Today, Friday 24th July, marks one year without a detected case of wild poliovirus in Nigeria, one of the last remaining polio endemic countries alongside Pakistan and Afghanistan. This represents huge strides for the fight against polio in Nigeria, which reported 122 cases as recently as 2012.
But this is by no means the end of the story. For the African region to be officially declared polio-free, Nigeria must go three years without a case. Here we explore five ways they have made progress against the disease, which must now be sustained to see polio eliminated for good.
Maintaining the cold chain in Nigeria. Photo: Gavi/Adrian Brooks
Nigeria’s immunisation infrastructure has been hailed as a pillar of success. The improved infrastructure as part of the polio programme has also benefitted routine immunisation, facilitated the roll out of new vaccines and supported programmes to improve maternal, newborn and child health. For example, the purchase and installation of more than 1,600 solar powered fridges for the country’s cold chain supply will help keep the vaccines at the right temperature for effective use. Introduced in February of this year, inactivated polio vaccine (IPV) will play a crucial role in keeping Nigeria polio free as part of the routine immunisation programme.
2. Building community trust
Community discussion and engagement have been key to success. Photo: Gavi/Adrian Brooks.
In 2003, immunisation programmes in Northern Nigeria suffered greatly after political and religious leaders in the states of Kaduna, Kano and Zamfara advised parents not to immunise their children. They inaccurately claimed that vaccines contained ingredients that would cause sterility; as a result immunisation campaigns ground to a halt. To combat this, the Nigerian government worked with respected religious, traditional and community leaders to improve the reputation of vaccines. Dispelling myths about vaccines, especially in northern states, remains a priority.
3. Technology strong enough to fight Ebola
An example of GPS technology used to fight polio in Nigeria. Photo: Gates Notes.
To ensure that every child was reached with the polio vaccine, cutting-edge technologies including GPS satellite tracking technology, were developed with guidance from WHO polio programmes. By enabling real-time contact tracing and daily mapping of identified chains of transmission, this same technology has also been used to help track the chains of Ebola transmission. As a result, the outbreak was swiftly contained, and Nigeria’s Ebola-fatality rate was much lower than elsewhere.
4. Facing the challenges of conflict
Inactivated polio vaccine being administered in Kano state. Photo: UNICEF/Melissa Corkum.
In 2013 immunisation programmes were suspended in Borno and Kano States following violence against vaccinators, making close to eight million children inaccessible for immunisation. In June 2013, vaccinators resorted to “hit and run” tactics which involved working with community leaders close to the lines of conflict to gain quick access to insecure areas to reach as many children as possible. Challenges remain, particularly in the north eastern region, but the success of Nigeria in vaccinating children in Boko Haram controlled areas offers hope that security issues in Afghanistan and Pakistan can also be overcome.
5. National support
Routine immunisation in Nigeria. Photo: Gavi/Adrian Brooks.
Nigeria must continue its commitment to ensuring the delivery of vaccines to all children, including continued vigilance on the part of surveillance and collaboration between government, partners, community leaders and health workers across Nigeria. The Nigerian government has demonstrated its commitment to this end; domestic funding for polio for 2015 is US$ 80 million.
With continuing challenges of corruption, poverty and instability, it’s clear that there is still a long way to go, and routine immunisation and a strengthened health system must remain priorities. Nevertheless, this anniversary represents progress and hope for improved healthcare in Nigeria and for the elimination of polio world-wide.
I don’t understand this thing about the vaccinated and non-vaccinated kids...
Like, if your child is vaccinated, how would they be in danger if there are non-vaccinated kids?
If they’re vaccinated, they’d (theoretically) be protected. So, do you not trust in your vaccinations or am I missing something here?
Using the same principles that the body uses to defend itself, scientists use vaccines to trigger the body’s adaptive immune system, without exposing humans to the full strength disease. This has resulted in many vaccines, which each work uniquely, separated into many different types.
First, we have live attenuated vaccines. These are made of the pathogen itself, but a much weaker and tamer version.
Next, we have inactive vaccines, in which the pathogens have been killed. The weakening and inactivation in both types of vaccine ensures that pathogens don’t develop into the full-blown disease. But just like a disease, they trigger an immune response, teaching the body to recognize and attack by making a profile of pathogens in preparation.
Another type, the subunit vaccine, is only made from one part of the pathogen, called an antigen, the ingredient that actually triggers the immune response. By even further isolating specific components of antigens, like proteins or polysaccharides, these vaccines can prompt specific responses.
Scientists are now building a whole new range of vaccines called DNA vaccines. For this variety, they isolate the very genes that make the specific antigens the body needs to trigger its immune response to specific pathogens. When injected into the human body, those genes instruct cells in the body to make the antigens. This causes a stronger immune response and prepares the body for any future threats, and because the vaccine only includes specific genetic material, it doesn’t include any other ingredients from the rest of the pathogen.
If these vaccines become a success, we might be able to build more effective treatments for invasive pathogens in years to come.
Learning to get HPV vaccines to the world’s poorest girls
Celina Hanson (Gavi), Paul Bloem (WHO) & Emily Loud (Gavi).
Women in developing countries disproportionately suffer from the burden of cervical cancer, yet often their countries do not have resources to establish screening programs that save women’s lives elsewhere. In these countries, human papillomavirus (HPV) vaccination provides an amazing opportunity to prevent cervical cancer and protect women’s health.
Vaccine delivery poses challenges, many of which are the same that we see for other vaccines. These may include not having enough fridges to keep the vaccines cold, or not enough health workers to vaccinate children, or children living in isolated rural areas where distance and unpaved roads make it harder for parents to reach facilities.
Other challenges are unique to the HPV vaccine. To start, most countries have experience vaccinating infants and these vaccinations are given when women visit clinics with their babies. The HPV vaccine, however, is not given to babies but to girls between 9 and 13 years old.
Here are some lessons from the experiences of introducing countries so far:
Learning by doing
Before introducing the HPV vaccine at a national level, many countries have started to learn by vaccinating girls in a small area to determine the best delivery strategy. Doing this in a Gavi supported pilot or demonstration also allows countries to secure the technical assistance they need, to develop training and monitoring materials, and to consider the integration of vaccination with other health services. This learning allows countries to develop solutions to challenges that were not anticipated.
Schools have been a popular place around which to centre much of the delivery of HPV vaccines in these countries. In order for this strategy to work well, strong co-ordination between health and education sectors is essential. From planning the vaccination dates, engaging schools in mobilization of parents and girls, to supporting implementation of vaccination sessions – schools and teachers make important contributions, which have translated in high acceptance levels of this new vaccine.
A venue for HPV vaccination in Ghana. Photo: Gavi/Evelyn Hockstein
How to reach all girls affordably?
In order to reach all girls with the vaccine, countries are testing other strategies to reach different populations as well, such as outreach and using alternative facilities. Delivering HPV vaccine with other health interventions like deworming, menstrual hygiene education or tetanus shots is also being explored.
A girl living in a rural Ethiopian community. Photo: Gavi/Niligun Aydogan.
HPV vaccination as a catalyst
HPV vaccination is a highly effective intervention – but it must be linked to effective screening and treatment programs to prevent cervical cancer. The demonstration programs assist countries to strengthen comprehensive cervical cancer prevention and control plans. Over time, it can also act as a catalyst for even wider health interventions that benefit all adolescents.
Kids pose together in the Pokhara region of Nepal. Photo: Gavi/Oscar Seykens.
This blog was based on a review of progress that was recently published in the journal Vaccines. Read it in full here.
It’s been said that English physician Edward Jenner (May 17,1749-Jan. 26,1823) saved more lives than any other human. Jenner developed the smallpox vaccine – the first successful vaccine – in 1798. In the late 18th century, smallpox cases were increasing and had a mortality rate of 40%. Through interviews and experiments with local farmers, Jenner observed that milkmaids who had been infected by cowpox – a milder form of the often deadly smallpox disease – during milking were immune to smallpox. The resemblance of the ulcer shape between the cowpox and smallpox viruses led to the discovery. Culled from our collections, here we have an original copy of Jenner’s “An Enquiry into the Causes and Effects of Variolae Vaccinae, known by the name of Cow Pox” (1798).
ALL YOU NEW PARENTS, LEAVE THOSE VACCINES ALONE!
Racism and white supremacy isn’t about getting your feelings hurt. Its about people who’s whole life and career purpose is centered around destroying and exterminating a certain people.
The bill eliminates religious beliefs as a valid reason for rejecting vaccination for once-common infectious childhood diseases, reports the Los Angeles Times (sub. req.). It allows an opt-out option only for children whose doctors say vaccination poses a serious health risk due to medical conditions such as allergies or a compromised immune system.
Those who do not vaccinate their children cannot send them to public school.
This is one of the few things that primarily liberal, well-educated parents are pulling and it makes zero sense to me. Keep your unvaccinated kids away from the rest of us, please and thanks.
The first ever vaccine was created in 1796 when Edward Jenner, an English physician and scientist, successfully injected small amounts of a cowpox virus into a young boy to protect him from the related (and deadly) smallpox virus.
Just like Edward Jenner’s amazing discovering spurred on modern medicine all those decades ago, continuing the development of vaccines might even allow us to one day treat diseases like HIV, malaria, or ebola.
vaccines don’t cause autism but that’s not the point and the “do vaccines cause autism?” debate should be a mere footnote when arguing for vaccines. how about we instead talk about how the hatred of autistic people is the reason people don’t want to get their kids vaccinated? sick of seeing pro-vaccination masterposts that tiptoe around the ableism surrounding the vaccine controversy.