Conquering polio's last frontier

Nigeria could be polio free by the end of this year, according to health officials.

Following massive vaccination campaigns, the country that almost caused the global eradication programme to collapse may soon be finally be clear of the deadly virus.

If this is achieved it will be a major achievement in the campaign to eradicate polio, as the country boycotted the vaccine in 2003 - threatening to reinfect the rest of the world with the virus.

In 1988 a global initiative to rid the world of polio by the end of the year 2000 was launched.

This highly ambitious programme of vaccinations started well.

The Americas, Western Pacific, and Europe were all certified free of indigenous wild poliovirus.

By 2003 only six endemic countries remained: Afghanistan, Pakistan, India, Egypt, Niger and Nigeria.

The number of polio cases has been reduced from an estimated 350,000 cases in 1988 to just under 700 reported cases per year in 2003 - a greater than 99% reduction.

Vaccine boycott

But this success suddenly turned to disaster.

Twenty previously polio-free countries were reinfected - and all because trust in the vaccine was lost.

Rumours that the oral polio vaccine contained anti-fertility agents and even HIV began to spread in Nigeria, particularly in the Northern State of Kano.

They were championed by local religious leaders.

Nafui Baba Ahmed, the secretary general of the Supreme Sharia Council of Nigeria was an outspoken critic of the vaccine.

He said: "There are greater risks than polio - I think either this is an imaginary thing created in the West or it is a ploy to get us to submit to this evil agenda."

With these types of comment being repeated in many media outlets across the state, trust in the vaccine fell to an all time low.

Vaccinators were also being put in danger - some were even stoned when they did their rounds.

In October 2003 the Kano State Governor, Ibrahim Shakarau, suspended the vaccine campaign whilst investigations in to the rumours were carried out.

Safety investigations

Two separate scientific reports were commissioned to verify the safety of the vaccine.

The first from South Africa was rejected by local leaders. Only when safety tests were done in Indonesia were they satisfied.

Once the local leaders felt included the campaigns restarted.

The vaccine boycott lasted almost a year and was limited to a few states in northern Nigeria, but this allowed the virus to spread rapidly around the world.

Dr Bruce Aylward, the WHO Director for Polio Eradication campaign, said: "Over 20 countries were re-infected by this virus.

POLIO

• Highly infectious disease that is caused by a virus
• Attacks the nervous system, initially causing fever, tiredness, headache and vomiting.
• One in 200 cases causes permanent paralysis - most often in the legs
• Out of these as many as 10% of cases are fatal
• The virus affects mostly children under five
• There is no cure but there are a number of highly effective vaccines

"We are still dealing with the vestiges of this outbreak and the suspension of the polio vaccine in the Horn of Africa - the world spent over half a billion dollars dealing with the epidemic spread of polio out of Nigeria."

Today, as a direct result of the ban, it is estimated over a 1,000 children have been paralysed by polio.

Dr Aylward said all these new cases could be traced back to the virus in Nigeria.

But in Nigeria despite full support from the federal government and local religious and state leaders, there are still those who will not vaccinate their children.

We met one father who refused to allow vaccination teams into his house.

Another group of volunteers was verbally abused by a mother.

Nafui Baba Ahmed also still maintains his opposition to the vaccines.

When I met him in a downtown hotel in Nigeria's capital, he calmly told me: "I was vaccinated but now I would not submit my children to these vaccines.

"Why the unnecessary emphasis on polio? There must be more to it than meets the eye."

The eradication dream

Dr Sulieman Abdullahi, the World Health Organisation's team leader in Kano, told me that polio transmission will stop in Nigeria by the end of this year.

This is a claim I have heard often at many international Polio meetings. Yet each goal that was set has been missed.

But there is quiet determination in Kano. Despite a national strike that had left the country at a virtual standstill, the vaccination campaigns continued passionately.

Polio has paralysed children for at least 500 years and much debate still goes on if eradication is possible at all.

But if there is any chance of ridding the world of this devastating disease then politics, religion and culture cannot ever interrupt the vaccine campaigns again.