Wednesday, November 07, 2007

WHO Global Polio Eradication Initiative and Nigeria: A History of Poor Planning

The World Health Organization (WHO) began its Global Polio Eradication Initiative (GPEI) in 2003, targeting Nigeria and distributing its oral polio vaccine (OPV) with the goal of eliminating the disease by 2005. Muslim leaders in the Nigerian state of Kano expressed their concerns about the distribution of OPVs, and warned the government against cooperation because they believed the vaccines were a Western ploy to spread infertility and disease. Their fears of infertility were based in test reports that some of the final OPVs produced had traces of oestrogen and progesterone, reproductive hormones that inhibit fertility, within them. The WHO released a positions statement in January 14, 2004, denying these claims. The fear of “Western” vaccinations is not empty, however, as residents of Kano were subject to poorly tested meningitis vaccinations in 1996 that lead to the deaths of some 11 children.

In 2004, half of all new polio cases originated in Nigeria, many in the northern states, especially Kano. While the WHO was spreading the oral vaccine throughout the nation, Kano officials refused to participate in the initiative for eight months, spurning the spread of polio into twelve countries that previously had been declared polio-free (such as Sudan, where a child was diagnosed with polio in Darfur for the first time in 3 years). Under great pressure, the northern state bent, and in October of 2004 President Olusegun Obasanjo showed his support for the initiative by giving OPVs to children in Kano.

By 2006, the vaccination initiative was on the rise, but so was the polio virus. Children in Nigeria need to be immunized over and over again to ensure they do not contract the virus, and this need to repeat doses makes families very nervous; oftentimes they refuse to let their children be repeatedly immunized. There are many factors that impede the efforts to immunize children repeatedly: Only women can distribute the vaccines in certain areas and they make meager wages; workers often report a 100% success rate, even when that is far from true; because children need to immunized between eight and ten times for OPVs to be effective in the long-term, it is hard to know which children have been and have not been immunized; and, finally, widespread sewage inefficiencies increase the exposure of children, who play in filthy streets, to the polio virus.

Today, as reported October 10, 2007, Nigeria faces an outbreak of rare, vaccine-derived form of the polio virus. Some children who had received vaccinations have excreted a mutated form of the polio virus and have infected other children who, likely, were not immunized or only given OPVs a few times. There are now, and rightly so, many questions in the air surrounding the issue of oral vaccinations in Nigeria:

Were the OPVs properly tested before they were administered to children in Nigeria?

Were the OPVs tested for repeated administration, as they were anticipated to be distributed in Nigeria, before they were given to children?

Did the WHO anticipate the mutations that occurred?

How should this new strain of polio be addressed?

Where could this new strain of polio spread if not properly addressed?

How can it be contained?

No comments: