DAKAR, 29 April 2009 (IRIN) - Nigeria has confirmed 193 polio cases in 2009 but as the latest round of vaccinations comes to a close international experts say they are gaining ground in the fight to eliminate polio in Nigeria.

"The campaign is going well," said Alex Gasasira, head of the World Health Organization's (WHO) polio programme in Nigeria. "I don't see why Nigeria cannot eliminate polio. A lot more work needs to be done to reach that goal. But if we can learn from and improve on each campaign round, we should at least see polio reaching very, very low levels by end of year."

Abdurrahman Yakubu, coordinator for Kano state immunisation programme, told IRIN: "We are making tremendous success in polio immunisation. With improved logistics we are now reaching all corners of the state."

He said resistance to the polio vaccine has waned "drastically" though there are still pockets of non-compliance in some areas, which health officials are working hard to overcome.

The Nigerian Health Ministry, the Global Polio Eradication Initiative, WHO and International Federation of the Red Cross (IFRC) undertook campaigns to vaccinate under-five children throughout West Africa in January and February and again in March and April.

WHO's Gasasira told IRIN far more families came foward for vaccinations in the latest round than in January-February, with health workers reaching 50.5 million children.

"This shows public officials are much more visibly engaged at all levels in the campaign," he said. While the government has shown "a high commitment" to fighting polio in recent years, in the past few months this has extended to state and local government area levels. "We credit the government with its intense outreach to people," he said.

Nigeria is one of four endemic countries worldwide where polio infections originate before they are transferred across borders; the others are Afghanistan, India and Pakistan. Globally in 2009, 328 polio cases have been reported, 240 of them in polio-endemic countries.

Incurable, the highly infectious virus causing polio leads to irreversible paralysis in one of 200 cases – and up to 10 percent of these die when their breathing muscles become frozen, according to WHO, which considers one case an epidemic.

Regional risk

The immunisation campaign is synchronised across seven West African countries: Benin, Burkina Faso, Côte d'Ivoire, Ghana, Mali, Niger, and Togo, which collectively have 40 cases but had been largely polio-free since 2004, according IFRC senior health officer, Kate Elder.

Six new cases were reported in West Africa in mid-April – three in Benin, one in Burkina Faso and two in Côte d'Ivoire.

Guinea, Sierra Leone and Liberia will soon be added to preventive campaigns in late May as the major risk is the potential further westward spread of the virus into polio-free countries, according to the Global Polio Eradication Initiative.

"There is still more we could be doing to contain the spread of the virus," IFRC's Elder said.

Campaigns will continue across the seven re-infected countries in West Africa in May, with possible additional rounds in June and July in Benin, Burkina Faso, Côte d'Ivoire and Togo.

Reluctance remains

Ensuring full vaccination coverage is a challenge for any polio campaign, said Elder. The IFRC uses its 1600-strong volunteer network spread across 22 Nigerian states to reach remote communities.

In the past, resistance among conservative religious groups in northern Nigeria stymied campaigns, but now Elder says lack of preparedness or familiarity with polio vaccines is the biggest challenge facing vaccinators.

"Many people, if not prepared, are perplexed as to why we are knocking on their doors and giving oral drops to children. Our volunteers come from the communities they are targeting so they are good at getting communities on board," Elder said.

Some residents said they will take part only if health facilities in their area are improved. "Some villagers scornfully tell us we should provide them with good medical facilities and essential drugs if we want them to accept the polio vaccine we offer them, said Adamu Abubakar head of the IFRC in Bauchi state, one of eight states in northern Nigeria considered to be a high-risk area. "It is often difficult to make them change their minds."

In some cases experienced vaccinators, who are paid US$12 per four-day campaign, are stepping down, resentful of the $2,500 fees consultants command over the same time period, leaving younger, less experienced staff to do the job, Abubakar pointed out. It is harder for the younger workers to persuade older men – usually the decision-makers in the north – to bring their children forward.

"The most effective method has been to engage village leaders, followed by mothers and other caregivers in a series of community dialogues to try to prepare them," WHO's Gasasira said, adding that the approach takes time and patience.

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