Facts about that stagnant whirlpool

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Written by Baraka Bashir

Some years ago four countries across the globe were identified as partners in battling to eradicate one threatening disease. Considering what condition the disease brought upon them, the countries bore the acronym PAIN- Pakistan, Afghanistan, India, and Nigeria. But when India finally stamped out the disease just about a year ago, the PAIN became PAN leaving Pakistan, Afghanistan and Nigeria

For decades, Poliomyelitis whose is commonplace is tropical sub-Saharan countries has been a killer of young children between the ages of 0-5 years.

The campaign to bring an end to the malady in Nigeria has seen collaborations stretching backward in years involving the National Primary Health Care Development Agency, the World Health Organization, UNICEF and other international agencies among others. Despite the seemingly vast efforts, the country is yet to effectively tackle the disease.

The disease which is more prevalent in the northern part of the country, is facing a serious setback by some communities for not accepting the vaccine ignorantly believing it has some negative effects that might leads to infertility

Polio as it is more commonly termed, is a killer disease cutting short the promising lives of young children in Nigeria by paralyzing either both or one of the arms.

Even though yours truly is a daughter of the soil, a whole new dimension awaited me the venture provided me with a whole new definition after the encounter we had with the people who live in the rural areas.

It was a mixed bag of an adventure for me as I got to learn albeit disappointedly that even as modern civilization and technology transfer has made information reach hitherto uncharted corners of the world through the commonest medium which is the radio set, some parents deliberately refuse to let their children to be immunized even as they are those to benefit directly.

The fight against polio was not only done by the national primary health care but with collaboration of some international agencies ,only to make their effort a wasted one as when recently despite the huge non compliance by some people in Kano state that a radio station washed away all these efforts, through one of its programmes

This radio station in of its a popular radio program, hosted some discussant who vehemently opposed to the campaign against the disease

But the most disturbing issue at hand is why does this person reject the vaccines, what are their fears? To answer this becomes necessary by asking the necessary officials on the issue at hand whether polio is harmful. In a social media forum made available to its members as well the general public, an expert in the field Dr Sani Gwarzo of The Federal ministry of health Abuja on the safety of these controversial polio vaccine as termed by many Nigerians and if relevant agencies to test samples, from consignments of OPVs - produced by different manufacturers for WHO - which are supplied to Nigeria, in our laboratories for compliance to NMoH standard for chemical composition?

The vaccines are based on international standards, certified by WHO and evaluated/verified by the National Agency for Foods and Drugs Administration and Control even before the vaccines are imported into Nigeria.

The composition of the OPV dose is described in details on each vial, pack and information leaflet.

that The information also includes the type of OPV, method of production, mode of Administration, Immunization schedule, side effects, and contra-indications storage.

He further speaks that the composition is clearly indicated on each vial and on the Package, as well as in the inserted product information leaflet. All these are Compulsory NAFDAC Requirements before importation and release to end users. The regulatory agency for drugs, food, vaccines and has a dedicated unit that carries out mandatory Pre-release batch-testing of each consignment and subsequent pharmaco-vigilance surveillance on all products (including OPV, other Vaccines and injection devices) imported into Nigeria.

The National Primary Health Care Development Agency (NPHCDA)on the other hand does not administer any product unless NAFDAC has issued a LOT-Release Certificate certifying that the Vaccines or Products are Satisfactory.

During the recent crisis where some adhoc staff that carry out the oral vaccine in the state were attacked by unknown gun men which resulted in death of some of them vaccination as it believed that the incident was the reaction to a professor of medicine who faulted the vaccine , the question was also channeled to Dr Sani Gwarzo if the research of this professor was as reason to non compliance, if they ever invite people like Prof Kaita to verify their claims about the existence of substances in the OPV that could have future harmful effect on children who were administered with the polio vaccines?

He said this has been done in the past, and even at the moment, there is an ongoing dialogue between the Federal Ministry of Health and National Primary Health Care Development Agency and Prof. Kaita/his team under the facilitation a neutral entity and in the presence of some Observes

Although, Prof Kaita is a senior scientist from a reputable University; thus, the question will be better answered by the professor and other people with similar views.

The FMOH does not sanction Researchers who don’t publish their works in scientific journals, but the Universities or Institutions where such Researchers work have their rules and regulations guiding academic activities and performance. However, in the case that Research fellows refuse to subject their findings to peer review and continue divulging such findings in the public domain such researchers could be sanctioned by their universities or respective professional regulatory agencies.

The question of what ACCEPTABLE dose of OPV required for a child to achieve a lifelong immunity against polio infection?

Dr Gwarzo also said the question requires a very clear understanding of the environment. For vaccines to be effective in achieving lifelong immunity, several factors have to be considered including, timing of the vaccination, scheduling (including number of rounds) of the doses, the prevalence and strains of the wild virus in circulation, and the presence of other competing microbes in the environment that may hamper vaccine efficacy, etc. A recent study by thes National Primary Health Care Development Agency in 2007 revealed that in some high risk locations in Nigeria, about 14.2% of the children under-5, have other competing viruses in their intestines (entero-viruses) that can dampen vaccine efficacy.

For polio immunization two types of vaccines can be used, – Injectible Polio Vaccine or Oral Polio Vaccine. Also there are two schedules for polio vaccination - Primary vaccination and Supplemental Vaccination Schedules.

The expert went further in the social media discussion explains that In the tropics (Nigeria inclusive), even the stipulated primary vaccine schedule of four (4) rounds of routine immunizations will not confer sufficient protection. Therefore, in addition to the minimum of 4- rounds of RI, every child is supposed to be vaccinated in ALL further rounds of Supplemental Immunization Activity Campaigns (5 – 7 rounds a year for all under-5s) in order to achieve life-long protection.

Another factor that necessitates multiple vaccinations in polio eradication as opposed to other single dose vaccines like measles is that Polio disease is caused by three different strains, namely Wild Polio Virus 1, 2 and 3. Thus the Oral vaccines also come in three forms of antigens, namely T.OPV (triple antigen); B.OPV (bivalent antigen) or M.OPV (mono-valent antigen). Each of the 5 – 7 SIA rounds differs in terms of the type of Antigen used. The selection of the type of antigen is further based on a carefully monitored national surveillance system on the disease pattern, and the WPV strains in active circulation. An Expert Advisory Team then determines the type of Oral Polio Vaccines to be deployed for each of the 5 to 7 rounds of SIA per year. Also note that even after successful administration of the Vaccine, ultimate immunity (protection) against any particular viral strain naturally differs between the three wild viruses, thus the need for careful selection of the type of antigen in each round of Immunization exercise.

The target for Polio infection/transmission interruption (ELIMINATION) programs is to attain at least 80% herd immunity (i.e. proportion of children actively protected by vaccines) however for the total eradication of the Polio, a minimum herd immunity of 90% is required. This high level of herd immunity has been difficult to achieve in Nigeria mainly because of non-compliance and missed children, resulting in large pools of Zero “0” -dose or under-immunized (sub-optimal number of doses) children in many communities especially in Northern Nigeria, That is why the campaign must continue until the proportion of “0” and under-dose children is sustained at less than 10% of total eligible population (i.e. under-5s) and until the desired herd immunity is attained and the wild polio virus infection/transmission ceases.