This report summarises the main findings, conclusions, and recommendations of the 33rd meeting of the Expert Review Committee (ERC) for Polio Eradication and Routine Immunization (RI), which was convened from January 17-18 2017 in Abuja, Nigeria.
Since the last ERC meeting in June 2016, the country was reclassified as a polio-endemic country by the World Health Organization (WHO) in September 2016 following the isolation from acute flaccid paralysis (AFP) cases of strains of wild polio virus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) in Borno and Sokoto States, respectively. The ERC acknowledges that the response to these outbreaks was "rapid, aggressive, unprecedented and of optimal quality, attributable to the extraordinary efforts and commitment of staff of the Government of Nigeria and partner agencies." In particular, the ERC commends the initiatives taken to increase access in partially and completely inaccessible areas, including: systematic engagement of the military and Civilian Joint Task Force (CJTF), deployment of health camps designed to reach underserved and non-compliant populations, targeted vaccination for internally displaced persons (IDPs), transit vaccination teams placed at strategic locations and Directly Observed Oral Polio Vaccine, or OPV (DOPV) administration in select areas.
As is noted here, the resilience strategy is being sustained through intensified high-level advocacy to increase political commitment and oversight, intensified social and community mobilisation through a range of stakeholders, efforts to build trust by addressing community felt needs, use of health camps, customised Immunization Plus Days (IPDs) providing supplemental health benefits in addition to oral polio vaccine (OPV), and promotion of integrated services and motivational awards. To cite a few examples of some specific groups that have been engaged:
- Motivational interpersonal communication (IPC) skill training was launched in Borno State, using an integrated package. Over 4,000 frontline workers were trained. In between vaccination rounds, over 17,000 Volunteer Community Mobilizer (VCMs) have continued to track and vaccinate missed children and conduct active AFP case search in households and IDP camps. In security-challenged areas of Borno, the VCM network was expanded from 13 to 23 Local Government Areas (LGAs), especially in recently accessible areas, including Dikwa, Kukawa, Mungono, Bama, and Nganze LGAs.
- 1,681 Federation of Muslim Women Associations in Nigeria (FOMWAN) mobilisers, 1,386 polio survivors, and 220 religious focal persons (RFPs) and community leaders are engaged in community mobilisation during and in between rounds. The RFPs are facilitating access to over 17,000 local religious leaders and Quranic schoolteachers. Sensitisation of traditional and religious leaders, women, and caregivers in both accessible and newly accessible settlements, including Gwoza, Dambao, and Nganzai LGAs is ongoing. Tsangaya School Malams and RFPs were trained on IPC skills.
The outcome of all these interventions is that non-compliance was reduced from 1% in the October 2016 outbreak response (OBR) to 0.2% in the December 2016 OBR.
However, in general, and as is reiterated several times in this report, there is from the ERC's perspective "evidence of waning political commitment [that] is available for all to see." ERC points to the inability of the Presidential Task Force on Polio and Routine Immunization (PTFoPE) to convene for two years, the suboptimal engagement of Governors and LGA Chairmen (e.g., poor attendance at evening review meetings, or ERMs), and the suboptimal and late release of counterpart funding by some States and LGAs. This issue must be addressed, according to the ERC, if the major challenge of inaccessibility (of children for vaccination) due to insecurity in Borno and other northeast States is to be addressed. "It is important and essential for government to urgently mount additional effort to ensure unhindered accessibility to these areas, without which it is impossible to even conceive a time frame to the end to polio transmission in Nigeria."
Major recommendations related to advocacy and communication include:
- The ERC urges that the PTFoPE meets urgently. Perhaps as was done in the past, a high-ranking government official (at the level of the Minister of State) could be saddled with the coordination of the function and activities of the PTFoPE. In addition, the programme should develop innovative strategies to increase political support at State and LGA level and increase active participation of LGA Chairmen in polio activities including attendance at ERMs.
- The programme should sustain and intensify the resilience strategy through community engagement and contextualised messaging in the North East (NE) using social networks such as VCM, Northern Traditional Leaders Committee on Primary Health Care Delivery (NTLC), and social mobilisation committees.
- The programme should ensure all missed children are systematically tracked by the VCM network and use of its full potential to vaccinate, using every opportunity during and in between polio campaigns. The programme should expand the VCM network to Gombe, Adamawa, and Taraba states to address missed children and ensure full community engagement to reduce noncompliance and child absence.
The ERC acknowledges that the timeline for the country transition planning process has been affected by the reclassification of Nigeria as a polio-endemic country. However, the ERC urges the government to take leadership in leveraging resources for RI, primary health care (PHC), disease surveillance and OBR, and other public health priorities.
Image credit: Polio Free Nigeria