Experts Recommend Strategic Shift in Nigeria's Polio Eradication Programme

This news story from WHO describes the outcomes of the 32nd meeting of the Expert Review Committee (ERC) on Polio Eradication and Routine Immunization in Nigeria, at a time when the country was working towards polio-free certification. In assessing the progress made, the challenges, and priorities for the next 6 months, the experts at the June 2016 meeting recommended a strategic programmatic shift that would entail strengthening of the routine immunisation (RI) programme, closing of surveillance gaps, and reduction in the intensity of supplemental immunisation activities (SIAs) to be implemented in Nigeria. (Editor's note: As of this meeting, the polio eradication programme had reached close to 2 years since Nigeria interrupted transmission of wild poliovirus (WPV) and 22 months since the last WPV on the African continent. So, Nigeria had been on track to be declared polio free on July 24 2017; a country must not have any case for at least 3 years to be declared polio free. However, in August 2016, two months after the meeting, the federal government confirmed two new cases of polio in Borno State. So, Nigeria has still not been certified as polio free as of this writing.)

Overall, the ERC acknowledged the continued good quality of SIAs, as indicated by the Lot Quality Assurance Survey (LQAS) and Independent Monitoring (IM) data showing reduction in proportion of missed children. However, the ERC recommended the implementation of plans to further improve quality of SIAs, particularly in low-risk states (southern states), including diligent use of pre-implementation dashboard and validated micro plans. The experts also charged the programme to consider extended age groups for selected campaigns and innovative strategies (rather than geographic areas) in accessible territories. Other recommendations include investigation and follow-up of all under-immunised and zero-dose acute flaccid paralysis (AFP) cases in the newly accessible areas in the north east and a focused response on strengthening RI, including inactivated polio vaccine (IPV), and on closing sub national surveillance gaps.

In terms of communication, the ERC noted that, as the world gets closer to attaining eradication of WPV, in Nigeria, there is evidence of waning political commitment and accountability at all levels. The ERC also described gaps and delays in domestic funding and inadequate focus on RI, inaccessibility, and pockets of low population immunity in the security compromised north-eastern states of Borno and Yobe. The ERC therefore recommended that the Presidential Task Force be convened immediately with a strong focus on RI strengthening and revitalisation/financing of Primary Health Care units, sustained tracking and reporting on Abuja commitments, including engagement of local government areas (LGA) chairmen, and continued engagement with traditional and religious leaders. Along those lines, the ERC utilised the closing session of the 32nd edition to thank the outgoing WHO Country Representative (WR), Dr. Rui Gama Vaz, for his role in removing Nigeria from the list of polio-endemic countries. Dr. Vaz urged the ERC members to extend their traditional roles beyond making recommendations to advocating to government for allocation of resources and timely disbursement of funds. He also suggested that they participate in critical activities periodically, such as taking part in inter-agency coordination committee (ICC) meetings to fast-track timely implementation of some of the ERC recommendations.