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It’s Been One Year Since Africa Had a Polio Case. Can This Last?

At midnight Tuesday night—Aug. 11, 2015—the continent of Africa passed a quiet milestone: one full year since the recognition of its last case of polio.

As a journalist, my job is to try to be objective, and to not be a partisan or booster. But I think it is just stating facts to say this is a remarkable achievement—one that, a decade ago, few people believed would happen.

Africa cannot yet be considered “polio-free”; that designation, conferred by the World Health Organization,  cannot come until the continent passes three years without a case. And all the countries in Africa will continue to vaccinate children against the crippling disease until it is declared eradicated forever, which still lies some uncertain time in the future.

But it is still really striking that this has happened at all.

In case you think of polio as something that happened to your parents or grandparents, here’s the background: The disease has been vanquished in the West for decades, but as recently as the 1980s, it paralyzed more than 1,000 children every day—most of them in poor areas where disability would doom them to a live of discrimination and poverty. In 1988, the World Health Organization and a host of health organizations—the US Centers for Disease Control and Prevention, UNICEF and Rotary International, joined later by the Gates Foundation—vowed to eliminate the disease around the world. They thought it would take about 10 years, but to be safe, they chose 2000 as the target date.

It took a little longer than they planned. And in the many setbacks that have kept the world waiting for polio’s death certificate, Africa, and especially Nigeria, played a significant role. There’s an archive of of about 20 posts at my old blog tracing the recent history of polio eradication’s struggles, but here’s the Nigeria piece of the story: In 2003, Muslim religious leaders in Kano state in northern Nigeria began preaching against polio vaccination campaigns, contending that the drops had been deliberately contaminated in a plot to sicken and sterilize children.

(The reasons for the suspicion were complex, but an important factor was Nigerians’ distrust of Western medical interventions, based on a meningitis vaccine trial that took advantage of them. A fictionalized version of that story is told in the book and movie The Constant Gardener; I told the actual story at WIRED in 2011.)

The imams’ opposition triggered massive vaccine refusal, a devastating setback because at the time, Nigeria accounted for half of the world’s polio cases. Shortly afterward it became responsible for many more, because new infections in Nigeria led to a wave of polio cases across Africa, reseeding the disease into countries that had chased it out. So many children went unvaccinated that when a random vaccine-virus mutation occurred, creating an infectious strain, it ripped through Nigeria and border countries in a second epidemic. And in 2011, an independent monitoring board set up to investigate the eradication campaign’s problems excoriated Nigeria (along with India, Afghanistan and Pakistan) for corruption and nonperformance that were keeping the vaccine from needy kids.

Yet, 12 years after accusations were first lodged against the vaccine and nine years after the vaccine-derived polio outbreak, Nigeria has turned from the biggest problem in the African polio fight to an example of how to do things right. I asked a few of the campaign’s lead organizers how this happened.

Carol Pandak, director of Rotary’s PolioPlus program, told me the campaign studied its hurdles and devised new, nimble ways of getting the vaccine where it was needed.

Because parents complained that the exclusive focus on polio did not address health needs that felt more pressing to them, the campaign staged “health camps” where children received the vaccines and parents could obtain “aspirin, cough syrup, soap, bed nets—whatever a community said it needed,” she said by phone. In areas where extremist attacks made it difficult to get into villages, the campaign created lightning-strike “hit and run” teams who positioned themselves near conflict zones and raced in and out whenever there was a lull in the fighting.

And in a tactic borrowed from the CDC, the eradication-campaign partners set up an “emergency operations center” modeled on the agency’s Atlanta war room, in which vaccination teams and their logistics officers huddled every night to report where they had been turned away or blocked from treating children. There was first one EOC in the capital, Abuja, and then six others out in the countryside, each focused on collecting very local data that they could act on quickly. “This let us pinpoint problems in very specific areas right away, instead of waiting weeks for reports,” Pandak said. “And it changed our focus from “How many children have we gotten?’ to ‘How many children do we continue to miss?'”

None of those strategies would have worked, though, if the vaccination campaign had not been able to convert distrust of its efforts into support. I asked Dr. Oyewale Tomori, a virologist who is president of the Nigerian Academy of Science, how opposition to the campaign was defused.

“I think we made a mistake, at first, by assuming this was purely a scientific issue,” he said by phone. “In fact, it is a social issue. People felt they were being told what to do, but we did not explain to them, we did not try to gain their confidence.”

Changing people’s minds, he said, required fanning out across the country and seeking personal  conversations with imams, and with chiefs and the kings of small tribes. “I think this was a game-changer, to engage the traditional leaders,” he said. It helped, he added, that the popular new president, Muhammadu Buhari, marked the year of no cases by publicly immunizing his infant granddaughter. A picture of him dripping the vaccine into her mouth is being made into a poster that will be distributed nationally, Tomori said.

Keeping Nigeria and the rest of Africa free from polio will not be easy. Nigeria is the continent’s most populous country; more than 5 million children are born there each year, and vaccinating them could be disrupted by militant attacks or by renewed loss of trust. Last week, for instance, Kenya’s Conference of Catholic Bishops urged followers to boycott the vaccine, making the same claims of contamination and bad intent that were made in Kano 12 years ago.

“The problem is not over, we know this,” Tomori told me. “But we have enough momentum within the country to do this. There can be no going back for us.”