Polio is a life-altering disease. It has affected millions of people around the world, including Oscar-winning director Francis Ford Coppola, acclaimed violinist Itzak Perlman and celebrated singer-songwriter Joni Mitchell. All had access to healthcare, overcame the disease and even drew strength from the hardships they endured, eventually becoming the icons they are today.
But not everyone is so lucky. Polio can also be an insidious disease. As with COVID-19, you can experience flu-like symptoms, such as a high temperature, sore throat or an upset stomach — or have no symptoms at all. But in 5% to 10% of cases, the virus — which has no cure — attacks the nerves, and can leave the victim paralyzed. This condition, known as poliomyelitis or polio, was paralyzing 75,000 children a year in Africa just one generation ago.
This is the story of how International Medical Corps helped Africa beat polio.
A Brief History of Polio
Judging both by mummified bodies as well as an ancient pillar describing the withered legs of a pharaoh, polio is as old as civilization. By the 1800s, polio epidemics were common across the globe; by the early 1950s, 21,000 children in the United States alone were paralyzed every year.
In 1953, a vaccine was introduced by Dr. Jonas Salk. Though several hundred million doses were administered over the next decade, the vaccine wasn’t perfect: it caused paralysis in three out of every 1 million children. This understandably raised concern and, though rare, vaccine-derived cases continue to this day. As with other diseases, lack of trust in the vaccine threatened the success of mass-immunization campaigns.
Though the United States was declared polio-free in 1979, the virus continued to run rampant around the world. In 1988, 350,000 cases of wild polio were recorded in 125 different countries, paralyzing an average of 1,000 children every day.
In response, the World Health Assembly announced that polio would be the next eradication target. It established the Global Polio Eradication Initiative, an unprecedented campaign that has since vaccinated some 2.5 billion children and achieved stunning results: cases have dropped by 99.9%, with only 31 reported in 2018. According to the CDC, this effort has saved 18 million people from paralysis.
By 2019, despite the overwhelming success of the campaign, the virus still lingered in three countries: Afghanistan, Pakistan and Nigeria. Getting to zero cases in these places — home to some of the world’s most marginalized communities — proved difficult due to several factors, including ongoing conflict.
Successes and Setbacks
In 2012, Nigeria accounted for half of all global polio cases, with 122 confirmed cases reported in 60 districts. International Medical Corps’ team in Nigeria was committed to defeating the virus despite widespread instability due to an insurgence by the Islamist sectarian movement Boko Haram.
Our team persevered and in September 2015, Nigeria was removed from the list of polio-endemic countries. However, in August 2016, the WHO announced two new cases had been discovered in Borno State — in the northeast where Boko Haram had been prevalent.
“It was a sad day when wild polio returned to Nigeria,” remembers Shehu Ramat, Project Eradication Initiative Coordinator with International Medical Corps in Nigeria. “Following a huge effort by everyone involved — with no confirmed cases for two years — we thought that the country was finally polio-free when suddenly, it reappeared.”
Debunking Myths and Working with Community Leaders
As part of our vaccination campaign, International Medical Corps staff trained and mobilized community members. The training centered around social mobilization — teaching volunteers to successfully communicate critical messages to local populations, encouraging them to participate in immunization activities. These messages were shared through groups, as well as through one-on-one discussions, where volunteers answered questions and addressed concerns.
However, to beat polio for good, our team in Nigeria had to debunk persistent — and dangerous — myths about the vaccination program. “I will never forget when nine polio vaccinators were shot dead by gunmen in Kano State in 2013,” says Ramat. The violence, he explains, was “the result of a rumor claiming that the vaccine makes you sterile.”
The need to overcome such misinformation is one reason why an essential element of International Medical Corps’ polio eradication program involves working with traditional and religious leaders. Without their understanding, acceptance and support of vaccination campaigns, the chances of success are slim. As the most trusted members within their communities, they often are the gatekeepers to local populations. If they approve of the immunizations, people will likely participate.
In addition to working with religious leaders, International Medical Corps’ team also attends naming ceremonies, referring new mothers and their babies for immunization. Team members connect with other key community members — such as traditional birth attendants, who use their networks to identify children — who also have proved vital in the battle against the virus.
In August 2019, Nigeria celebrated three years without a single confirmed case. The official declaration, however, came one year later.
Eradication: Making History in Africa
On August 25, 2020, the World Health Organization declared Africa free of wild polio, bringing the world achingly close to eradicating the virus and leaving only Pakistan and Afghanistan on the list of endemic countries. Eliminating wild polio completely would be a monumental achievement — except for smallpox, officially declared eradicated in 1980, no other disease affecting humans has been globally eradicated.
— WHO African Region (@WHOAFRO) August 25, 2020
But challenges remain. Along with vaccine-derived polio cases, which continue to be an issue, COVID-19 has put a strain on the vaccination program.
“Due to the pandemic, national immunization days to provide supplementary doses to children have been postponed,” explains Ramat. “Many other essential health services have been disrupted, and the surveillance system — the way we monitor the spread of the virus — has slowed down. The government must continue its efforts so that we can sustain the gains achieved toward eradication so far.”
International Medical Corps will, of course, continue our efforts to immunize children in Nigeria, helping to ensure that the country remains free of wild polio.
Ending wild polio on the African continent amid a raging pandemic is an enormous feat. It’s also evidence of how much we, as a global community, can accomplish when we rally around solutions to seemingly insurmountable problems. We’ve done it once — with smallpox in 1980 — and we’re very close to doing it again with polio. Working together, who knows what other diseases we might eradicate in the future?
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