Polio eradication in Nigeria: an African success story and the need to decolonise global health.

April 11, 2021 | Lenias Hwenda: Let's Talk About Health in Africa provides insights on Nigeri´s final push to eradicate wild polio virus in 2020  Watch the YouTube Podcast

11 April 2021 | Lenias Hwenda: Let's Talk about Health in Africa - Polio eradication in Nigeria: Decolonise global health to enable the world to benefit from the experiences of African countries. ​Watch YouTube Podcast.

Dr Faisal Shuaib, the Executive Director and CEO of the National Primary Healthcare Development Agency of Nigeria. shares his insights and analysis on Nigeria's final push to eradicate polio to achieve one of the greatest public health achievements in history. The African continent was certified Wild Polio Virus (WPV) free by the World Health Organization (WHO) on August 25 2020. Global health could benefits from this kind of successes in Africa, but strong colonial sentiments that Africa can only learn from the West are getting in the way of learning from each other.

Key Messages: Full Podcast
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Key Turning Point for Polio Eradication in Nigeria

• Nigeria removed silos and brought all polio prevention and control efforts under the single leadership of governments so that all partners worked under a single priority, strategy and national plan.
• When President Muhammad Buhari took office and vaccinated his grand-daughter. It helped to convince communities in Northern Nigeria where he has a large following.

 
Vaccine hesitancy: a growing global phenomenon

• Vaccine hesitancy, is a growing global phenomenon. Vaccine hesitancy in Europe and the US partly driving hesitancy in Africa.
• Unlike western countries, African systems are very community driven.  To overcoming vaccine hesitancy in communities, Nigeria learned to equip community leaders with accurate information, address the concerns of communities with empathy and getting leaders to set the example for the community.
• More participation of African countries in clinical trials could help Africa overcome vaccine hesitancy.

 
Using technology to address Africa health systems problems.

• Simple technologies can make a difference in improving primary healthcare .
• Nigeria used Geographical Information Systems (GIS) technology to accurately identify communities, their needs and priorities, available infrastructure and appropriate response.
• Deployed scarce resources in a more targeted manner. Nigeria has used telemedicine, mobile phone and Zoom technology used to provide service and train health workers.
• Some rural communities using drone technology to deliver blood and medicines to the last mile. Countries need low-cost technologies for improving service delivery. Cost of technology tend to decline with more usage.

Nigeria's response to Covid-19 pandemic

• Nigeria´s vaccine roll out strategy is using a hybrid model that integrates best practices from high income countries (HICs) and traditional approaches.
• Nigeria's Covid-19 Response and vaccination campaign is using community led efforts from polio to drive Covid-19 respond and addressing people's fears and leading by example.
• In Nigeria, frontline workers are a first priority, then people over 50 years, then people with underlying conditions.

Overcoming chronic health workforce shortages 

• Necessity is the mother of invention. Nigeria trained community health workers (CHW) to improve capacity. Nigeria trained 220'000 primary health care workers (HCW) to prepare for controlling community transmission. Increasing numbers of CHW helped mitigate the impact of service disruptions.

• African countries facing great challenges with not having enough health workers. Use a combination of community health workers and nurse-led care supported by technology
• Nigeria knows how to reach its last mile from its experience with measles, meningitis, polio etc

 
Impact of Covid-19 in Nigeria and Equitable Access to Covid-19 Vaccines

• Deaths from Covid-19 not necessarily lower than those from service disruption. Data collection in African countries not as accurate. Deaths in Africa may be lower than Europe and the Americas, but many Africans have died. Ultimately, it is about how individuals are affected by the pandemic

• Africa needs more equitable access to Covid-19 vaccines to be able to protect Africans. The fact that many African countries are still struggling to get their first doses does not augur well for the global control of Covid-19.
• To solve vaccine shortages in future pandemics, African countries need to ramp up ability to locally produce vaccines.

Nigeria's polio eradication informed other disease control programs 

• Understanding what was needed to prevent spread helped Nigeria's rapid response and control of the Ebola outbreak. Nigeria quickily established an Ebola Emergency Operation Centre with one plan and one team.
• Polio strategies informed Nigeria's Ebola Virus Disease response use of community leaders to overcome conspiracies & GIS tracking to deploy resources.

• Disseminated accurate information on the right mitigation strategies to communities. Used rapid deployment, contact tracing, health worker training respectful communication.

 
Opportunities for the global community to learn from Africa

• High income countries have had many challenges with Covid-19 vaccine roll out. They have more experience with structured routine immunization and less with outreach campaign scenarios Experienced many hiccups before finally getting it right. 
• African countries' greater experience with campaign scenarios - measles, yellow fever, meningitis, polio. Nigeria rapidly controlled Ebola outbreak, but the US struggled to rapidly bring Ebola virus disease under control. A good example where the US could learn from the African experience.

Key lessons for the Covid-19 pandemic from polio eradication

• Covid-19 is a global phenomenon. To build back, every country must have access to vaccines. There is no such thing as partial eradication of Covid-19.
• Control and eradication of Covi-19 requires equitable access to vaccines. Vaccine nationalism and protectionism we are witnessing will only delay global eradication of Covid-19.

 
Impact of Covid-related health service disruptions in Nigeria

• Access to services due to fear, lockdown, reduced mobility of people declined. Early training of community health workers proved critical.​