innovative way of vaccine financing because if you look at the vaccine landscape by 2020, it is expected that Nigeria would have fully introduced the entire required antigens. The cost of immunising Nigerians will cost almost $220 Million annually and it is huge and we need to see how we can cater for that. For that to happen we have to bring in private sector and we are discussing with the states to see how they can co-finance immunisation. We are also considering taxation, all these is what a committee working on vaccine financing is trying to explore the options we have, by the time they complete their work we will be presenting it to the Federal Government.