The worldreeledlast week when Nigeria reported that, after a 2-year absence, polio had resurfaced in the northern state of Borno. The news of the two new cases hit just as Nigeria and the global community were celebrating
2 years without a wild-type polio case in a
country that until recently accounted for half
of all cases in the world. The setback has triggered massive emergency vaccination campaigns in Nigeria and neighboring countries.
The outbreak didn’t come as much of a
surprise to those who have long been trying to eradicate the virus, however. Much of
Borno is under control of the ruthless terrorist group Boko Haram, vaccinators have been
unable to reach hundreds of thousands of
children, and the insurgency has disrupted
surveillance for the virus, which appears to
have been circulating undetected for years.
“This is what keeps people in polio eradication up at night—the worry that polio virus
could be lurking in the insecure parts of
Borno and Somalia,” says Steve Cochi, the
point person for polio eradication at the U.S.
Centers for Disease Control and Prevention
(CDC) in Atlanta.
Cochi mentions another factor: compla-
cency. With Nigeria off the list of endemic
countries—only Afghanistan and Pakistan
remain—eradication leaders have been opti-
mistic they would stop transmission world-
wide in 2016, bringing them tantalizingly
close to the end of the 28-year, $14 billion
eradication effort. But there were signs that,
after its hard-won success, the government
of Nigeria was letting down its guard. “It is
not surprising that attention would slip after
2 years without a case,” says Michel Zaffran,
the new director of polio eradication at the
World Health Organization (WHO) in Geneva, Switzerland. “You lose political commitment very quickly when a disease appears to
have disappeared,” Cochi agrees.
A 4-and-a-half-year-old girl named Aisha
in Jere district was the first new case. In May,
her extended family had escaped from Boko
Haram–controlled territory and trekked
2 days to the Muna camp for internally displaced persons in Jere, according to Zaffran.
The girl, who became paralyzed on 6 July, has
recovered “and now walks without a limp,”
he says. Health officials are still investigating
the second case, a 12-month-old boy who was
paralyzed on 13 July in Gwoza district, not far
from Chibok, where Boko Haram abducted
more than 200 schoolgirls in 2014.
CDC scientists quickly sequenced viral
isolates from the two cases. Both viruses are
closely related to one last seen in Borno in
2011, suggesting that polio has persisted
there for 5 years. Cochi and others fear the
virus has spread widely throughout the countries of the Lake Chad region. “The borders
are all insecure,” he says.
Because of the 2-year respite, many of the
government experts who led the battle to
wipe out the virus in Nigeria have moved on.
“New people will have to come to grips with
the problem,” says Muhammad Pate, the former minister of state for health who headed
the country’s polio effort (Science, 4 October
2013, p. 28) and who is now an adjunct professor at Duke University in Durham, North
Carolina. The presidential task force on polio
eradication he used to chair hasn’t convened
in at least a year. Although the central government has budgeted money for polio eradication this year, it has not yet released it,
and interest among some local government
officials had been waning.
Pate worries that people will attribute the
outbreak to insecurity alone and “might miss
the significance of this as a wake-up call to be
more diligent when there are no cases.” That
means making sure that each campaign is
meticulously executed, monitoring every vaccinator, and using real-time data from one
vaccination round to plan the next.
Vaccination campaigns began on 15 August
in Borno. A second campaign is scheduled
to launch 27 August across four northern
states, with the goal of reaching 4 million to
4.5 million children under 5. Chad, northern
Cameroon, southern Niger, and parts of the
Central African Republic will synchronize
campaigns. Already helicopters are flying
vaccine into hard-to-access areas like Gwoza,
and “the next step is to airlift vaccinators because the road is not safe,” says Alhaji Samaila
Muhammad Mera, the emir of Argungu in
Kebbi state and the deputy chairman of the
Northern Traditional Leaders Committee on
Primary Health Care. In one bit of good news,
the military recently wrested control of large
swaths of Borno from the insurgents, which
may enable vaccinators to reach what were
previously “no-go” zones.
Traditional and religious leaders, who
have been pivotal in convincing suspicious
populations to accept polio vaccination, are
mobilizing quickly, Mera says. Because the
camp where the girl was diagnosed is close to
Maiduguri, Borno’s densely populated capital, “we need to do something there very
quickly,” he says. “There is so much at risk.”
WHO’s Zaffran says the speed and magnitude of the response bode well for quashing
the outbreak quickly. “I personally believe we
can still interrupt transmission worldwide in
2016.” Bruce Aylward, the longtime leader
of the global initiative who more recently
ran WHO’s Ebola response, says program
leaders should be ready for more setbacks.
“You are dealing with the tail end of a huge
eradication effort … this is when the virus
will do everything to depress, demoralize,
and derail you,” he says. “Are we as committed to its extinction as it is to surviving?” j
New polio cases in Nigeria
spur massive response
Country’s hopes for polio-free status are dashed
Massive vaccination campaigns like this one in 2010
beat back polio in Nigeria but did not eliminate it.
By Leslie Roberts