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Polio’s Last Stand

GENEVA – It has been a tough year for Nigeria. In the last 12 months, the country has suffered attacks by child suicide bombers and brutal massacres by Boko Haram. The vast majority of the 276 schoolgirls abducted in Chibok last year are still missing. And yet, during this time, despite such horrors, Nigeria has quietly managed to achieve something truly remarkable: an entire year without a single new case of wild polio.

This is a great achievement for Nigeria and all of its partners in the effort to eradicate the disease. Less than 30 years ago, polio plagued 125 countries, paralyzing 1,000 children a day. Until now, there were only three countries where the virus was still considered endemic: Afghanistan, Pakistan, and Nigeria. Health officials wait three years before declaring a country polio-free, but the one-year milestone in Nigeria raises hopes that we may have already seen the last case of wild polio in the country – and the whole of Africa.

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In addition to the logistical challenge of reaching every child in Africa’s most populated country, the Nigerian polio-eradication campaign has had to overcome security issues, opposition by religious fundamentalists, and rampant corruption. The fact that a country as troubled as Nigeria could pull off such an important feat is cause for celebration and provides grounds for optimism, not only in the fight against polio, but for global health efforts in general. Nigeria’s success shows that it is possible to bring the miracles of modern medicine to the world’s most marginalized and hard-to-reach children.

This has huge implications for the reduction of childhood mortality. The children that had previously not been reached with polio vaccines live in communities with little or no access to routine immunization, maternal healthcare, nutritional supplements, deworming, or malaria prevention. They are the children who are most at risk of dying before they reach their fifth birthday.

Nigeria’s success in reaching these children is the result of the efforts of thousands of dedicated local volunteers, some of whom lost their lives in the process. Since 2012, there has been nearly a fivefold increase in the number of volunteers involved in mobilizing communities during immunization campaigns.

Meanwhile, government, global health organizations like the World Health Organization and UNICEF, civil-society organizations, and community leaders, all working together, managed to identify and bridge the gaps that have historically impaired access to polio vaccines. In early 2012, for example, Nigeria’s government established dedicated emergency operations centers to coordinate data flow, facilitate decision-making, and improve accountability within the program. With support from Gavi, the Vaccine Alliance, Nigeria also installed more than 1,600 solar-powered refrigerators, which are critical to ensuring that vaccines remain safe and effective during their long journey through the distribution chain.

These investments in physical and social infrastructure provide a means of protecting children from a range of diseases. Already, polio workers in Nigeria are spending more than half their time providing unrelated but vital health services. The infrastructure has helped introduce new vaccines – such as pneumococcal conjugate vaccines, which protect against pneumonia, the biggest killer of children under the age of five – and increased coverage of routine immunization against measles and rubella. Thanks to the emergency operations centers, this infrastructure even helped to stop the Ebola outbreak in Nigeria in 2014, by enabling contact tracing and surveillance.

These efforts have the additional benefit of ensuring that Nigeria cements its polio-free status. The health infrastructure put in place during the eradication campaign has enabled the deployment of injectable polio vaccines, which will complement the oral vaccines in ensuring that the virus does not return.

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This was also the pattern in India, the most recent country to be declared officially free of polio, with no cases since 2010. The infrastructure put in place to deliver polio vaccines there is now being used to increase coverage of routine immunization, like the 5-in-1 pentavalent vaccine. India can now wind down its polio-eradication campaigns, but still maintain its polio-free status.

So far, in 2015, only 34 cases of polio have been documented worldwide – the majority of them in Pakistan. There is now a very real prospect that we could see the last ever case of wild polio – a disease that once threatened millions of people – before the end of 2016. To eradicate the disease, however, we will have to build on successes like Nigeria’s and strengthen routine immunization efforts. The end of polio should mark not just the defeat of a terrible disease, but also the beginning of a new phase in the effort to reduce childhood suffering and death, the benefits of which will be felt for generations to come.