The chances that polio could be eradicated from the world seem to be rising with dramatically fewer cases reported in Nigeria, the country where the disease has been most endemic in the world, yet coordination with bordering countries remains a weak link in the chain, polio experts say.

“A lot of people move from one side of the border [between Nigeria and Niger] to the other and so [when there is a vaccination campaign] many children may be missed,” UN Children’s Fund (UNICEF)’s communications chief in Nigeria Christine Jaulmes, told IRIN.

UNICEF in Nigeria facilitated meetings in August between government and aid officials from Niger, which shares a 1,000 kilometre border with northern Nigeria, where most of the world’s cases of polio have been reported in recent years.

Of the 2,000 cases reported around the world in 2006, 1,125 were from Nigeria, according to figures provided by the Polio Eradication Initiative. Yet as of 10 August only 156 cases had been reported in Nigeria in 2007, compared with 753 cases on the same date in 2006, Jaulmes said.

What went right?

She attributed the vast reduction in the number of cases to more effective vaccination campaigns.

Until recently many Nigerians in the mostly-Muslim north had refused to allow their children to be vaccinated, saying the anti-polio campaign was a conspiracy to sterilize Muslim children.

Jaulmes said such misunderstandings had been dispelled and now there was better communication between health workers and Islamic leaders n the area.

“Before, Koranic schools refused to allow vaccinations on their premises,” she said. “Now there is a strategic alliance with the schools, which are very important because they are places where health workers can vaccinate a lot of children at the same time.”
She said the government also introduced a new strategy in April 2006 called Immunization Plus in which, at the same time as immunizing against polio, health workers distribute insecticide-treated mosquito nets, de-worming medicine and Vitamin A supplements, while also immunizing children against diseases such as measles and hepatitis.

“By addressing many health concerns we also increase people’s motivation to immunization against polio,” Jaulmes said.

Another reason the number of cases have dropped so dramatically is that health workers are using new targeted vaccines. “The old vaccines were for Type 1, Type 2 and Type 3 polio but today Type 2 no longer exists here and we are mostly now vaccinating against Type 1 which is the most virulent strain”.

She said that with Type 1 now in abeyance, health workers are beginning to target Type 3.

The overall cost of polio eradication in Nigeria for 2007 is almost US $100 million.

Crossing borders

A problem remains that, campaigns have not crossed boarders while people do.

“Niger is currently polio-free, so there has been less vaccination there than before,” she said. “It used to be that campaigns were synchronized between the bordering countries,” she said, “but that stopped a year or so ago.

“We are trying to start synchronize again now,” she said adding that discussions are underway between officials from the governments of Niger and Nigeria and their respective UN country teams.

She said the weak link with polio campaigns is not just at the borders between Nigeria and its neighbours but within Nigeria among states. “We need to have teams working on both sides of all borders in coordination with each other,” she said.

The long-term aim is to have routine immunizations rather than special campaigns, she said, and that people in the region develop a culture of immunization.

“This could bring about total eradication,” she said, responding to the view held by some epidemiologists that eradication of polio from the world is no possible and that the health workers can at best hope to contain the disease.

She said she was hopeful that those experts will soon be proved wrong. “But we still don’t give a clear date of when eradication will be possible,” she said.