So They Can Walk: The Story of Polio Eradication in Nigeria - The Rotary Perspective

By CBN Ogbogbo and Rotary International

This book, So They Can Walk: The Story of Polio Eradication in Nigeria, chronicles the story of polio eradication in Nigeria - the challenges, confrontations and contests that led to Nigeria becoming certified as a country that has interrupted the transmission of the indigenous wild poliovirus. It is a story of courage, audacity, dauntless brave

• Language: English
• Publisher: Nigeria National PolioPlus
• Release date: Dec 25, 2021
• ISBN: 9788689644685

Book preview

Acknowledgements

An apt beginning is to congratulate Nigeria on the crowning of her efforts with the World Health Organization’s eventual pronouncement as being polio free on 19 June 2020 after a prolonged thirty-two years sustained efforts by Rotary International and several other strategic partners. Given the enormous and strategic roles played by Rotary International in the eventual declaration of Nigeria as being Wild Poliovirus (WPV) free, it is pertinent to document her story as it pertains to the eradication of the debilitating virus.

Writing this book that X-rays the efforts and challenges of Rotary International in the eradication of the WPV from Nigeria has been very educative. Our subject matter falls within the jurisdiction of medical history and this has compelled us to interrogate medical as well as other literature on poliomyelitis and also conduct extensive interviews across every nook and cranny of Nigeria.

I will like to appreciate the Nigeria National PolioPlus Committee (NNPPC) members, a body chaired by Dr Tunji Funsho. I thank them for engaging me to write this memorial in honour of the efforts of the organization, that is, Rotary International’s legacy in the eradication of polio in Nigeria. Their cooperation and willingness to grant interviews throughout the pendency of this project is much appreciated. I must single out Mr Obafunso Ogunkeye, a member and secretary of the NNPPC team, whose constant prodding and encouragement ensured that the writing was brought to a quick and successful end.

Next on my list of gratitude are my colleagues and fellow researchers who committed their time at a very short notice in carrying out research and interviews across the length and breadth of the country. A big thank you is therefore due to Professor Akachi Odoemene, Drs Chiamaka Nwaka, Albert Onobhayedo, Olisa Muojama, Attahiru Seifuwa, Bashir Animashaun, Fidelis Egbe,

Maryam Tanko, Abolorunde Ayodele, Evelyn Owaniban and Adepeju who are all lecturers from various universities in the country. It will be important to acknowledge the input of our informers in various states of the federation. When we flagged off our fieldwork from the Rotary House in Ikeja, Lagos, we met Bunmi Ogunjirin who provided the chunk of documentary evidence we required for piecing our story together. She deserves special thanks for her unwavering cooperation. Several Rotarians in various Districts and non-Rotarians also provided useful information with regard to the fight against the wild polio virus. I will like to specially mention a quintessential Professor of Virology in Nigeria, Professor Oyewale Tomori, who provided his writings on the subject matter and granted us an extensive interview. Mention must also be made of personalities such as Prof. Shehu Umar and Dr Ajoritsedere Awosika. In the same vein, I am grateful to a number of traditional rulers who granted us audience in the course of the research. Amongst them are the Emirs of Kaltungo, Bama and Shonga.

I thank my wife, Peju, for her care, affection, support and for constantly helping to edit my writings at very short notices.

CBN Ogbogbo

House 66, Niger Barracks Abuja

Foreword

It is not often that a disease is eradicated from a geographical region. Indeed, only one disease, smallpox have we had the singular fortune of eradicating from the world. The certification of Africa as wild polio virus free is a huge step towards the total eradication of polio from the world. This leaves just one more WHO region; the Eastern Mediterranean region where polio is still circulating in Afghanistan and Pakistan. It is therefore vital that we document the incredible journey that brought us to the important milestone of Africa polio free certification by virtue of Nigeria leaving the company of polio endemic countries.

This realization led the Nigeria National PolioPlus Committee to engage the expertise of a foremost Nigerian historian, Professor C.B.N. Ogbogbo, to document the role that Rotary has played along with its corporate partners and individuals in getting us to the very important milestone of Africa polio free certification. Rotary, since its founding by Paul P. Harris, has carried out numerous projects across the world in more than two hundred countries and geographical regions with positive life changing outcomes. However, none of these has attained the sheer scale, cost and impact of the world polio eradication initiative.

This global polio eradication initiative was a spin off Rotary’s successful polio eradication programme in the Philippines in 1978. This success gave Rotary the impetus to embark on the journey of polio eradication in the world. The first seed money for this project after getting the nod of WHO was raising $240 million by 1987. This was twice the amount WHO estimated will be required for polio to be eradicated by the year 2000. However, the effort has been very daunting and faced many challenges which varied in different parts of the world. In spite the challenges, we have made great progress.

Various African governments rose to the occasion particularly in 1996 after Nelson Mandela made the clarion call to African heads of state to kick polio out of Africa. The partnership with the World Health Organization (WHO), the United Nations Children’s Education Fund (UNICEF), the United States Center for Disease Control (CDC), and the Melinda and Bill Gates Foundation which led us to this milestone is the largest public-private partnership for a health intervention in the world. Every partner has brought in their unique skills for us to achieve this milestone.

Prof. Ogbogbo has captured in this book the essence of Rotary’s role in ridding Nigeria of the wild polio. This will be a great legacy for Rotary and its Global Polio Eradication Initiative (GPEI) partners and a resource for public health scholars and researchers.

Dr Tunji Funsho

Chairman, Nigeria National PolioPlus Committee

August 2021

Nigeria National PolioPlus Committee

Contents

Acknowledgements

Foreword

List of Abbreviations

1. Understanding Poliomyelitis

2. Rotary International and the Global Initiative to Eradicate Polio

3. Rotary in Nigeria

4. Rotary International’s Involvement in Polio Eradication in Nigeria

5. The Challenges and Innovations of Rotary International at Eliminating Polio from Nigeria

6. Icons in the Rotary Polio Eradication Drive in Nigeria

7. Conclusion

Appendices

List of Abbreviations

Acute Flaccid Paralysis (AFP)

Africa Regional Certification Commission (ARCC)

Aliko Dangote Foundation (ADF)

Bill & Melinda Gates Foundation (BMGF)

Communication for Development (C4D)

Deoxyribonucleic Acid (DNA)

Directly Observed Polio Vaccination (DOPV)

Emergency Operation Centres (EOCs)

End Polio Now Zonal Coordinator (EPNZC)

Expanded Programme on Immunization (EPI)

Expert Review Committee (ERC)

Federal Capital Territory (FCT)

Geographic Information System (GIS)

Global Alliance for Vaccines and Immunization (GAVI)

Global Immunization Division (GID)

Global Polio Eradication Initiative (GPEI)

Global Public-Private Initiative (GPPIs)

Human Immunodeficiency Virus (HIV)

Inactive polio Vaccine (IPV)

Incident Management System (IMS)

Indigenous People of Biafra (IPOB)

Interagency Coordinating Committee (ICC)

Internally Displeed Persons (IDPs)

International Committee of Red Cross (ICRC)

International PolioPlus Committee (IPPC)

Jama’atu Nasril Islam (JNI)

Memorandum of Understanding (MoV)

Millennium Development Goals (MDGs)

National Immunization Days (NIDs)

National Immunization Programme (NIP)

National Primary Health Care Development Agency (NPHCDA)

National Programme on Immunization (NPI)

Nigeria Polio Eradication Emergency Plan (NPEEP)

Nigeria Governors’ Forum (NGF)

Nigeria National PolioPlus Committee (NNPPC)

Nigerian Red Cross Society (NRCS)

Oral Polio Vaccine (OPV)

Presidential Task Force on Polio Eradication (PTF on PE)

Ribonucleic Acid (RNA)

Rotary Clubs (RCs) Rotary International (RI)

Sir Emeka Offor Foundation (SEOF)

State Primary Health Care agency (SPHCDA)

State Task Force (STF)

Stop Transmission of Polio (STOP) Supreme Council for Islamic Affairs (SCIA)

Technical Consultative Group (TCG)

The Rotary Foundation (TRF)

United Nations General Assembly Special Session (UNGASS)

United Nations Children Fund (UNICEF)

US Centre for Disease Control (CDC)

United States Agency for International Development (USAID)

Vaccine-Derived Polioviruses (VDPV)

Wild Poliovirus 1 (WPV1) Wild Poliovirus 2 (WPV2)

Wild Poliovirus 3 (WPV3)

World Health Organization (WHO)

1

Understanding Poliomyelitis

Polio: A Conceptualization

Polio has been a disease of global concern. It is classified among infantile diseases that inhibit the proper development of a child. In terms of frequency, it was for several decades regarded as the foremost cause of infantile paralysis.¹ Though known in virtually all societies and cultures over the centuries, a scientific understanding of the disease is a 20th century phenomenon. Apart from smallpox, which was eradicated in Nigeria in 1966, no other disease has received as much attention as polio in terms of a deliberate and well- structured plan geared towards its total eradication in Nigeria.

The causative virus (poliovirus) was discovered in 1908 by an Austrian pathologist, Karl Landsteiner, who successfully isolated the poliovirus from a victim of the disease. ² Prognosis of the disease indicates that the resultant paralysis (temporary or permanent) stems from the damage caused by the virus to the nerves that control the muscles. On account of this, it is classified as a nervous disease. Beyond paralysis, the poliovirus can infect the central nervous system by a virulent attack on the brain and spinal cord, resulting in complications and sometimes, death. Ninety-five per cent of the victims are children. ³Nevertheless, adults can be victims, too. ⁴Polio is contracted in diverse ways, including contact with already infected persons and exposure to contaminated droplets, excrement, flies and objects. ⁵In the human host, the disease incubates for about 5 to 35 days. ⁶In its mildest form, polio attack can be asymptomatic or produce only mild symptoms such as stomach upset, cold and muscle ache (without paralysis) that get resolved by the immune system within a few days or weeks. In this mode, polio infection may go unnoticed, though this does not preclude the possibility of infecting others. A second category of polio cases produces temporary paralysis, which also goes away in a few days or weeks. However, in these two categories, the virus lurks around, and could be transmitted by such carriers. The severe cases of polio usually result in irreversible paralysis and even death. These three levels of manifestation and variation in virulence and intensity of polio are typologically identified as abortive-polio, non-paralytic polio and paralytic-polio.

Studies have shown that a community can have 200 abortive or non-paralytic cases for every one paralytic case of poliomyelitis. ⁷ Both categories account for 95.5% of all polio cases worldwide. ⁸ The global concern for the eradication of polio stems from the fact that in its virulent form, it results in incurable wastage of the muscles of the limbs, paralysis, deformity and even death which could occur within a few days. Any of the limbs or even muscles of the neck and diaphragm can be affected. Typically, 2 to 5% of children who develop paralytic polio die. The death rate among adults is even higher, amounting to about 15 to 30% of infected persons.⁹

The epidemiology of the disease indicates that polio was a global menace. It occurred more in the warmer seasons of the year, yet it was not classified as a tropical disease because of its scale of occurrence in temperate countries of Europe and the Americas such as Britain and the United States before the invention of the anti-polio vaccine. Before the invention of the polio vaccine, all polio cases were wild. The classification of the disease as ‘wild polio’ or ‘circulating vaccine-derived polio’ came in the wake of vaccine production and administration. Poor and improper handling of production, preservation and administration of polio vaccine, have in some cases, resulted in vaccine-induced infection. With increased efficiency in vaccine production, the risk of acquiring the disease through oral polio vaccine (OPV) reduced to 1 in 2,400,000 doses. ¹⁰

The causative virus of polio is called poliovirus and it is one of the smallest viruses. It is a ribonucleic acid (RNA) virus belonging to the genus Enterovirus C, a member of the family of picornaviridae. The picornaviridae is a family of small viruses with single-stranded, highly diverse positive-sense RNA genomes. ¹¹ Unlike bacteria, a virus can neither move nor replicate outside its host. It hacks and grafts to the cells of other organisms in order to express itself fully and replicate. Where the deoxyribonucleic acid (DNA) viruses infuse their (DNA) with their host’s genetic code, the poliovirus injects its RNA into its host’s cytoplasm and so synthesizes the protein it would require to replicate itself. ¹² Other examples of RNA viruses are the zika virus, Ebola virus, influenza virus, dengue virus and rabies virus. ¹³ There are three strains of the poliovirus - Wild Poliovirus 1 (WPV1), Wild Poliovirus 2 (WPV2), and Wild Poliovirus 3 (WPV3). Each strain is differentiated by the protein shell - capsid antigen - it generates and occupies in its host. The capsid antigens vary structurally between strains, creating a pattern where immunity to one does not confer immunity to the other two. ¹⁴

According to Jonas Salk (the developer of the Inactive Polio Vaccine (IPV)), the type I appears more dangerous than type 2 or 3 and eight times more frequent than 2 or 3. ¹⁵ All three have genetic peculiarities, which are taken into account in the formulation of polio vaccines. Monovalent vaccines are prepared specifically for each strain, bivalent for two strains at a time and trivalent for all three.

Manifestation and Spread: A Global Overview

The history of polio dates back to the ancient world. It was a major bio-medical challenge in virtually all cultures of the world. It was dreaded because it defied medical and herbal intervention. Nothing in the pharmacopoeia of the ancient world proved useful in the prevention and cure of the disease. Evidence of the prevalence of polio in ancient Egypt could be gleaned from Egyptian arts where the disability and paralysis arising from polio are depicted.

Screenshot_2020-01-05-00-30-03

Plate 1.1: Polio in Ancient Egypt

Source: Google.com/search. See also https//owlocation.com/humanities

In Europe and the Americas, the scourge of polio left behind a trail of paralysis that defied solution over the centuries. Therefore, up to the beginning of the 20th century, polio remained a puzzle and the dominant cause of infantile paralysis. Reports indicate that the United