Nigeria’s Success as the Last Country in Africa Declared “Wild Polio Free”

Poliomyelitis, commonly known as polio, is a disease that can cause mild flu-like symptoms or instead, severely affect the brain and spinal cord causing paresthesia, meningitis, or paralysis [1]. It is highly infectious and most commonly affects children. Since 1988, polio cases have decreased by 99.9% worldwide and the disease is on its way to becoming the second disease ever eradicated globally after smallpox [2]. 

Today, the wild polio virus still remains in Afghanistan and Pakistan[3]. While there is no cure, the progress made towards the eradication of polio can be attributed to effective vaccination programs and campaigns. Unfortunately, the onset of vaccine-derived polio cases came at the expense of using live attenuated vaccines to prevent the spread of the wild polio virus [4]. A live attenuated vaccine means that it is a weakened form of the virus and normally helps create a stronger immune response[6]. In this case, it allowed for a rare, genetically mutated strain of poliovirus to emerge. In under-immunized populations, children are more susceptible to the spread of vaccine-derived polio which gives the virus time to replicate and grow[4].  Until this virus is completely interrupted in all countries, every country remains at risk of reinfection, especially those who lack access to immunizations[4]. Despite the threat of vaccine-derived polio, the eradication of wild polio in Africa is a huge feat in itself. Nigeria was the last country in Africa to be declared polio free on August 25th, 2020 by The Africa Regional Certification Commission.  

illuminAid has been fortunate enough to conduct an enlightening interview with Rohey Njie, a past trainee with illuminAid and Senior Program Officer for the Directorate of Health Promotion & Education with the Ministry of Health in the Gambia. Rohey, now based in Northern Nigeria, described Africa’s battle with both the wild polio virus and vaccine-derived polio. 

Rohey receiving a certificate of recognition after completing illuminAid’s video training workshop in 2017

Rohey started working for the Global Eradication Initiative in July 2019 in Northern Nigeria. Her journey started way back in 2009 in the Gambia where she worked with the Ministry of Health and Social Welfare under the Health Education Unit. In 2014, she started working in the health communication division where she was responsible for planning, coordination, implementation, and evaluation of health promotion programs. She worked within all sectors of Public Health in the Gambia ranging from immunization, communication, social mobilization, and community engagement for disease prevention and control. She worked with individuals, families, and communities to support and empower them with the health information they need so they can take control of their health and well being. According to Rohey, the Gambia had one of the strongest immunization programs for all preventable diseases with a vaccine coverage of 95%. The Gambia was able to eradicate polio in 2004.  

Prior to then, The Gambia faced outbreaks of many preventable diseases including smallpox, cholera, yellow fever, measles, meningitis, and malaria. During this time, Rohey explained how many people were ignorant of the benefits of vaccines and how they can prevent the spread of disease. Rohey worked to educate her community as a whole and explained how awareness, communication, and social mobilization were major factors in the eradication of polio in The Gambia. She noted that when people hear the information together, they will act together. After 10 years in The Gambia, Rohey got started with the Global Polio Eradication Initiative, relocated to Northern Nigeria, and has now been involved for over a year.  

Rohey continued to reveal her journey fighting the spread of polio in the following interview questions. 

Rohey giving a child an oral polio vaccine in Sokoto, Nigeria

What are the biggest obstacles you have faced regarding efforts to eradicate Polio?

There are religious barriers, cultural barriers, misconceptions, and ignorance. Northern Nigeria consists of strong religious states. These religious barriers prevent women from interacting with men and other women in their community. Women stay home most of the time and rarely leave their homes. Only women health workers or development workers can enter houses for healthcare and vaccinations, while men have to wait outside. Northern Nigeria has the highest rate of non-compliance when it comes to vaccinations. Some people perceive that vaccines may cause infertility or that vaccines are a kind of family planning method. However, there are many strategies and interventions that the Global Polio Eradication Initiative used in Nigeria. And on August 25th, we got to experience a Public Health Legacy when Africa finally succeeded.  

As a woman who shares the culture and religion of many Nigerian women, what are some of the advantages you have in your efforts to spread information about immunizations?

Indeed, share the same religious and cultural status with the people that are here in Northern Nigeria. As a woman, I am able to enter houses and communicate with families. We have reached kids that were unreachable. Development workers like me will enter homes, talk to the mother, and provide vaccinations for her children. When I go to supervise in the field, I make sure things are being done correctly. Then, I go back to the local government area regional health team for a review meeting where we can fill in the gaps. From there, matters are handled at the State Emergency Operation Center (EOC) level and if necessary, to the national level.  

What have been the most effective measures taken to eradicate Polio in Nigeria? 

Northern Nigeria often uses supplementary vaccination activities and vaccination campaigns to respond to outbreaks of vaccine-derived polio where it occurs especially in high-risk states. The Global Polio Eradication Initiative, in collaboration with the National Primary Health Care Agency, and partners are doing remarkable efforts to sustain the gains and work towards a polio-free world.  

Now that wild polio is gone, how do we keep it that way? And what steps should be taken to prevent the spread of vaccine-derived polio cases?

The entire Public Health family is proud to finally eradicate the wild polio virus, but we still have the vaccine-derived polio virus. Therefore, we are doing supplementary immunization activities and strengthening routine immunization.

Now that we have kicked out the wild polio virus, we want to maintain our momentum and this means more work, still, for the Global Polio Eradication Initiative. Now is the time to work harder. 

How have videos helped you promote health in your community and what are your future plans for implementing video education? 

Video has always been a part of my work. As a health educator and a change agent, I realized that only talking to people won’t change their behavior. But, when they see what is being talked about practically, they can gain a better understanding. Video is able to influence their behavior quickly. In the Gambia, we used to use the radio and television before illuminAid. But, not everyone has access to television. Now, thanks to the training we received during illuminAid’s Video Education Workshop, we are able to create videos and share them on battery-powered projectors. We started developing stories on health promotion. When we put up the projector, community members come out, and they listen to the story. It serves as entertainment and education for them at the same time, and that has really helped influence their behaviors.   

Recently, I have been working a lot with the media, developing documentary stories about health problems. The latest documentary I have been working on is about polio survivors and their stories. It’s called “A Day in the Life of a Polio Survivor.” These survivors are advocates to their people for change; they don’t want to see their next generation like them. They share how polio has affected them, how they survived, what they are doing to cope with it. 

A group of polio survivors during a rally for world polio day in Sokoto, Nigeria 2019

What behavior change do you dream of seeing in the future?

I dream of seeing a behavior change of the people—I want them to be well-informed, take ownership, and to demand vaccinations for themselves and for the development and growth of their children. I want people to seek all health care services for themselves. I want to see routine immunization coverage increase for all vaccine preventable diseases in Northern Nigeria.