Birth control row hits polio eradication in Nigeria  

I came across this interesting piece of article in a Daily Trust Newspaper as written by Judd-Leonard Okafor:
When President Good luck Jonathan made his famous pronouncement about needing to control Nigeria’s exploding population through birth control, he didn’t anticipate how it would impact efforts to kick polio out of the country.
Weeks after his announcement, ongoing campaign to break transmission of polio this year has taken the first blow.
Polio eradication has historically faced tough resistance among residents mostly in the north of the country where people often feared that the vaccine came with a side effect: to render young girl children infertile in a bid to control population.
It showed up in Nasarawa A, a ward in Chanchaga council area of Niger. This time, residents cited the president’s comments when they refused vaccines meant for their children.
The ward, one of 11 sandwiched in the council area, has not been known for stiff resistance in recent past. Despite the comments, it recorded only a handful of non-compliant households (where parents refused the vaccine) on the first of four days of massive vaccination planned this July.
That’s because officials saw the problem coming, said a field supervisor.
In days before the immunisation took off, said a local World Health Organisation staff, officials sat with religious leaders and explained that the president’s comment was not final—and birth control couldn’t become legislation without going through the national assembly.
“We told them they have representation in the Senate and House of Representatives who will speak for them,” said the official. Similar assurance was broadcast on Radio Kaduna, he noted, and people listened.
Broken covers
Mixing a shaky polio eradication programme with murky politics of birth control is calling for trouble. Already, some northern states not on the list of high-risk areas in the north have seen record new cases of polio.
Immunisation still needs stronger political will to see it through. Officials meeting for to review the day’s work in the chambers at Chanchaga council secretariat believe they see the will in the local government politicians who sit in on the review.
It was always the case, they explain. Before they simply met under a tree in an open space, quoted figures from the field and dispersed. Now a lot has changed, the local WHO official said.
But pockets of resistance remain, and with them newer problems. Vaccine carries in use since mass immunisation rounds started years ago have worn out.
In May, field workers in Birnin-Kebbi swaddled the worn-out lids of vaccine carriers in polythene bags and foam, and vigorous complaints prompted release of 10 new carriers for the council area.
Field workers in Minna sought new improvisation: thermos food flask of nearly same capacity as the vaccine carriers. They stuff the plastic flasks with ice boxes to keep the vaccine within optimally cool for the four, five hours it takes to administer all the vaccine doses they carry in a day’s work.
But that depends on parents accepting the vaccines. Vaccination teams combing through households in Chanchaga and Bosso still come up against households who don’t “give us any response,” complained one field worker.
“He [the head of the household] didn’t even answer us. Zamu koma anjima tare da shi.” He meant the team would go back later together with him—him being the ward focal person, local facilitators who accompany field teams.
Such focal persons are becoming crucial to breaking through resistance.
Needed links
Officials reviewing Saturday’s work prepared to visit churches during service the following Sunday, but the absence of representatives from Christian Association of Nigeria and Rotary left plans in the air.
“We need them to liaise with churches so that we have things easier,” admitted a top official in Minna, amidst worry over low coverage.
While some are not getting the right coverage, other residents in Soje find fault with the rounds. A field vaccinator who worked there on Saturday reported cases of noncompliance. “They are complaining that their children have received vaccines and why are we coming around to [vaccinate] them again.”
Another WHO supervisor said noncompliance among Fulani dwellers of Soje was “critical”.  She recorded 15 households who refused, telling her “they don’t go to hospital, they don’t take vaccines [or injections]—it is not part of them.”
Many of the cases go unreported and undocumented, she suspects, and blames it on field vaccinators being indifferent, concluding—even before being told—that the households have no children under age five.
In general, concern about noncompliance isn’t shocking anymore. It’s the biggest entrenched front in polio eradication, but “we are more concerned where ward focal persons are around and nothing is done,” observed one official.
It is the task of focal persons, after the day’s work, to revisit noncompliant homes in hope of turning their no to yes.
A bigger picture
Focusing on statistics alone can paint the wrong picture in polio eradication.
On the first day of vaccination this month, field workers reported figures far above or below the numbers they targeted. In one ward, only one newborn was vaccinated for the first time (known as zero dose).
There are as much children growing out of the age-five bracket as there are children growing into it.
Newborns and migration also swell the group. So less number of children under five immunised can sometimes be cancelled out by more newborns.
When children move out of one location, they shrink the numbers there and swell numbers of new neighbourhoods their families enter. This way, immunising fewer children than targeted may not necessarily be underachievement, explains a WHO official. What’s important is to get the right children—those who need the vaccine.
Witchcraft plus
Vaccinators are sure they will continue to get the children—despite the absent of incentives.
So-called pluses—sweets given to children, soap and salt given to their mothers—are used to entice households to take the vaccine. That’s the “plus” in the programme’s name—Immunisation Plus Days.
Pluses were pulled from Niger’s immunisation programme last year, according to one official, in the wake of rumours about secret cults and witchcraft.
The rumour was that children could be initiated through petty offerings of sweets and biscuits. Even teachers who sold such items to children at schools stopped.
“Imagine your child wakes up in the morning and tells you they went to a [night] meeting with their teacher,” explained one official. The mental picture was chilling.
However, the numbers of children receiving vaccines in Niger are comfortably high, compared with states seeing more noncompliance despite using pluses.
It has managed to overcome bickering over incentives. Now it must face ideologies that could scuttle the efforts. Such is the impact of statements regarding birth control.
One at a time, officials still hope to bring those refusing on grounds of the pronouncement to see reason.
The day team couldn’t finish what it started. By evening, another team including the ward focal persons will visit homes of sceptics. If that fails, another revisit is scheduled next day.

The End of Polio: Polio’s last percentage – Bill and Melinda Gate’s Foundation

I came across this on the internet and as an agent of social change, fighting inequity across the globe, I felt duty bound to spread the message. It reads as follows:
Polio – a disease which has disabled millions and pulled people further into poverty – has been reduced by 99% over the past 25 years.
Global efforts have delivered incredible progress: immunising more than 2 billion children and saving more than 8 million children from life-long paralysis or death. In January, the world reached a remarkable milestone in the fight to eradicate polio – 12 months without a case of polio in India for the first time in history.
But progress towards eradication is at risk: with the critical work of the Global Polio Eradication Initiative constrained by a funding gap of almost US$1 billion for 2012/13 – threatening international polio eradication efforts.
That’s why the Global Poverty Project is working with partners to support the Global Polio Eradication Initiative, and make the end of polio reality.

We can all play a role in ensuring that polio is eradicated.

Last year, more than 20,000 ordinary people made their voices heard and helped convince five world leaders, together with Bill Gates, to announce an additional $118 million in funding for the Global Polio Eradication Initiative. This year, we’re calling on delegates to the United Nations General Assembly to announce further funding for polio eradication, closing the funding gap that’s currently leaving millions of children vulnerable to polio.

Global PEI under threat: A Ban on Polio Vaccination in Parts of Pakistan Puts the Entire World at Risk

I came a cross a colleagues link on this from TIME magazine and decided to share the story:
Thousands of public-health workers fan out across Pakistan today in the first day of a three-day campaign to vaccinate the country’s children against polio, an estimated 250,000 won’t be receiving the potentially lifesaving dose, the social-affairs secretary for Pakistan’s Federally Administered Tribal Areas, Aftab Akbar Durrani, told VOA’s Urdu Service yesterday. Last month, militant leaders in two of the most lawless districts of Pakistan’s Federally Administered Tribal Areas (FATA) declared that the vaccination teams would not be allowed to conduct their campaign, declaring that the locally run program was merely a ruse to allow American spies to penetrate the region. “In the garb of these vaccination campaigns, the U.S. and its allies are running their spying networks in FATA, which has brought death and destruction on them in the form of drone strikes,” wrote Mullah Nazir, one of South Waziristan’s major militant commanders, in a pamphlet that was widely distributed on June 25. His screed echoed that of a commander in North Waziristan, Hafiz Gul Bahadur, whose own pamphlet from a week earlier was even more direct: “We don’t want benefits from well-wishers who spend billions to save children from polio, which can affect one or two out of hundreds of thousands, while on the other hand the same well-wisher (America) with the help of its slave (Pakistan’s government) kills hundreds of innocent tribesmen including old women and children by unleashing numerous drone attacks.” The ban on vaccinations, he continued, would not be lifted until the drone strikes stop.

Both Nazir and Bahadur reiterated to TIME through a special correspondent in Peshawar yesterday that they would not reconsider the ban on vaccination teams, citing the ongoing drone campaign in the country’s tribal regions.

(MORE: The Taliban Halts Polio Vaccines — and Pakistan’s Kids Will Pay)

As my colleague Jeffrey Kluger wrote in the wake of the first pamphlet,

Using children as medical poker chips is indefensible under any circumstances, but the Pakistanis do have other reasons to be suspicious of Westerners bearing vaccines. In the months leading up to [Osama] bin Laden’s killing in May 2011, a local doctor who was also working for the CIA ran a hepatitis-vaccination campaign in and around Abbottabad, where bin Laden was holed up. The real purpose was to try to obtain DNA samples that would confirm bin Laden or his family members were indeed in residence. That, surely, figured in the Taliban’s decision.

But the militant’s math — “one or two out of hundreds of thousands” — demonstrates an egregious misunderstanding of the sinister swath that polio can cut through a population of healthy, active kids, according to Kluger:

For every clinical case of polio, there are 200 subclinical ones that can present themselves merely as a bad summer cold; but that’s 200 active carriers who can and do spread the wild virus. Even people who are infected with what will turn out to be a crippling strain of the disease do not know they’re sick for a week or more, as the virus makes the long journey from the throat to the gut to the bloodstream — multiplying explosively all the way — and finally to the anterior horns of the spinal cord and the medulla oblongata of the brain, where it wipes out the cells that signal the muscles, paralyzing them forever.

(MORE: Polio’s Back. Why Now?)

The vaccination campaigns take place every six weeks or so; each child under the age of 5 requires three doses to ensure that he or she is truly immune. So not only will the militants’ ban leave the very young vulnerable, it will also negate the effects of previous vaccination campaigns. That too will have long-term consequences, not just for the children but for the worldwide campaign to eradicate polio for good, according to Kluger:

Until very recently, polio appeared to be at the very brink of eradication — which would make it only the second disease ever to be wiped out in the wild, following smallpox, which was finally vaccinated out of existence in 1977. As recently as 1988, there were 350,000 cases of polio worldwide, distributed across 125 countries. Thanks to an aggressive, 24-year eradication campaign headed by UNICEF, WHO, the CDC and Rotary International, however, there were only 650 cases worldwide last year and only 73 so far this year — confined to just three countries: Afghanistan, Pakistan and Nigeria.

Afghanistan’s 10 cases this year have occurred in the country’s south, along the border with Pakistan, where ongoing fighting has prevented vaccination teams from accessing the children. Pakistan’s 22 cases, however, have occurred in all four of the country’s provinces, a worrying sign of the disease’s spread. Nigeria, with 52 cases of paralysis this year, will still be the most difficult country to tackle, though numbers have plummeted over the past four years. (There have been 11 new cases in Nigeria in the three weeks since Kluger wrote his story, which explains the discrepancy.)

Still, with so few cases worldwide, the prospect of global eradication is tantalizingly close. The longer the Pakistani militants’ ban on vaccination goes on, the more difficult it will be to reach that goal. They might think they are making a point, instead they are holding the lives of Pakistan’s, and the world’s, children hostage. When challenged on that point, both Nazir and Bahadur argued that they were looking out for the long-term good of their people. It’s hard to see how.

MORE: Bill Gates: ‘We’re Making Progress’ at Eradicating Polio