Review of Polio Eradication Initiative in Nigeria - 2013

2013 witnessed a remarkable progress in the Polio Eradication initiative in Nigeria, with more than 57% reduction  of  Wild Polio Virus  cases compared to 2012.  51 cases of WPV  were recorded in 9 states versus 117 cases in 11 States  recorded in 2012. 

No WPV type 3 (WPV3) cases have been reported since November 2012.


3 confirmed circulating vaccine derived polio-virus (cVDPV2)  was recorded in 2 States compared to 6 cases in 3 States in 2012.

This report highlights polio eradication activities in Nigeria during January - December 2013.

In January 2013 the National Polio Emergency Operations center (EOC) developed a National Emergency Action Plan to eradicate polio in Nigeria, this plan prioritized improving quality of supplemental immunization activities (SIAs),  implementing strategies to reach underserved populations, adopting special approaches in security-compromised areas, 4) improving outbreak response, 5) enhancing routine immunization and activities implemented between SIAs, and 6) strengthening surveillance.

Epidemiology:

In 2013, no  polio case was detected in most states of  Northwest - Nigeria, however transmission continues in Kano and states in the northeast.

 Efforts to interrupt transmission remain impeded by insecurity, anti–polio-vaccine sentiment, and chronically poor SIA implementation in selected areas.
The activities of insurgents in Borno and Yobe states have reduced access to children and had further negative impact on planned SIAs, some SIAs were repeatedly missed in both states. 

In February 2013, Nigeria's polio eradication program suffered setbacks when 13 health workers were targeted and killed in separate attacks in Borno and Kano. This act was condemned by the Government of Nigeria and the International development partners.

A detailed operational plan for Borno and Yobe was developed with specific interventions for security compromised areas which includes: Use of permanent health teams, Hit and run strategy during periods of calm, Firewalling Borno & Yobe borders, introduction of Health Camps to provide free drugs and antenatal  counseling etc. 
  

Poliovirus Surveillance:

A nonpolio AFP rate of ≥2 cases per 100,000 children aged <15 years and collection of adequate stool specimens in ≥80% of AFP cases are key performance indicators for AFP surveillance. In 2013, the nonpolio AFP rate was 8.8 cases per 100,000, and 86.5% of AFP cases had adequate stool specimens collected, although these indicators decreased slightly from 2012. The proportion of high-risk states that met both indicators increased from 82% in 2012 to 91% in 2013. Within these states, the proportion of LGAs meeting both requirements increased from 67% in 2012 to 75% in 2013.

What did the National and State EOC's do Differently in 2013?

• National EOC Worked closely with the other 5 State EOCs- Borno, Kaduna, Kano, Katsina & Sokoto
• Sub-groups within the EOC facilitates the various activities of the program: Strategic, Communications, Operations and Data
• Regular Planning meetings were conducted 
• Use of data for action –  LQAS, EIM, GIS, campaign indicators
• The EOC Focused activities towards hard to reach areas and High Risk LGAs
• Use of dashboard for accountability – Pre, Intra and Post campaign indicator
• Review the algorithms  for selecting high risk LGAs every 6 months
• The EOC deployed  Management Support Team members, Polio Survivor Groups to High risk LGA's - Best hands in worst places. 
• Regular Teleconference/Video conference was held  with the state EOCs and  LGA facilitators 
• Senior officers of the EOC made regular field visits to monitor plans and provide support
• Use of reward and sanction schemes to enforce accountability. 

Political commitment 

President Jonathan flagging of Polio Vaccination Campaign 

2013 experienced the highest level of political commitment by President Goodluck Ebele Jonathan who chaired the first Presidential Task-force meeting  which held on January 31^st 2013,  also Mr Preseident held  several meetings with state Governors and LGA chairmen on multiple occasions to emphasize the importance of polio eradication in the country.

Mr President also made additional financial commitment of $30 million for 2013. 

Also the chairman of Presidential task force on Polio Eradication (PTFoPE)  and the Executive Director of the National Primary Health Care Development Agency
 (Dr. Ado Muhammad) had several meetings with Governors of High Risk States and made supportive supervisory visits to poor performing LGA's to renew engagement of traditional leaders in the supervision of IPDs and resolution of non-compliance (including MOU to ensure ownership and accountability for PEI - Abuja Commitments).

Dr Pate (Chairman PTFoPE) on field visit to HR LGA

Key Events in 2013: 
ERC Meeting: The Nigerian  The Nigerian Expert Review Committee brings together global polio experts twice a year to review the status of the polio eradication programme in Nigeria, and put forward key recommendations for the Government and GPEI partners, in 2013 the ERC  met twice in March and November 2013 in FCT Abuja. Find here ERC Recommendation of the last meeting. 

IMB Meeting:  The Independent Monitoring Board assesses progress towards the attainment of a Polio-free world. The IMB convenes on a quarterly basis to independently evaluate progress towards each of the major milestones of the Global Polio Eradication Initiative (GPEI) Strategic Plan on the basis of polio epidemiology, poliovirus virology, standard performance indicators and other programme data.  
In 2013, IMB met twice (May and October) in London and was attended by a Nigerian  delegation from the National Primary Health Care Development Agency and Polio Emergency Operations Center. 
Find attached here the Seventh IMB Report - May 2013 and Eighth IMB Report - October 2013 as officially released by the IMB 

 66th WorldHealth Assembly Meeting:  The WHA is the supreme decision-making body of World Health Organization. The Sixty-sixth session of the World Health Assembly (WHA) took place in Geneva during 20–28 May 2013. The Board provided additional guidance on addressing the short- and long-term risks to attaining the milestones of the new polio eradication and endgame strategic plan 2013–2018, particularly in the areas of: 
vaccination of travellers; fast-tracking access to affordable inactivated poliovirus vaccination options 
for all countries; strengthening routine immunization; and legacy planning.  The Meeting was attended by  a Nigerian  delegation from the National Primary Health Care Development Agency and Federal Ministry of Health. Find here a Summary Report of the 66tth WHA meeting 

Global Vaccine Summit: In April 2013, His Highness General Sheikh Mohammed bin Zayed bin Sultan Al Nahyan, Crown Prince of Abu Dhabi, and Bill Gates, co-chair of the Bill & Melinda Gates Foundation, co-hosted a vaccine summit in Abu Dhabi  to continue momentum in the Decade of Vaccines, a vision and commitment to reach all children with the vaccines they need. The summit highlighted the role that vaccines and immunization systems play in achieving global child health and development goals.  
More than 300 global leaders, health and development experts, vaccinators, celebrities, philanthropists, and business leaders  gathered in Abu Dhabi in the first Global Vaccine Summit to endorse the critical role that vaccines and immunization play in giving children a healthy start to life.
find attached here Report of the Global Vaccine Summit 

Bill gates Visits Nigeria: 

 In November 2013, Bill Gates - Co chair of the Bill & Melinda Gates Foundation made a visit to Nigeria to  learn firsthand about how work is going on polio eradication initiative, he visited the National  Polio Emergency Operations Centre, where  he met with government  officials and partners  to analyze the latest polio data.   Mr Gates also met with President Goodluck Jonathan, leadership of the National assembly, traditional and religious leaders. He was conferred the distinguished honor -  the Commander of the Order of the Federal Republic by Mr President.    
Bill gates also went on a filed visit along with Aliko Dangote to Lagos state to learn more about Nigeria’s efforts to improve its vaccine supply chain
More information on Bill gates visit can be found Here. 

Launch of the Nigerian  Routine Immunization Strategic Plan:

In November 2013, Nigeria unveiled its National Routine Immunization Strategic Plan (NRISP) 2013-2015, outlining a comprehensive strategy to increase access to live-saving vaccines through strengthened routine immunization (RI) systems. The plan was co-launched by the Nigerian Minister of Health, Prof. Onyebuchi Chukwu and Mr. Bill Gates in an event hosted by the National Primary Health Care Development Agency (NPHCDA) and attended by traditional and religious leaders, private sector representatives, and development partners, including Alhaji Aliko Dangote and the Sultan of Sokoto.

The NRISP outlines responsibilities for implementing RI at the National, State, and Local government levels, and integrates three strategies that are already in place in the country’s RI sector: Accountability for RI in Nigeria (AFRIN), Reaching Every Ward (REW), and Health System Strengthening. In line with the government’s Saving One Million Lives Initiative, the plan aims to achieve 87% national vaccine coverage, with at least 80% coverage in 90% of Local Government Areas, for all scheduled childhood immunizations by 2015.

Find attached here summary of National Routine Immunization Strategic Plan (NRISP) 2013-2015. 

Focus  for 2014: 

Improvements in  quality of Supplemental Immunization activities, enforcing rigorous accountability and improving  access to children in insecure areas are some of  the essential  focus to stopping the transmission of  WPV in Nigeria in 2014. 

Proposed Schedule for Polio SIA's in 2014
1	NIDs (bOPV)	January  18th - 21st
2	NIDs  (bOPV)	March 1- 4
3	SNIDs  bOPV	April 12 - 15
	Easter (April 19 - 22)
4	SNIDs  (bOPV)	May 24 - 27
5	Undeserved + Child Health Week (OPV)	June 21 - 24
	Ramadan (29 June - 27 July)
	Micro-planning (July 3 - 26)
6	SNIDs (bOPV)	August 9 - 12
7	SNIDs (bOPV)	September 20- 23
	Eid Mubarak (October 4 - 5)
8	SINDs bOPV)	November 1 -4
9	Undeserved + Child Health Week	December 13 -16

*Note: All dates listed above are tentative and subject to change by the National EOC/ NPHCDA

Summary Report compiled by: Suleiman Oshioke Yakubu

Technical Consultant – Nigeria CDC - NSTOP  

Email: iamsuleiman@gmail.com

Mobile: +2348029584568             

References:      

1. Independent Monitoring Board of the Global Polio Eradication Initiative. Eighth report. London, England: Independent Monitoring Board; 2013. Available at http://www.polioeradication.org/aboutus/governance/independentmonitoringboard/reports.aspx.
2. National Primary Healthcare Development Agency. Nigeria polio eradication emergency plan 2013. Abuja, Nigeria; 2013. Available athttp://www.polioeradication.org/Portals/0/Document/Aboutus/Governance/IMB/9IMBMeeting/4.2_9IMB.pdf .
3. National Primary Healthcare Development Agency. National Routine Immunization Strategic Plan 2013-2015
4. Recommendations of the 26th Expert Review Committee Meeting - 
5. CDC- Progress Toward Poliomyelitis Eradication — Nigeria, January 2012–September 2013, MMWR 2013 / 62(49);1009-1013
6. Bill Gates - What I Learned About Polio in Nigeria - http://www.impatientoptimists.org/Posts/2013/12/What-I-Learned-About-Polio-in-Nigeria
7. Poliomyelitis: intensification of the global eradication initiative - Report of the 66th WHA:  http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_18-en.pd