One of the most valuable and cost-effective tools for preventing and controlling diseases in the world is through vaccination. It is generally and routinely administered to induce immunity which prevents people from premature death, falling sick, suffering, and also reduces the disability-adjusted life years lost (DALYs). The World Health Organization (WHO) in 2002 estimated that about 1.4 million deaths occurred among children under the age of five all due to preventable diseases such as polio, tetanus, measles, tuberculosis, rubella, etc [1]. It is therefore necessary and important for all humans to understand and acknowledge the effectiveness of vaccines available to eradicate diseases like poliomyelitis (polio). The poliovirus can not survive outside the human host over a long period of time, thus making the vaccine highly effective and inexpensive which also provides a life-long immunity [2].
Poliomyelitis (polio) is a threat to everyone but a major threat to children under five years anywhere and everywhere in the world with the poliovirus. The disease is highly infectious and is caused by a deadly virus. Humans become infected when the poliovirus enters and lives in the throat and gastrointestinal tract, intend invades into the bloodstream and is carried into the central nervous system. This transfer can then cause severe and total paralysis within hours because it destroys the motor neuron cells [3]. Most people infected with the poliovirus have no visible symptoms initially; however it causes permanent and irreversible paralysis usually in the legs and may even cause death [3]. Amongst those paralyzed, 5%-10% die when their breathing muscles become immobilized [1] due to the fact that, the motor neuron controls the muscles used for respiration, swallowing, circulation, arms and legs of the human body [3]. It is scary to know that, the poliovirus can spread through person-to-person contact with the stool of an infected person. The virus is shed intermittently in feaces for several weeks and during this period causes the disease to spread rapidly. Polio may also spread through oral or nasal secretions widely before cases of paralysis are seen [2].
In 1988, the World Health Assembly (WHA) all member state of the World Health Organization (WHO) launched a global initiative to eradicate Poliomyelitis (polio) in the world by the end of 2003 [1]. All countries worked together to achieve the objective to prevent 855,000 death, 40 million disability-adjusted life years (DALY’s), and 4 million cases of paralysis by 2050 [2]. So far, 10 million doses of oral polio vaccines (OPV) have been successfully administered to help the polio eradication process [2]. The polio eradication campaign has reduced the indigenous countries with wild polio from seven to four counties: India, Nigeria, Pakistan and Afghanistan as of 2008[1]. A single child who remains infected with polio is a threat to other children all over the world because the poliovirus can easily be imported into a polio-free country and can spread rapidly among un-immunized populations [1]. For a successful eradication process, the WHO monitors progress; countries perform surveillance for acute flaccid paralysis (AFP). The WHO African Regional Office (WHO-AFRO) and the U.S Centers for Disease Control and Prevention (CDC) are also involved in strengthening infectious disease surveillance and response in Africa [8].
In 2003, the political and Muslim religious leaders in the northern part of Nigeria, Kano, Kaduna, and Zamfara states halted the polio vaccination campaign. Each state in Nigeria has its own administrative control over their health affairs at both the primary and secondary levels; immunization falls in the primary level. The government has control at the tertiary care level. However, even though they set health policies for the nation, the Kano state government was able to stop the campaign themselves while the federal government could not do much because the Kano government had the authority to take firm decision concerning vaccinations [9]. These leaders boycotted the polio vaccinations because of the rumor that the United States had contaminated the poliovirus with an anti-fertility agent as well as HIV virus (which cause AIDS) against the Muslim world [4]. This boycott caused an eleven-month halt in the poliovirus vaccine eradication campaign. The boycott also generated controversial issues among the Muslim community in Nigeria and the government, while the leaders continued to encourage parents not to allow their children to be vaccinated. It was reported by the New York Sun that, the fear arising to boycott the polio eradication campaign was because of the war in Iraq [6]. A World Health Organization doctor, Ali Guda Takai who investigated the polio cases in Kano made this statement to the Baltimore Sun, “what is happing in the Middle East has aggravated the situation. America fighting with the Middle East concludes that they are fighting Muslims [7].” To continue the eradication process, a meeting was held with UNICEF, WHO, the Government of Nigeria, the local state leaders and the state governor of Kano, Ibrahim Shekarau to resume the campaign. The agreement was made and the Nigerian government sent leaders to South Africa, India, and Indonesia to observe testing of the polio vaccine and to bring back proof of non- contamination [10]. It is essential for the general public to trust health care providers because lack of trust could draw back important campaigns such as the boycott in Kano, Nigeria did for the eradication process. Another problem WHO encountered was the suspicion of the aggressive mass vaccination campaign going on because basic health care in Nigeria was not easily available [7]. It was probably too good to be true to have the vaccination free of charge. The boycott in northern Nigeria resulted in new cases in neighboring countries such as Ghana (8), Burkina Faso (7), Cameroon (1), Benin (1) Chad (5) and Togo (1) all linked to Nigeria [5]. Since the polio virus can be very infectious, between 2003 and 2005, 25 previously polio-free countries were re-infected due to importations [1]. Currently, 36 countries are declared free from polio; America still remains the largest and first global region that effectively eliminated polio in their population in 1994, while the Western pacific followed in 2000, and the 51 countries in Europe region got certified polio free countries [1]. It has however been difficult to eradicate the polio in these regions of the world, Northern Africa, India and the Middle East. There must be a continuous massive vaccination campaign to build an immunity wall mainly around countries like Nigeria because disease surveillance becomes very important to track down all the information needed to eradicate the polio disease all over the world [5].
For a successful future in vaccination eradication campaigns, the health care providers and all other agencies involve must address cultural, political, and religious issues to enable a smooth and fast process. The campaign must stress on how valuable the vaccinations are using pictures more than words in their posters, mainly because of the educational level in these African countries. The media must be involved to help reach people through local radio stations, local television broadcasts, and by using their local artists to compose local music, plays and other forms of entertainment that the native people can easily understand. This approach will help the locals to develop trust and confidence in the vaccination about to be ministered. It is also important to keep agents and volunteers who are willing to learn and do a little extra effort to help eradicate future diseases.
It is still very important for Nigeria to eradicate the polio disease mainly because about 82% of all cases have come from Nigeria causing global burden [5]. Bill Gates in Nigeria to lead the way and support polio-free Africa has caused states governors to put in more effort to enable a polio-free Africa [12] as others like America and Europe have already achieved to be polio-free countries, with the determination of the WHA, Africa and the other remaining countries can get there. The eradication of polio is raising awareness so much that a movie has been made. The movie talks about some challenges the health organizations and governments face during the final stages of polio eradication. The film also follows health workers as they immunize Indian and Pakistani children [13]. This movie would create awareness for the public to understand some challenges health care professional go through to provide a better and safer world for all of us to live in. This movie “The Final Inch” has also been nominated for the Oscar which is good because it will increase the awareness about the disease and eradication process.
Even though there are challenges and controversies concerning vaccinations, it is still very effective and inexpensive to save more lives than to lose lives. As health providers, we all have to help in educating people around us about the importance of eradicating all diseases especially preventable diseases in the world. The polio eradication process even though it drifted a little, there is still hope that polio in all countries over the world with aggressive eradication plans and campaigns, with set goals, the eradication will be met and we will all enjoy the polio-free world. I’ll start my part by talking to my family and friends back home in Ghana about the importance of vaccinations for example.
References
Poliomyelitis (January.2008)In World Health Organization online .Retrieved February 10,2009, from
http://www.who.int/mediacentre/factsheets/fs114/en/index.html
Krym, Valerie F., and Russell D. MacDonald.” Global efforts to eradicate polio.” Canadian Medical Association Journal 170(2004): 2009.
How the poliovirus works (2000) In National Museum of American History online Retrieved February 10,2009, from
http://americanhistory.si.edu/polio/virusvaccine/how.html
Obadare, Ebenezer (2005) “A crisis of trust: history, politics, religion and the polio controversy in Northern Nigeria.” Patterns of Prejudice Journal 3 (2005):265-284.
Pincock, Stephen (2004) “Poliovirus spreads beyond Nigeria after vaccine uptake drops.” BMJ Journal 7328(7435):310
Pipes D (2005) A conspiracy theory spread polio. New York Sun. Available: http://www.danielpipes.org/article/2644. Retrieved 11,February, 2009
Murphy J (2004) Distrust of US foils effort to stop crippling disease. Baltimore Sun. Available: http://www.baltimoresun.com/news/nationwide/bal-polio0104,
1, 6396183.story?ctrack=1&cset=true. Retrieved 11, February, 2009
Nsubuga P, McDonnell S, Perkins B, et al. ( 2002) “Polio eradication initiative in Africa: influence on other infectious disease surveillance development” BMC Public Health 2:27 http://www.biomedcentral.com/1471-2458/2/27 Retrieved 11,February,2009
Odutola A (2004) Nigeria polio, politics and power play. African Networks for Health Research and Development (AFRO-NETS) http://www.afronets.org/acrchive/200401/msg00069.php. Retrieved 10, February, 2009
10.Yahaya M (2005) Polio Vaccines-Difficult to swallow. The story of a controversy in Northern Nigeria. Institute of Development Studies. http://www.ids.ac.uk/IDS/KNOTS/PDFs/VaccYahyaNigeria.pdf Retrieved 08, February, 2009
11. Wipfli, H. Global Efforts to Eradicate Polio. Presentation observed at the University of Southern California, February 9, 2009.
12. Global Polio Eradication Initiative (2009) Gates: "Nigeria can lead the way to a polio-free Africa." http://www.polioeradication.org/content/general/LatestNews200902.asp#GATES Retrieved 13, February, 2009
13. Ryan H (2009) The Final Inch. Polio film nominated for Oscar.
Rotary International News . http://www.rotary.org/en/MediaAndNews/News/Pages/090126_news_finalinchfilm.aspx%20Retreived%2013, February, 2009
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