October 24th is World Polio Day, a global health observance for the global polio eradication community to renew its promise of a polio-free world to future generations. World Polio Day is held on the birthday of Dr. Jonas Salk, the man who led the first team to develop a vaccine against polio. The development of the polio vaccine reduced polio worldwide by 99% with only Afghanistan, Nigeria, and Pakistan as the remaining polio endemic countries in 2013. In the spirit of World Polio Day, polio eradication program epidemiologist Wick Warren describes his work over the past year in Nigeria.
‘Every last child’ – this is one of the long-running slogans and ideals of the Global Polio Eradication Initiative (GPEI). The Initiative began in 1988, and while incredible progress has been made, (13 million cases of paralytic polio and more than 500,000 deaths prevented in 25 years), the fact that polio has not yet been eradicated proves that we are still not reaching every last child.
No child anywhere in the world should have to suffer from a debilitating, and sometimes fatal, disease like polio. Because polio has no cure, vaccination is the best way to protect our children and the only way to stop the disease from spreading. In many countries, children get their polio vaccines during routine well-baby visits. Even so, more than 22 million infants do not receive even the bare minimum of protection from routine immunization. Many of these children are in Nigeria, and many of them are not protected against polio.
In Nigeria, the data are clear: many thousands of children are being missed by polio vaccination campaigns in many parts of the country, and for many reasons. I have been working with UNICEF-Nigeria, one of CDC’s main partners in the polio eradication initiative, since July 2012 on their Volunteer Community Mobilizer (VCM) project in northern Nigeria. The strategy is to put in place a house-to-house campaign that more clearly communicates the risks of polio and the benefits of being immunized. This is especially true in high risk settlements where it is hoped the number of missed children will be greatly reduced, and ultimately make Nigeria polio-free.
How the VCM project works: Selected from their respective settlements, the volunteers have been trained to work as “change agents” in the community and are responsible for house-to-house visits, educating families about polio and explaining the benefit of routine immunization. With a pictorial flipbook, VCMs conduct interpersonal counseling house-to-house on immunization and promotion of some key household practices such as treatment of diarrhea, prevention of malaria, breastfeeding and hand washing. In total, more than 2,150 people have been recruited for VCM. They are trained and deployed to their home settlements where surveys suggested children are being missed and where refusals of oral polio vaccine are still persistent.
CDC is providing technical assistance to UNICEF on all phases of the VCM project, including data entry, analysis and report writing. Currently, we are doing a lot of data entry and analysis. We have data from more than 80% of the VCMs out in the field representing over 500,000 children. Each VCM is responsible for collecting the age, sex and vaccination status after each polio campaign of at least 300 children less than 5 years old. That is a large population which means a huge amount of work and data.
We have run into a lot of unexpected roadblocks – some states had major security issues throughout 2012 and even today, which hurts the data collection in those areas. Those areas are also home to tens of thousands of children who are not receiving their vaccines. Not being able to travel to places where children are vulnerable is very frustrating, and required extra effort on planning and supervision in all phases of the project roll-out.
Nevertheless, the VCMs and our partners are extremely dedicated, and we have found that the VCM approach is working – almost all the states in northern Nigeria report decreasing numbers of children missed by polio campaigns. According to one VCM, Maimuna Umar, pictured above, “families pay more attention to polio immunization when we talk about other key practices like breastfeeding, malaria prevention, hygiene and sanitation.”
For me, the VCM project is showing the number of missed children is decreasing in many parts of Nigeria – this is good news. Today, I feel positive about the polio eradication effort in Nigeria. UNICEF is doing the best job possible at the settlement level – no easy feat – but they are working hard and are not discouraged by slow progress.
Ending polio is a critical step toward improving the lives of the world’s most vulnerable children. On World Polio Day 2013, we’re closer than ever to ridding the world of this devastating disease. A child we reach with polio vaccine is a child we can reach with other vaccines, vitamins other basic essentials for child survival and health.
I believe that every child should have a shot at a healthy life, and that is why I’m working to reach every last child.