This report describes the outputs from the 24th Expert Review Committee (ERC) for Polio Eradication and Routine Immunization, which was convened from September 10-11 2012 in Abuja, Nigeria. Since the 2012 World Health Assembly declared completion of polio eradication a global public health emergency, this is the first meeting of the ERC. The ERC is "reviewing the programme in the context of increasing reports of polio cases that has made Nigeria the most polio infected country on the planet and the primary threat to a polio free world."
According to the report, the ERC was encouraged by a number of developments in the national programme. For example, a pact signed by traditional leaders to lead repeat vaccination efforts in poor-performing wards "offers a new avenue to bring their influence to some of the fundamental challenges with vaccinators and accountability". Also, the ERC notes that a revised national communication strategy would create an enabling environment for delivering oral polio vaccine (OPV) if it can be rolled out in time to support the low-transmission season Immunization Plus Days (IPDs). "Finally, under-pinning everything, is the hope that the government can succeed in truly elevating completion of polio eradication to an emergency status at all levels."
Major recommendations outlined in the report include:
- "Immediately Implement New House-Based Planning: fundamental to improving the coverage of both Immunization Plus Days (IPD) and routine immunization, is the full implementation of the new house-based microplanning process initiated in August 2012. LGA [local government association] Immunization Officers and Ward Focal Points must be directly accountable for the completeness and quality of these plans, which must in term be independently validated by NPHCDA [National Primary Health Care Development Agency], partners and/or other authorities. This new, grassroots planning process must be fully assessed immediately after the Sept IPD and updated following each round through end-2012.
- Optimize the 'Emergency Surge': the lessons learned from the new house-based microplanning and monitoring process should be rapidly incorporated into a thorough refresher training for all surge personnel and their supervisors in advance of the October IPD....
- Address the Fundamental Problem of Vaccinator Selection, Training & Supervision: the new Traditional Leader pact should be fully supported to finally address the chronic problem of vaccinator performance in the worst-performing Wards and LGAs...
- Enhance Understanding of Chronically Missed Children: the ERC is concerned that the reasons underpinning the high number of chronically missed children are still not fully understood. The programme should have protocols for rapidly conducting social research in the worst-performing LGAs and wards to reduce 'child absence/non-compliance' through more targeted social mobilization efforts and improved vaccinator performance.
- Intensify oversight of the National Emergency Plan: the decline in state level commitments to polio eradication, and continued gaps at the LGA level, as reflected in the recent Abuja Commitments monitoring report, must be reversed with the active support of the Nigeria Governors' Forum and the Federal Government...
- Plan for programme implementation in Insecure Areas: the Government of Nigeria urgently needs a comprehensive plan to access all children....It is urgent that a proper analysis of the nature and true impact of the insecurity on programme performance, particularly in Borno and Yobe....If possible, environmental sampling should be introduced in Maiduguri as part of that plan to facilitate the ongoing assessment of the programme's impact and risks.
- Give proper attention to improving routine immunization coverage: the ERC ...requests that adequate time and due attention be devoted to this issue at its next meeting.
- Plan for a full, intensive IPD schedule beyond end-2012..."
Global Polio Eradication Initiative (GPEI) website, October 25 2012.