POLIO CONTINUES NIGERIA ADVANCE; WHAT TO DO NOW?

UNCLAS SECTION 01 OF 02 ABUJA 001252 SIPDIS E.O. 12958: N/A TAGS: PGOV EAID SOCI NI SUBJECT: POLIO CONTINUES NIGERIA ADVANCE; WHAT TO DO NOW? REF: ABUJA 404 ¶1. Summary. Polio in Nigeria by most measures continues to worsen -- and Nigerian travelers are carrying the virus abroad. In five Nigerian states there are four times as many cases of polio as in the same period in 2004. More than 40% of the children in those states have not received one dose of the oral polio vaccine. As of May 12, Nigeria had 250 cases of wild poliovirus in 15 states, compared to 113 for the same period in 2005 in 14 states. Nigeria accounted for 79% of the world's wild poliovirus cases in 2006, and for 98% of the cases in Africa. Nigeria's polio- eradication campaign has made progress in reducing the virus's geographic extent within the country, from 325 infected Local Government Areas in 2004 to 63 since December 2005, but polio has proved difficult to defeat in its remaining strongholds. The GON recently adopted a new strategy, supported by donors, of Immunization-Plus Days. These offer additional health services during polio campaigns using a combination of fixed immunization points and house-to-house vaccinator teams. End summary. ¶2. Despite substantial international assistance, polio in Nigeria by most measures continues to worsen -- and Nigerian travelers are carrying the virus abroad. In five northern Nigerian states there are now four times as many cases of polio as in the same period in 2004. More than 40% of the children in those states have not received a single dose of the oral polio vaccine. The Current Situation -------------- ¶3. As of May 12, Nigeria had 250 cases of wild poliovirus in 15 states, compared to 113 for the same period in 2005 in 14 states. Nigeria accounted for 79% of the world's wild poliovirus cases in 2006, and for 98% of the cases in Africa. Some states in northern Nigeria are recording a higher incidence of polio than at the same time in each of the previous three years. While 22 of Nigeria's 37 states did not report cases of polio in the past six months, Nigeria overall had triple the number of cases it did at this time last year. Five states - Bauchi, Jigawa, Kaduna, Kano, and Katsina - accounted for 80% of all cases of polio in Nigeria in 2006 and 56% of all cases worldwide. Nigeria's polio-eradication campaign has made progress in reducing the virus's geographic extent within the country. The number of infected Local Government Areas declined from 326 in 2004 to 217 in 2005 and 63 since December 2005, but polio has proved difficult to defeat in its remaining strongholds. The Global Polio Eradication Initiative cautioned recently that the five states' high level of polio transmission could require an additional 12 to 18 months of intensive efforts to interrupt the spread of the virus. ¶4. Nigerians also are spreading the virus abroad as they travel. A Nigerian citizen reinfected Indonesia with polio. Indonesia's case was imported from Kano, based on the evidence of genetic sequencing. Recent cases in Yemen were introduced by a Nigerian, Somalia imported polio from Nigeria, and a Nigerian carried polio to Sudan. Alarmingly, for every reported case of polio, there are 10 carriers, who do not demonstrate any clinical symptoms. The Government of Nigeria changes its strategy -------------- - ¶5. Polio in Nigeria is worsening despite international donors' best efforts. A U.S. Department of Health and Human Services officer assigned to the World Health Organization (WHO) discussed this situation with economic officer on March 29. Some public-health officials suggest the strategy of going door to door is not working because this misses the same children repeatedly. Polio is spreading in Nigeria because of gaps in the household strategy. The house-to- house strategy should be continued, but there is a need to adopt a strategy for those families who hide their children from vaccination teams. Immunization coverage in the states around Kano State has improved, leaving a clustering of the virus in Kano, where the unvaccinated population is so large that the virus has a pool in which to sustain itself. Kano city, for example, has a population of about 4 million. The WHO official recommended targeting the cluster and isolating the virus even more, but most other donors did not support that. ¶6. Fighting polio is costly. The cost of a national immunization round, including vaccine, is $13,070,265. The cost of a sub-national immunization day is less, depending on how many states participate. Nigeria's national immunization day (NID) for January was delayed, and NID rounds were carried out in February and March. Some donors and the Government of Nigeria (GON) contend that routine immunization first must be improved before a heavy push is made against polio, although the donor community and immunization experts are not in full agreement on this. The WHO views regular NIDs as simply "treading water" at high cost -- at a time when money for multiple immunization rounds is decreasing. The GON urges that routine immunizations be carried out. Building up Nigeria's routine immunization program will take five to seven years, the WHO official said. ¶7. The GON has since adopted a new strategy, supported by donors, of Immunization-Plus Days (IDPs). These offer additional health services during polio campaigns using a combination of fixed immunization points and house-to-house vaccinator teams. IDPs will better address children's health in Nigeria by offering measles vaccinations, vitamin A injections, treatment for worms, and insecticide-treated bed nets to combat malaria. IDPs are scheduled for May 25 to 29 and June 29 to July 5 for 11 high-risk states, in which more than 10% of children are missed or receive no dose of polio vaccine. ¶8. Ambassador met on May 17 with Edugie Abebe, interim coordinator of Nigeria's National Program on Immunization. Dr. Abebe discussed the factors causing Nigeria's polio- eradication campaign to falter, including "community fatigue," too many NIDs, a general loss of confidence in immunization, and a perceived excessive emphasis on polio. The latter sentiment is linked to northern Nigerians' perception that the polio campaign neglects other community needs such as combating measles, malaria, diarrheal diseases, and general poverty. Abebe then detailed the GON's expectations for the IDP program. Comment -------------- ¶9. Some malams and imams in northern Nigeria continue to preach against vaccinations, hampering polio-eradication efforts. At the same time, the emirs -- the north's traditional leaders -- do not have sufficient political strength or credibility to successfully counter the messages of the religious critics. The emirs have been distracted in recent months by their opposition to President Obasanjo's third-term initiative. Embassy Abuja will report the GON's and international donors' evolving strategy to address the challenge of polio in Nigeria. CAMPBELL