The introduction of the Inactivated Polio Vaccine (IPV) into the nation’s routine immunization schedule has given fresh hope not only to the country but to the entire world that the global eradication of polio is in sight. Nigeria is one of the last frontiers in the global campaign to eradicate polio, being one of the three countries – others are Pakistan and Afghanistan – where polio is said to be endemic.
The introduction of IPV, given as an injection in the leg or arm, as against the Oral Polio Vaccine (OPV), taken by mouth and currently being used in the country, is in line with the commitment of the government to make Nigeria the next country to be declared polio-free by the World Health Organisation (WHO). It would be recalled that WHO in 2012 had called on all countries using OPV to introduce at least one dose of the IPV into their routine immunization schedule by the end of 2015, and gradually phase out the use of OPV.
According to WHO, IPV has been used successfully in the polio eradication programmes in some countries. But the vaccine continues to be used in countries where polio is endemic or where the risk of importation and transmission is high. The introduction of IPV would provide a quantum-leap opportunity for Nigeria in the polio-eradication end game strategy. Dr Rui Gama Vaz, the WHO Country Representative described IPV as a very safe and highly effective in preventing paralytic disease caused by polio. While we commend the federal government for this bold move we have to caution against complacency which could be a major setback to the national programme.
In 2003, the country had the highest number of polio cases anywhere in the world and accounted for 45 per cent of all confirmed cases globally. Fortunately, the polio prevalence figure has dropped significantly. From 798 cases recorded in 2008, the figure declined to 388 in 2009 and 21 in 2010. The number rose to 53 in 2013 and then declined to six in 2014. It is interesting to note that Nigeria has recorded no fresh case of wild polio virus type-1 since August last year and wild polio virus type-3 since November 2013, an indication that the innovations of the polio eradication programme in the past two years are on point.
However, there was an increase in circulating vaccine derived poliovirus in 2014 with 30 reported cases.
This is the more reason why the plan to discontinue the use of OPV should be pursued vigorously. We know that OPV has been the preferred choice of most countries because it is cheaper and easier to use. But it is made from a live polio virus which carries a small risk of causing polio for every million or so doses given. In rare instances, the virus in the vaccine can mutate into deadlier version that sparks new outbreaks. Nigeria has recorded outbreak of polio in the past caused by the polio vaccine itself. For instance, about 69 children were reportedly paralysed in 2007 due to a mutation of a vaccine’s virus. It is believed that the use of IPV will tackle this challenge since it is produced from wild-type poliovirus strains of each serotype that have been inactivated (killed) with formalin and so cannot cause polio.
This is not the time for Nigeria to rest on her oars. She should strive to emulate countries like India which has completely eradicated the virus from her shores. India’s poor sanitation, mass internal migration and dilapidated public health system made many experts believe it would be the last country to eradicate the disease, if it ever did. But India recorded a milestone last year when, together with 10 other Asian countries, she was declared polio-free by WHO having recorded no fresh case of polio in three years.
Nigeria can replicate India’s feat and be the next country to be declared polio-free. The quantum leap in polio eradication that the country requires to make that mark should be pursued with gusto. There is need for Nigeria to surmount the challenges of limited health infrastructure, insecurity, inadequate mobilisation of community groups, as well as management and funding issues, among others, if she is to meet that goal. We are convinced that Nigeria has the wherewithal to overcome these obstacles and kick polio out of the country. By so doing, the country can put an end to the sufferings, paralysis and death often associated with the disease and also save resources that could be channelled to the provision of better health services to Nigerians.