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Rotary At The Forefront Of International Effort To Eradicate Polio

By Ovie Ebireri
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About Rotary
With 1.2 million members in more than 34,000 clubs worldwide, Rotary International is dedicated to volunteerism, high ethical standards and goodwill. It is a 108 year old organization of business and professional persons united to serve their communities.

Its major project and undertaking since 1985 is to eradicate the crippling disease polio from the world.

Rotary International was the organization in 1985 that proposed to the World health Organisation that we can eradicate polio from the world and since then have been in the forefront in advocacy and raising funds to ensure the world is rid of Polio.

Rotarians have been personally involved in going into remote areas of the country by car , canoes, motorbikes and even on foot to ensure every child gets the vaccine.

Rotary has expended $160 million to eradicated polio in Nigeria alone. Add to this the number of voluntary man hours.

sTATUS REPORT: 99% POLIO-FREE
Polio cases have declined rapidly since 1985, but the fight isn't over. Polio is a crippling and potentially fatal infectious disease, and for as little as US$0.60, a child can be protected against the virus for life. If we don't finish the fight right now, more than 10 million children under the age of five could be paralyzed by polio in the next 40 years.

1988 - Polio-Endemic Countries 125
1988 - Polio-Free Countries -71
Today - Polio Endemic countries 3 ( Afghanistan, Pakistan and Nigeria)

Today - Polio Free countries - 193
1985 - Rotary International launches PolioPlus, the first and largest internationally coordinated private-sector support of a public health initiative, with an initial pledge of US$120 million.

1987Rotarians raise US$247 million for PolioPlus, more than double their fundraising goal of $120 million. The World Health Assembly passes a resolution to eradicate polio, setting up the launch of the Global Polio Eradication Initiative. More than 125 countries are polio-endemic.

Main partners in this efforts
Rotary International
WHO
UNICEF
CDC
Bill and Mellinda Gates Foundation
Governments of the world.

Overall we have made good progress in keeping the role Rotary is playing in the PEI in the limelight amongst Rotarians and the general public and ensuring that every child gets immunized.

Statistical update- As of 7th August 2013
Nigeria has reported 43 confirmed polio cases this year compared to 65 cases for the same period last year. There were 13 states with polio last year and just 9 this year.

Latest case reported on 14 July 2013 from Gwale LGA in Kano State

20 (47%) are from the security-compromised states of Borno and Yobe

The main challenges that remain are principally reaching all children particularly those in the security challenged areas, the anti OPV propaganda, apathy on the part of local government officials and funding.

We are going to deploy our new PA Sani Danja to assist in countering the anti OPV propaganda. The CWG is working on this.

In the security challenged areas, measures such as fire walling which ensures that children going in and out of Borno and Yobe states are immunized have been put in place. Furthermore Permanent Health Teams(PHT) have been put in place who working with the security agencies go into security challenged areas to immunize children and withdraw from these areas within a short period of time. Usually campaigns in these areas last for a maximum of two days.

We are optimistic that the prediction of the Independent Monitoring board ( IMB ) to see the end of transmission of the Polio virus by the end of 2014 will come to pass.

Dr Tunji Funsho
Chairman
Nigeria National PolioPlus committee

Draft Polio FAQs for Non-Medical and Non-Scientific Elites

1. Q: What exactly is polio?
A: Polio is an infectious disease caused by a virus. It leads to permanent paralysis (usually in the legs) and can cause death as well. The polio virus is silent. This means that polio can be widespread in a community before it manifests itself as a case of paralysis and can be fatal if it paralyzes the muscles used for breathing. Polio mainly affects children under five years of age.

2. Q: How does the polio virus spread?
A:The polio virus spreads through the faecal-oral route (from excreta to hand and to the mouth). Usually this is a result of poor hand washing or by eating/drinking contaminated food or water. Those infected with the virus can excrete the virus in their stool for several weeks and are likely to infect others with the virus due to poor hygiene and sanitation. Individuals are most contagious (likely to pass on the virus to others) immediately before the onset of symptoms and soon after they appear

3. Q: Can polio be treated?
A:There is no treatment for polio because the nerve damage is permanent but the polio vaccine has proven to be very effective in giving children lifelong protection from the virus. Physical therapy and braces can help paralysed children to regain some function, but nerve damage is permanent.

4. Q: Is the polio vaccine safe for children, including sick ones?

A:Yes. The Oral Polio Vaccine (OPV) is the safest and most effective way to protect children from polio. Even when given many times, the polio vaccine is safe and effective in providing protection against polio, and is the recommended vaccine for the global eradication of polio. Children sick with another illness can still be given the polio vaccine as there is no harmful effect.

5. Q: Are other Muslim countries using the same polio vaccine?

A:The Oral Polio Vaccine (OPV) used in Nigeria is exactly the same as that being used in all other countries of the world for polio eradication efforts. The Governments of Saudi Arabia, Indonesia, Egypt and Yemen are all using the same vaccine as that being used in Nigeria. All of these countries have successfully contained the spread of the virus. For instance, Saudi Arabia has celebrated 10 years with no polio cases.

6. Q: How many doses of OPV does a child need before they are protected from polio infection?

A:The Oral Polio Vaccine (OPV) needs to be administered several times to be fully effective. Each and every child under the age of five years needs to receive the vaccine during each round. The number of doses a child needs to receive in order to be fully protected against polio depends entirely on the child's health and nutritional status, as well as the number of other viruses that the child has been exposed to. No child is safe if there is one child under the age of five years who is underimmunized. This is why every child must be immunized during every immunization campaign against polio. Every missed child is a place for the poliovirus to hide and spread even if that child does not get sick with polio. For as long as the polio virus is in Nigeria every child needs to take the vaccine every round.

7. Q: Is it safe to administer so many doses of OPV to children?

A:Yes, it is safe and it is very important to administer multiple doses of polio vaccine to children. The vaccine requires multiple administrations to ensure full protection. In the tropical climate where the weather is hot and sanitation system is poor, several doses of polio vaccine are required for a child to be fully protected - sometimes more than ten. This vaccine is safe for all children. Each additional dose further strengthens a child's immunity level against polio and ensures that the child does not act as a carrier of the virus.

8. Q: Why do some children with multiple doses of Oral Polio Vaccine still come down with polio?

A:A child's ability to convert the Oral Polio Vaccine into immunity depends upon his or her living circumstances. In temperate climates or industrialized countries with excellent sanitation and health systems, it takes at least three doses of the polio vaccine for a child to reach immunity level and ensure safety from the polio virus. In tropical environments or in the developing countries like Nigeria where some children may be malnourished, sanitation systems are inadequate and immunity levels low, it can often take more than ten doses of the vaccine to reach the same level of immunity. Most of the children who still come down with polio are under-immunized, meaning they received fewer than the number of doses thought necessary to protect children in their circumstances from the virus.

As many as 4 or 5 out of every 100 children fail to develop required immunity after multiple doses and can still come down with polio. If these children live in communities where vaccination coverage is low, they have a high risk of exposure and infection. As the number of children repeatedly missed during immunization campaigns goes down, the children at risk are those who have not reached their immunity level. The only way to ensure that no child comes down with polio is to ensure that each and every child is immunised every round.

9. Q: Is the polio vaccine in Nigeria effective in preventing polio?

A: Yes. The estimated annual number of polio cases in Nigeria in the mid-1980s was 20,000-30,000. Extensive use of the polio vaccine during campaigns, particularly in the last 10 years, has led to a 99.9% decrease in the number of cases. This shows that the vaccine is very effective.

10. Q: Is the vaccine tested in Nigeria before being used?

A: All batches of vaccine are tested for quality before use. The polio vaccine loses potency if exposed to heat for prolonged periods of time. For that reason each vial has a vaccine vial monitor (VVM), a heat sensitive label, which indicates if the vaccine has been exposed to heat. All personnel working in the polio eradication campaign are trained to examine the monitor and discard any vaccine that might be weakened from exposure to heat. All polio vaccines supplied by UNICEF include the vaccine vial monitor since 1997.

11. Q: Are there any harmful additives in the polio vaccine used in Nigeria?

A: No, the polio vaccine used in Nigeria is purchased from facilities that have been carefully evaluated by WHO. All vaccines, including the polio vaccines, which are procured by UN agencies, must meet rigorous quality-control specifications, which govern the exact contents used in the production of the polio vaccine and ensure the purity of the vaccine. This ensures that the polio vaccine cannot contain any harmful additives.

12. Q: Why are the polio campaigns held so frequently?

A: One of the main reasons national immunization campaigns are held so frequently is that this gives more chance for the uptake of the vaccine in the child's intestine. If too much time is taken between campaigns, the wild virus can have a chance to infect non-immunized children. When children are given the polio vaccine, it provides some immediate protection by not allowing the virus to reproduce in the child's intestine. Since the virus does not survive in the environment for long period, it cannot be passed on to other children. If the virus has no place to live, it dies out in that area. That is why all children under five years of age must receive the polio vaccine during every campaign. Globally experience has shown that in the end stages of eradication, if campaigns are held less frequently, the chances of an outbreak are increased.

13. Q: Is it necessary to vaccinate the children for routine immunization if they have been vaccinated in every polio campaign?

A: Yes, polio campaigns are supplementary and not a substitute for routine immunization. All children should receive all the doses outlined in the routine immunization schedule which protects against 7 diseases, in addition to polio.

14. Q: The attention being given to polio is so much. Is this same level of attention being given to other diseases?

A:Attention is being given to all diseases but it is particularly important to emphasize polio for the following reasons:

a. Polio is one of only a few communicable diseases which can be completely eradicated because humans are the only host (as was the case with smallpox). It also has a safe and effective vaccine which is not the case with most diseases. The virus does not survive for extended periods of time in the environment, and while it is contagious, its infection period is relatively short. Global evidence suggests that through repeated immunization campaigns with the polio vaccine, polio can be completely eliminated. The fact that polio remains endemic in only 3 countries of the world, demonstrates the effectiveness of this strategy. In addition, efforts to eradicate polio can and should lay the groundwork to address other important health and social issues in Nigeria. Polio eradication activities are helping to strengthen routine health services.

b. It kills and causes permanent paralysis in our children. By paralyzing them it reduces their ability to help themselves, it causes them avoidable hardship and reduces their ability to contribute effectively in our communities compared to if they were not paralyzed.

c. The whole world has almost eradicated polio just like it banished small pox forever; Only Nigeria and two other countries, are left; therefore if we redouble our efforts, we can also banish polio and focus the money and efforts to banish other diseases such as Measles which is also important and we are also giving vaccine against; you will agree that because of the vaccines, Measles cases are reducing in our communities but for us to also completely banish Measles, we have to finish polio and then face other disease such as malaria, meningitis, pneumonia, and diarrhoea, squarely.

d. Other important diseases that we are fighting with free drugs include leprosy, river blindness, guinea worm (which has almost been eradicated), free bed nets against malaria, free routine immunization vaccines and free drugs for people with HIV/AIDS

15. Q: The masses buy even simple drugs like Paracetamol and pay for hospital cards before seeing a doctor. But polio is free-why?

A:Polio is cheaper to prevent than to cure. It is cheaper for you to prevent paralysis than to try and cure it. It is mostly money that we pay as tax that is used to buy the vaccines we use. All vaccines against diseases such as measles, tuberculosis, hepatitis and polio are free because it is cheaper to give the vaccines than to try and cure the diseases when they happen, this is apart from the human suffering. When our children don't take the vaccine, then they fall sick: we have to leave our work, pay for transport to go to the clinic, pay for card to see the doctor, pay for medicines, and pay for some operations; whereas the illness could have been prevented by a drug that is brought free to your house or available in a clinic that is near your house.

16. Q: Does the polio programme, by any means, have a linkage with family planning?

A:No. The Oral Polio Vaccine being used in Nigeria is the same being used in rest of the world to stop polio transmission. The vaccine does not cause infertility and has no side effects. The census figures shows that Nigeria's population has been growing even faster than that of any other country in this region in spite of the fact that the polio eradication programme and other immunizations against childhood diseases has been going on for quite some time. If you ask people who took the vaccine while they were children, they will tell you they are having children On the contrary, the census figures show that we in Nigeria are having more children than most other countries. The polio program and other immunizations against childhood diseases have been going on for quite some time. If you ask people who took the vaccine while they were children, they will tell you they are having children.

17. Q: When will the government stop giving children OPV?

A:We will stop giving OPV when every child is protected from the threat of becoming paralyzed by polio. This is why we must give many rounds of OPV to ensure all children are reached with enough doses that will protect them forever. Also, once we stop seeing any children that are paralyzed by polio in Nigeria, then we know we have succeeded in finishing polio the way our parents and grandparents finished small pox. Then we shall stop vaccinations against polio the way we have stopped vaccinations against small pox.

18. Q: Why is the OPV given only to children under the age of five years?

A:Children under the age of five years are the most likely to get polio; once they are given the vaccine, it protects them from the disease. All vaccines are given to children while they are still under 5 years old.

19. Q: Why is the polio programme a door to door programme?

A:The polio program goes door to door so that every child can be reached with the vaccine and that no child is missed. If too many children are missed during campaigns the virus will continue to circulate in these children putting all others at risk. Going house to house is essential to ensure reduction in the number of children who may be missed.

20. Q: Why are polio vaccines free and given up to people's houses when drugs are not free at hospitals?

A:There is a difference between community and public health work and community health work. Community health work is done at community level, targeting diseases that spread, and vaccines are free at point of delivery. It has been so since time immemorial. Public health service is obtained in hospitals and it may not be free.

21. Polio is not the people's felt needs at the moment. Why is it a top priority for the government?

A:People have many priorities depending on their unique situation. For some people, it may be drinking water, for others it may be electricity or roads. However, if possible, everyone will like to have all three of these amenities that I have mentioned. Some people have all three; others have two while some have only one. As with all things in life, we have to assess all our challenges, rank them from the easiest to the most difficult, and then confront the one that we can tackle easily first, gradually as we finish the easier ones, then we take on the more difficult tasks with time. As people understand that polio is preventable, they have started also appreciating that it is a felt need. Until they understand that polio kills children and paralyzes others, people will still feel it is better to have a road than to protect a child from dying or becoming paralyzed. Both are important but some become more important than others when we gain a better understanding of how it affects everyone. Government is interested in finishing polio because, we are at a stage where it is relatively easy to finish the job; just like we joined our hands with other countries to finish small pox.

22. Q: Does a new-born baby need polio vaccination even before his/her naming ceremony?

A:Yes a new-born needs protection against polio because the vaccine should get to the child before the germ that causes the disease gets to the child; the earlier the child gets the vaccine, the better since the polio germ is everywhere in the environment. All unimmunized children are at risk, including new-borns.

23. Q: Sometimes children over five years are vaccinated. Why?

A:The polio vaccine is for children under five years of age. Some parents are not very sure about the exact age of their child. It is better to vaccinate in case there is doubt that the child may be under five years of age. Vaccinating a child who is more than five years old does not affect the child but if the child is not given the dose for fear that he/she is more than five years, he may get the disease if he had not been fully immunized and fully protected.

24. Q: How can one be sure of the safety of the vaccine?

A:The polio vaccine is the safest and most effective way to protect children from polio. Given multiple times, the polio vaccine is safe and effective in providing protection against polio, and is the recommended vaccine for the global eradication of polio. The polio vaccine has been administered to more than 2 billion children across 125 countries around the world as part of the eradication programme. Since the launch of the polio vaccine programme in 1988, the number of polio cases has been reduced by 99 per cent globally, sparing at least 5 million children from total paralysis and permanent disability. Children sick with another illness must still be given the polio vaccine as there is no harmful effect. OPV is safe and it is very important to administer multiple doses of polio vaccine to children. The vaccine is designed to be administered multiple times to ensure full protection. In the tropics where the weather is hot and sanitation systems are poor, several doses of polio vaccine are required for a child to be fully protected - sometimes more than ten. This vaccine is safe for all children. Each additional dose further strengthens a child's immunity level against polio.

You can be sure of the vaccine because when you look round, there are respectable people in the society like the Sultan of Sokoto, the Emir of Kano, Aliko Dangote, our religious leaders and others who have vaccinated their children and grand-children with the oral polio vaccine in public. If the vaccine were not safe, they will not give it to their loved ones.



25. Q: Do the Federal Ministry of Health and other agencies at federal and states levels have a reliable database of all households visited by the vaccination workers and number of children immunized from the beginning of recent Polio Eradication campaign to date?

A:Yes, the NPHCDA has a database for immunization nationwide. It is this same database that provides guidance on the number rounds per year, number of States, LGAs, Wards, households, number of eligible children, nature, antigen (type of OPV either TOPV; BOPV; or MOPV) and also where mop-up or repeat immunization needs to done.

Frequently Asked Questions and Answers on Polio for Vaccination Teams and Community-Based Health Workers

1. Q: Some people in the community do not want their children immunised if the children have fever, cough or other sicknesses. What should I explain to them?

A:Explain to them that the Oral Polio Vaccine (OPV) is the safest and most effective way to protect children from polio, and that children sick with other illnesses can still be given the polio vaccine as there is no harmful effect.

2. Q: Many people in the community complain about too many rounds, what should I tell them?

A: First, thank them for their question and tell them you appreciate the question because it shows that they are concerned about the safety of the children. Tell them that their children are also your own children, and that you are involved in immunisation work because you are concerned about the health of the children. Thereafter, explain to them that it is safe and very important to administer multiple doses of polio vaccine to children. Let them know that the vaccine requires multiple administrations to ensure full protection. Tell them that in a tropical climate like Nigeria where the weather is hot and sanitation system is poor, several doses of polio vaccine are required for a child to be fully protected - sometimes more than ten doses. Re-assure them that the vaccine is safe for all children and that each additional dose further strengthens a child's immunity level against polio and ensures that the child does not act as a carrier of the virus.

3. Q: Some people say that their children will not receive OPV at home because they received it at the clinic. Other people claim that since their children received OPV at home there is no need to take the children to the clinic for routine immunisation. How should I handle this situation?

A: Explain to them that polio campaigns are supplementary and not a substitute for routine immunization at the health facility. Let them know that all children should receive all the doses outlined in the routine immunization schedule that protects against 7 diseases, in addition to polio. Also let them know that even if their children had been immunised during routine immunisation at clinic they still have to take OPV at home. Each additional dose further strengthens a child's immunity level against polio.

4. Q: Some people in the community want proof that OPV is safe. What should I tell them?

A:Let them know that all batches of the Oral Polio Vaccine are tested and approved by NAFDAC before use. Also, let them know that respectable people in the society like the Sultan of Sokoto, the Emir of Kano, Alhaji Aliko Dangote, as well as many other traditional and religious leaders have vaccinated their children and grand-children with the Oral Polio Vaccine in public. If the vaccine were not safe, they would not have given it to their own children and grandchildren. Ask them to also watch the video where prominent religious sect leaders have advocated that people should accept OPV.

5. Q: Some parents do not want their new-born babies to be give polio vaccination before their naming ceremonies. What should we do?

A:Explain to them that new-born babies need protection against polio because the vaccine should get to the child before the germ that causes the disease gets to the child. Tell them that the earlier the child gets the vaccine, the better since the polio germ is everywhere in the environment. Let them know that all unimmunized children are at risk, including new-borns.

6. Q: I met a highly educated family that does not accept OPV. They asked me to explain how many doses of OPV a child needs before they are protected from polio infection. If I come across such people again what should I tell them?

A: If you come across such families again, simply explain to them that the Oral Polio Vaccine (OPV) needs to be administered several times to be fully effective and that each and every child under the age of five years needs to receive the vaccine during each round .Explain to them that the number of doses a child needs to receive in order to be fully protected against polio depends entirely on the child's health and nutritional status, as well as the number of other viruses that the child has been exposed to. Let them know that no child is safe if there is one child under the age of five years who is under immunized. Tell them that this is why every child must be immunized during every immunization campaign against polio. Remind them that every missed child is a place for the polio virus to hide and spread even if that child does not get sick with polio, and also that for as long as the polio virus is in Nigeria every child needs to take the vaccine every round.

7. Q: Some people want to know if other Muslim countries are using the same polio vaccine that we use in Nigeria.

A:Explain to them that the Oral Polio Vaccine (OPV) used in Nigeria is exactly the same as that being used in all other countries of the world for polio eradication efforts. Saudi Arabia, Indonesia, Egypt and Yemen are all using the same vaccine as that being used in Nigeria.

8. Q: Why do some children with multiple doses of Oral Polio Vaccine still come down with polio?

A:A child's ability to convert the Oral Polio Vaccine into immunity depends upon his or her living circumstances. In temperate climates or industrialized countries with excellent sanitation and health systems, it takes about three doses of the polio vaccine for a child to reach immunity level and ensure safety from the polio virus. In tropical environments or in the developing countries like Nigeria where some children may be malnourished, sanitation systems are inadequate and immunity levels low, it can often take more than ten doses of the vaccine to reach the same level of immunity. Most of the children who still come down with polio are under-immunized, meaning they received fewer than the number of doses thought necessary to protect children in their circumstances from the virus.

As many as 4 or 5 out of every 100 children fail to develop the required immunity after multiple doses and can still come down with polio. If these children live in communities where vaccination coverage is low, they have a high risk of exposure and infection. As the number of children repeatedly missed during immunization campaigns goes down, the children at risk are those who have had multiple doses of the polio vaccine but have not reached their immunity level. The only way to ensure that no child comes down with polio is to ensure that each and every child is immunised every round.

9. Q: I have been challenged before that much attention is being given to polio and not to other diseases. If I am challenged again what should I say?

A:If you are challenged again, simply explain as follows:

Attention is being given to all diseases but it is particularly important to emphasize polio for the following reasons:

a.Polio is one of a few communicable diseases which can be completely eradicated because human beings are the carriers (as was the case with smallpox). It also has a safe and effective vaccine which is not the case with most diseases. The virus does not survive for extended periods of time in the environment. In addition, efforts to eradicate polio can lay the groundwork to address other important health and social issues in Nigeria. Polio eradication activities are helping to strengthen other routine health services.

b.Polio kills and causes permanent paralysis in children. By paralyzing them it reduces their ability to help themselves. It causes them avoidable hardship and reduces their ability to contribute effectively in our communities compared to if they were not paralyzed. For as long as the polio virus is circulating even in one part of the world, children around the world are at risk of getting infected.

c.The whole world has almost eradicated polio just like it banished small pox forever; Only Nigeria and two other countries are left. Therefore if we redouble our efforts, we can also banish polio and focus the money and efforts to banish other diseases such as measles for which government is also giving vaccines. As a result of the vaccines being provided, measles cases are reducing in our communities but for us to also completely banish measles, we have to finish polio and then face other diseases such as malaria, meningitis, pneumonia, and diarrhoea, squarely.

d. Other important diseases that we are fighting with free drugs include leprosy, river blindness and guinea worm (which has almost been eradicated). Free bed nets are being given to protect against malaria; routine immunization vaccines are freely available, and free drugs are being provided for people living with HIV and AIDS.

10.Q: Some communities claim that they have more important needs than polio vaccines and that government, for example, should give them water to drink and meet their other needs.

A:You can explain to them as follows:
Different people in different areas have different needs. Although government cannot meet all demands at once, it is important to start from somewhere. Polio is a disease that does not spare any child, so it is being given top priority to ensure that all children are fully protected against it. Finishing polio is one thing that we need to do because we cannot continue to allow our children become paralyzed because we failed to protect them with vaccines. We must protect them so they can grow up to become productive citizens who can help bring water, electricity, roads, houses and free drugs to our communities in the future. Like they say, 'children are the future'

11. Q: Some people have also complained that they buy even simple drugs like Paracetamol and pay for hospital cards before seeing a doctor. They wonder why polio immunisation is free.

A:Let them know that all vaccines against childhood diseases such as measles, diphtheria, tetanus, meningitis, and polio are free because it is cheaper to give the vaccines than to try and cure the diseases when they happen, apart from the human suffering. Tell them that polio has no cure though it can be prevented by the oral polio vaccine, and that when our children do not take the vaccine, then they fall sick and we would have to leave our work, pay for transport to go to the clinic, pay for card to see the doctor, pay for medicines, and pay for some operations; whereas the illness could have been prevented by a vaccine that is brought free to our houses or available in a clinic.

12. Q: Is it true that the polio programme has a linkage with family planning?

A:No, this is not true. The Oral Polio Vaccine being used in Nigeria is the same being used in rest of the world to stop polio transmission. The vaccine does not cause infertility and has no side effects. The census figures shows that Nigeria's population has been growing even faster than that of any other country in this region in spite of the fact that the polio eradication programme and other immunizations against childhood diseases has been going on for quite some time. If you ask people who took the vaccine while they were children, they will tell you they are having children.

13. Q: I have been asked when the government will stop giving our children the OPV. What should I say?

A:Explain that we will stop giving OPV once we stop seeing children that are paralyzed by polio in Nigeria. Then we will know that we have succeeded in finishing polio the way our parents and grandparents finished small pox. Then we shall stop vaccinations against polio the way we have stopped vaccinations against small pox.

14. Q: Some people also want to know why the polio programme is a house-to-house programme.

A:The polio programme goes house-to-house to door so that every child can be reached with the vaccine and to ensure that no child is missed. If too many children are missed during campaigns the virus will continue to circulate in these children, putting all others at risk. Going house to house is essential in order to reduce the number of children who may be missed.

15. Q: Is OPV Haram or Halal?
A:OPV is Halal, it is not haram. There are many fatwas from religious leaders both in Nigeria and from Muslim countries that have emphasized that OPV is halal. The OPV we use in Nigeria is the same one that is used in Muslim countries such as Indonesia, Saudi Arabia and others.

16. Q: Some people feel that polio is not their felt need at the moment and they wonder why it is a top priority for the government.

A:People have many priorities depending on their unique situation. Government is interested in finishing polio because, we are at a stage where it is relatively easy to finish the job, just like we joined our hands with other countries to finish small pox.

17. Q: I have explained to people repeatedly that there is no excess dose of OPV, and they keep asking again every round. Any additional explanation?

A:There is no such thing as an excess dose. The polio vaccine is very safe. In countries where eradication has taken place, children have taken more than 10 doses of the vaccine without side effects. OPV needs to be administered many times to be fully effective. The number of doses it takes to immunize a child depends entirely on the child's health and nutritional status, and the number of other viruses that the child has been exposed to. While there is polio virus in a country, all children are still at risk from polio and need the extra doses of vaccine to ensure their protection. This is why every child must be immunized during every immunization campaign against polio. Every missed child is a place for the polio virus to hide.

18. Q: Can polio vaccine be used after the expiry date if the vaccine vial monitor is still valid?

A: No. Expiry dates on vaccines are established at the time of production, similar to the expiry dates on food products. Even if the vaccine has passed its expiry date or the VVM indicates it may no longer be potent, it is not harmful. In fact the only danger is that people might think they are getting potent vaccine when potency might be compromised. Any vaccine where the VVM indicates it is no longer potent or which has passed its expiry date should be removed and reported to the district or provincial health offices. All polio workers are trained to examine both VVMs and expiry dates to avoid using potentially compromised vaccine.

19. Which children are most likely to be missed during polio immunization campaigns?

A:The children who are most likely to be missed are those who cannot or do not come to the door when the vaccination teams visit homes. These include very young children who cannot walk, children who are sleeping or are otherwise engaged, and the children who are ill or afraid of the vaccinators. Children may also be away from home or out with their parents. It is important that all children, including the very young and sick are given the immunization when the teams visit or are taken to a fixed vaccination site to receive the polio vaccine during the national immunization campaigns. In addition, parents sometimes neglect to ensure that all their children are vaccinated. As vaccinators and health workers, it is our duty to ensure that no child is missed during the rounds. We must do mall that is possible to ensure that missed children are found and immunised.

20. Q: If a child is missed, is it compulsory to go back for revisits?

A:Once an eligible child is missed, it is compulsory to revisit the household and ensure that all eligible children in the house are traced an immunised. Any unimmunised child is a risk to all other children in the community, and as vaccination team members or health workers we have a duty to ensure that no child remains a risk to other children in the community.

21. Q: Sometimes the workload is too much. If I don't go back for revisits, who can blame me?

A:As a member of a vaccination team, you have a duty to ensure that any house marked by your team for revisit is actually revisited. If any house marked for revisits is not re-visited, you have to explain to your ward focal person and discuss what plans you have about revisiting such houses. Also, you have to report at the evening review meeting why the house was not revisited and the plans you have to ensure that such houses are re-visited. Under the new accountability framework, you will be held personally accountable if your fail fails to do all the revisits. There is no longer a hiding place because everybody is under watch. But over and above that, your conscience and your God will see you even if no other person sees you. If any child is paralysed or killed because you failed to conduct revisits, God the ultimate judge will call you into account on the judgement day.

Frequently Asked Questions and Answers on Polio for Medical Doctors, Clinicians and other Science-oriented Elites

1. Q: Where can I obtain information on the composition of an OPV dose?

A: The composition of the OPV dose is described in detail on each vial, pack and information leaflet. The information also includes the type of OPV, method of production, mode of Administration, Immunization schedule, side effects, and contra-indications, storage, etc. You can obtain this information in any Vaccine Cold Store across the country.

2. Is the Oral Polio Vaccine tested for safety and potency before being administered?

A: All batches of the Oral Polio Vaccine are tested for quality before use. The polio vaccine loses potency if exposed to heat for prolonged periods of time. For that reason each vial has a vaccine vial monitor (VVM) , a heat sensitive label, which indicates if the vaccine has been exposed to heat. All personnel working in the polio eradication campaign are trained to examine the monitor and discard any vaccine that might be weakened from exposure to heat. All polio vaccines supplied by UNICEF include the vaccine vial monitor since 1997.

3. Q: Is the chemical composition of the OPV clearly indicated on each vial?

A: Yes, 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.

4. Q: What is the acceptable dose of OPV required for a child to achieve a lifelong immunity against polio infection?

A:Dose should not be confused with immunization schedule as dose (in this parlance) refers to the quantity of vaccine given at any one time -'T', while schedule refers to the number of vaccination rounds and the time period in-between them. The doses for both Oral Polio Vaccine (OPV) and Injectable Polio Vaccine (IPV) are specific and standard. Each vial of the vaccine contains specific information on the quantity of vaccine per unit dose.

Also this question requires a very clear understanding of the environment in which we operate in Nigeria. 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 2007 study by the National Primary Health Care Development Agency (NPHCDA) revealed that in some high risk locations in Nigeria, about 14.2% of the children under-5 five years , have other competing viruses in their intestines (entero-viruses) that can dampen vaccine efficacy.

For polio immunization two types of vaccines can be used, - Injectable Polio Vaccine (IPV) or Oral Polio Vaccine (OPV). Also there are two schedules for polio vaccination - primary vaccination and supplemental vaccination schedules.

In the tropics (Nigeria inclusive), even the stipulated primary vaccine schedule of four (4) rounds of routine immunizations (RI) 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 (SIA) Campaigns (5 - 7 rounds a year for all under-5s) in order to achieve life-long protection.

Another factor that necessitates multiple vaccination in polio eradication as opposed to other single dose vaccines like measles is that polio is caused by three different strains, namely Wild Polio Virus (WPV) 1, 2 and 3. Thus the Oral Polio Vaccines (OPV) also come in three forms of antigens, namely T.OPV (triple antigen); B.OPV (bivalent antigen) or M.OPV (monovalent antigen). Each of the 5 - 7 SIA rounds differs in terms of the type of Antigen (OPV: T, B, or M)) 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 OPV 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 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) programmes is to attain at least 80% herd immunity (i.e. proportion of children actively protected by vaccines). However, for the total eradication of 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.

5. Q: Is there any Nigerian Federal Ministry of Health standard on chemicals?

A:Yes, there is, and it is based on international standards, pre-qualified by the World Health Organisation (WHO) and evaluated/verified by the National Agency for Foods and Drugs Administration and Control (NAFDAC) whenever the vaccines are imported into Nigeria.

6. Q: Is the Nigerian standard any different from the one set by WHO?

A: No, it is not different. The polio vaccine used in Nigeria is purchased from facilities that have been carefully evaluated by WHO. All vaccines, including the polio vaccine, which are procured by UN agencies, must meet rigorous quality-control specifications which govern the exact contents used in the production of the polio vaccine and ensure the purity of the vaccine. This ensures that the polio vaccine cannot contain any harmful additives.

7. Q: If the answer is no, then how acceptable are WHO standard variations to that of the Nigerian Federal Ministry of Health?

A: The WHO Standards are internationally acceptable, Nigeria inclusive.

8. Q: Do relevant agencies of the Federal Ministry of Health test samples, from consignments of OPVs - produced by different manufacturers for UNICEF - which are supplied to Nigeria, in our laboratories for compliance to the Federal Ministry of Health's standard for chemical composition?

A. Yes, NAFDAC, the regulatory agency for drugs, food, vaccines and biological, 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) does not administer any product unless NAFDAC has issued a LOT-release certificate certifying that the vaccines or products are satisfactory.

9.Do the Federal Ministry of Health and other agencies at federal and states levels have a reliable database of all households visited by the vaccination workers and number of children immunized from the beginning of recent Polio Eradication campaign to date?

A:Yes, the NPHCDA has a database for immunization nationwide. It is this same database that provides guidance on the number of rounds per year, number of states, LGAs, wards, households, number of eligible children, nature, antigen (type of OPV - TOPV, BOPV, or MOPV) and also where mop-up or repeat immunization needs to done.

10. Q: I noticed two separate alphanumeric marks written with white chalk over a smooth space on the fence of my farm house, which contains numbers ('01' and '03) that depicts January and March 2013, being the respective months in which the two immunization exercises were conducted. Now, assuming the farm houses children, there is every possibility that the OPV will be administered on them twice within the time frame of 3 months. These same marks were made by the immunization workers on a wall part, close to the gates of my house. Therefore, unless if our children require more than 1 OPV dose to get a lifetime immunity, is there any wisdom in repeated doses of polio vaccines over a space of three months?

A: Yes it is true that children require more than one dose to get the required level of immunity (full protection). Thus, vaccination is done few months apart and many times a year. The alpha-numeric markings you see on houses contain coded information for the vaccination team and even evaluators of the vaccination exercise to note/verify whether the house has been visited; if there are eligible children (under 5 years) in that house; if they have all been vaccinated; if there has been refusal (non-compliance) or child-absence; if there is need to return and vaccinate a missing child. Special precaution measures have also been put in place to avoid vaccinating a child more than once in any given SIA round. Such safety measures include the house marking you mentioned, the apportioning of specific teams to specific locations, the indelible marking of a finger of all vaccinated children, etc. Through these measures, a child is very unlikely to be vaccinated twice in one immunization circle. Moreover the safety margin for such repetition is wide, but still vaccinators are trained to avoid such mistakes.

Also, note that the target of the polio vaccination campaign goes beyond protecting individual children and controlling the polio epidemic.It is additionally to completely eradicate wild polio virus from anywhere in the world. Thus, a high level of herd immunity (population level protection) must be attained, before the wild polio virus can be totally displaced. Such a goal has been achieved in the past with smallpox and even in polio disease by many countries. Today only three countries remain in endemic polio situations i.e. Nigeria, Pakistan and Afghanistan. Even in Nigeria, the polio problem is predominantly in the northern states.

There is every tendency that parents will become suspicious at the frequency of mass OPV immunization exercises when other diseases that kill children like malaria, measles and CSM, and malnutrition which affects the immune system of infants are not given deserved attention.

It is true with every intervention that when people do not fully understand they may become suspicious, but that does not make their suspicions valid. However, Government is addressing many more health concerns as well as stepping up efforts at educating people especially at community level.

All the diseases you mentioned incidentally have been included in the immunization campaigns, e.g. for malaria, parents are given free long lasting insecticide treated nets (LLIN) and each net is expected to last a family about four years. Based on the recent study (Nigeria malaria indicator survey - NMIS 2011) the Northwest (58%) and Northeast (63%) have the highest availability of LLIN in Nigeria compared to national average which is only 41%. The cost of the recommended treatment of malaria in Nigeria (i.e. Athemicinin-Combination therapy - ACT) has been highly subsidized from an average of N1, 200 for a full treatment cycle with a brand product, whereas the generic subsidized one costs N120 per full treatment. Other Free services for children include vaccination for all childhood diseases (Measles inclusive); hepatitis vaccine and the recently introduced Meningitis vaccine. Other free treatment programmes of Government include free HIV and AIDS treatment; free treatment of tuberculosis; free treatment of leprosy, buruli ulcer, onchocerciasis (river blindness) and anti-snake venom, just to mention a few. Furthermore, if you ask women attending ante-natal care (ANC), they have sessions on nutrition and even after delivery; they attend child nutrition clinics - all in the bid to improve child nutrition and prevent/manage mal-nutrition. It is only fair if people acknowledge and appreciate these services.

11: Q: Why do some children with multiple doses of Oral Polio Vaccine still come down with polio?

A:A child's ability to convert the Oral Polio Vaccine into immunity depends upon his or her living circumstances. In temperate climates or industrialized countries with excellent sanitation and health systems, it takes about three doses of the polio vaccine for a child to reach immunity level and ensure safety from the polio virus. In tropical environments or in the developing countries like Nigeria where some children may be malnourished, sanitation systems are inadequate and health immunity levels low, it can often take more than ten doses of the vaccine to reach the same level of immunity. Most of the children who still come down with polio are under-immunized, meaning they received fewer than the number of doses thought necessary to protect children in their circumstances from the virus.

As many as 4 or 5 out of every 100 children fail to develop the required immunity after multiple doses and can still come down with polio. If these children live in communities where vaccination coverage is low, they have a high risk of exposure and infection. As the number of children repeatedly missed during immunization campaigns goes down, the children at risk are those who have had multiple doses of the polio vaccine but have not reached their immunity level. The only way to ensure that no child comes down with polio is to ensure that each and every child is immunised every round.

Frequently Asked Questions and Answers on Polio for Community Members

1. Q: What exactly is polio?
A: Polio is an infectious disease caused by a virus. It leads to permanent paralysis (usually in the legs) and can also cause death. The polio virus is silent. This means that polio can be widespread in a community before it manifests itself as a case of paralysis and can lead to death if it paralyzes the muscles used for breathing. Polio mainly affects children under five years of age.

2. Q: How does the polio virus spread?
A:The polio virus spreads through the faecal-oral route (from excreta to hand, food or drink and to the mouth). Usually this is a result of poor hand washing or by eating/drinking contaminated food or water. Those infected with the virus can excrete the virus in their stool for several weeks and are likely to infect others with the virus due to poor hygiene and sanitation. Infected people can pass on the virus to others even if they don't show any sign of having been infected.

3. Q: Can polio be treated?
A:There is no treatment for polio because the nerve damage is permanent. But the polio vaccine has proven to be very effective in giving children lifelong protection from the virus. Physical therapy and braces can help paralysed children to regain some function, but nerve damage is permanent.

4. Q: Is the polio vaccine safe for children? Is it safe even if a child is sick?

A:Yes. The Oral Polio Vaccine (OPV) is the safest and most effective way to protect children from polio. Even when given many times, the polio vaccine is safe and effective in providing protection against polio, and is the recommended vaccine for the global polio eradication programme.

Children sick with another illness can still be given the polio vaccine as there is no harmful effect.

5. Q: Are other Muslim countries using the same polio vaccine?

A:The Oral Polio Vaccine (OPV) used in Nigeria is exactly the same as that being used in all other countries of the world for polio eradication efforts. Saudi Arabia, Indonesia, Egypt and Yemen are all using the same vaccine as that being used in Nigeria.

6. Q: How many doses of OPV does a child need before they are protected from polio infection?

A: The Oral Polio Vaccine (OPV) needs to be administered several times to be fully effective. Each and every child under the age of five years needs to receive the vaccine during each round .The number of doses a child needs to receive in order to be fully protected against polio depends entirely on the child's health and nutritional status, as well as the number of other viruses that the child has been exposed to. No child is safe if there is one child under the age of five years who is underimmunized. This is why every child must be immunized during every immunization campaign against polio. Every missed child is a place for the polio virus to hide and spread even if that child does not get sick with polio. For as long as the polio virus is in Nigeria every child needs to take the vaccine every round.

7. Q: Is it safe to administer so many doses of OPV to children?

A:Yes, it is safe and it is very important to administer multiple doses of polio vaccine to children. The vaccine needs to be taken several times to ensure full protection. In a tropical climate like Nigeria where the weather is hot and sanitation system is poor, several doses of polio vaccine are required for a child to be fully protected - sometimes more than ten doses. This vaccine is safe for all children. Each additional dose further strengthens a child's immunity level against polio and ensures that the child does not act as a carrier of the virus.

8. Q: Why do some children with multiple doses of Oral Polio Vaccine still come down with polio?

A:A child's ability to convert the Oral Polio Vaccine into immunity depends upon his or her living circumstances. In temperate climates or industrialized countries with excellent sanitation and health systems, it takes about three doses of the polio vaccine for a child to reach immunity level and ensure safety from the polio virus. In tropical environments or in the developing countries like Nigeria where some children may be malnourished, sanitation systems are inadequate and immunity levels low, it can often take more than ten doses of the vaccine to reach the same level of immunity. Most of the children who still come down with polio are under-immunized, meaning they received fewer than the number of doses thought necessary to protect children in their circumstances from the virus.

As many as 4 or 5 out of every 100 children fail to develop the required immunity after multiple doses and can still come down with polio. If these children live in communities where vaccination coverage is low, they have a high risk of exposure and infection. As the number of children repeatedly missed during immunization campaigns goes down, the children at risk are those who have had multiple doses of the polio vaccine but have not reached their immunity level. The only way to ensure that no child comes down with polio is to ensure that each and every child is immunised every round.

9. Q: Is the polio vaccine in Nigeria effective in preventing polio?

A: Yes. The estimated annual number of polio cases in Nigeria in the mid-1980s was 20,000-30,000. Extensive use of the polio vaccine during campaigns, particularly in the last 10 years, has led to a 99.9% decrease in the number of cases. This shows that the vaccine is very effective in preventing polio.

10. Q: Is it necessary to vaccinate the child for routine immunization if they have been vaccinated in every polio campaign?

A: Yes, polio campaigns are supplementary and not a substitute for routine immunization. All children should receive all the doses outlined in the routine immunization schedule which protects against 7 diseases, in addition to polio.

11. Q: Why give attention to polio always and not to other diseases?

A:Attention is being given to all diseases but it is particularly important to emphasize polio for the following reasons:

a.Polio is one of a few communicable diseases which can be completely eradicated because human beings are the carriers (as was the case with smallpox). It also has a safe and effective vaccine which is not the case with most diseases. The virus does not survive for extended periods of time in the environment. In addition, efforts to eradicate polio can lay the groundwork to address other important health and social issues in Nigeria. Polio eradication activities are helping to strengthen other routine health services.

b.Polio kills and causes permanent paralysis in children. By paralyzing them it reduces their ability to help themselves. It causes them avoidable hardship and reduces their ability to contribute effectively in our communities compared to if they were not paralyzed. For as long as the polio virus is circulating even in one part of the world, children around the world are at risk of getting infected.

c.The whole world has almost eradicated polio just like it banished small pox forever; Only Nigeria and two other countries are left. Therefore if we redouble our efforts, we can also banish polio and focus the money and efforts to banish other diseases such as measles for which government is also giving vaccines. As a result of the vaccines being provided, measles cases are reducing in our communities but for us to also completely banish measles, we have to finish polio and then face other diseases such as malaria, meningitis, pneumonia, and diarrhoea, squarely.

d. Other important diseases that we are fighting with free drugs include leprosy, river blindness and guinea worm (which has almost been eradicated). Free bed nets are being given to protect against malaria; routine immunization vaccines are freely available, and free drugs are being provided for people living with HIV and AIDS.

12.Q: We have more important needs than polio vaccines. Why can't government, for example, give us water to drink and meet our other needs?

A:Different people in different areas have different needs. Although government cannot meet all demands at once, it is important to start from somewhere. Polio is a disease that does not spare any child, so it is being given top priority to ensure that all children are fully protected against it. Finishing polio is one thing that we need to do because we cannot continue to allow our children become paralyzed because we failed to protect them with vaccines. We must protect them so they can grow up to become productive citizens who can help bring water, electricity, roads, houses and free drugs to our communities in the future. Like they say, 'children are the future'

13. Q: We buy even simple drugs like Paracetamol. We buy hospital cards before seeing a doctor. But polio immunisation is free. Why?

A:All vaccines against childhood diseases such as measles, diphtheria, tetanus, meningitis, and polio are free because it is cheaper to give the vaccines than to try and cure the diseases when they happen. This is apart from the human suffering. And polio has no cure though it can be prevented by the oral polio vaccine. When our children do not take the vaccine, then they fall sick and we would have to leave our work, pay for transport to go to the clinic, pay for card to see the doctor, pay for medicines, and pay for some operations; whereas the illness could have been prevented by a vaccine that is brought free to your house or available in a clinic that is near your house.

14. Q: Is it true that the polio programme has a linkage with family planning?

A:No, this is not true. The Oral Polio Vaccine being used in Nigeria is the same being used in rest of the world to stop polio transmission. The vaccine does not cause infertility and has no side effects. The census figures shows that Nigeria's population has been growing even faster than that of any other country in this region in spite of the fact that the polio eradication programme and other immunizations against childhood diseases has been going on for quite some time. If you ask people who took the vaccine while they were children, they will tell you they are having children.

15. Q: When will the government stop giving our children the OPV?

A:We will stop giving OPV once we stop seeing children that are paralyzed by polio in Nigeria, then we will know that we have succeeded in finishing polio the way our parents and grandparents finished small pox. Then we shall stop vaccinations against polio the way we have stopped vaccinations against small pox.

16. Q: Why is the OPV given only to children under the under the age of five years?

A:Children under the age of five years are the most likely to get polio. Once they are given the vaccine, it protects them from the disease. All vaccines are given to children while they are still under 5 years old.

17. Q: Why is the polio programme a house-to-house programme?

A:The polio programme goes house-to-house to door so that every child can be reached with the vaccine and to ensure that no child is missed. If too many children are missed during campaigns the virus will continue to circulate in these children, putting all others at risk. Going house to house is essential in order to reduce the number of children who may be missed.

18. Q: Is OPV Haram or Halal?
A:OPV is Halal, it is not haram. There are many fatwas from religious leaders both in Nigeria and from Muslim countries that have emphasized that OPV is halal. The OPV we use in Nigeria is the same one that is used in Muslim countries such as Indonesia, Saudi Arabia and others.

19. Q: Polio is not the people's felt need at the moment. Why is it a top priority for the government?

A:People have many priorities depending on their unique situation. Government is interested in finishing polio because, we are at a stage where it is relatively easy to finish the job, just like we joined our hands with other countries to finish small pox.

20.Q: Does a new-born baby need polio vaccination even before his/her naming ceremony?

A:Yes a new-born needs protection against polio because the vaccine should get to the child before the germ that causes the disease gets to the child. The earlier the child gets the vaccine, the better since the polio germ is everywhere in the environment. All unimmunized children are at risk, including new-borns.

21. Q: I have children over five years old and they were vaccinated. Why?

A:The polio vaccine is for children under five years of age. Some parents are not very sure about the exact age of their children. It is better to vaccinate in case there is doubt that the child may be under five years of age. Vaccinating a child who is more than five years old does not affect the child, but if the child is not given the dose for fear that he/she is more than five years, he/she may get the disease if he/she had not been fully immunized and fully protected.

22. Q: What is an excess dose? How much is too much?

A:There is no such thing as an excess dose. The polio vaccine is very safe. In countries where eradication has taken place, children have taken more than 10 doses of the vaccine without side effects. OPV needs to be administered many times to be fully effective. The number of doses it takes to immunize a child depends entirely on the child's health and nutritional status, and the number of other viruses that the child has been exposed to. While there is polio virus in a country, all children are still at risk from polio and need the extra doses of vaccine to ensure their protection. This is why every child must be immunized during every immunization campaign against polio. Every missed child is a place for the polio virus to hide.

23. Q: How can I be sure of the safety of the vaccine?

A:You can be sure of the vaccine because when you look around, there are respectable people in the society like the Sultan of Sokoto, the Emir of Kano, Alhaji Aliko Dangote, as well as many other traditional and religious leaders who have vaccinated their children and grand-children with the Oral Polio Vaccine in public. If the vaccine were not safe, they would not have given it to their own children and grandchildren.

24. Q: There has been no polio here for years. But it is difficult getting three meals a

day. Why not address that instead?

A:Life is tough. Since the time of our forefathers we have had challenges with food, water and shelter but man cannot live on food alone. We must eat what we need today but preserve and protect our children so they can live long to also take care of the future generation and us. When we allow them to die or get paralyzed, we are not safeguarding our future generations with the health they need to be able to live well , worship, take care of their families and procreate.

25. Q: 'I saw vaccinators and asked them what polio was. The answers were not clear. Who can I trust?'

A:First, you can trust your community leaders who say that it is safe to vaccinate your children because they have publicly vaccinated their children and continue to do so in the clinics. You can also trust the health workers in the clinic who advise you to get your children immunised, because they are there to ensure that the community is in good health.

Polio is a disease that kills and paralyzes children and sometimes adults. It is caused by a germ called the polio virus. The only way to protect your children from the virus is by vaccinating them with the Oral Polio Vaccine. The paralysis caused by polio has no cure; it is permanent.




Press Conference
Polio Update, August 2013
By
Dr. Abdulrahman Tunji Funso
Chairman, Nigeria National Polio Plus Committee (NNPPC)

08053334570
In this presentation, we'll review the current status of global polio eradication efforts and Rotary's role in it. These past 12 months have been a period of huge achievement, huge challenge and huge change. Rotarians have been at the centre of these achievements; and Rotary's vision has been the driving force behind these changes.


The partnership with the goal of eradicating polio was formed in 1988 and is called The Global Polio Eradication Initiative or GPEI.

In the GPEI, Rotary works in concert with the World Health Organization, UNICEF and the Centers for Disease Control and Prevention, and with the governments of the world, both in the polio affected and donor countries, and with the support of the Bill & Melinda Gates Foundation, among other partners who have joined this successful global effort.

When the Global Polio Eradication Initiative was launched in 1988, the poliovirus was circulating in 125 countries, paralyzing or killing 1,000 people a day.

Today polio cases have been reduced by 99 percent with only 223 cases reported worldwide in 2012. Only three countries have never stopped the transmission of the wild poliovirus-- - Pakistan, Afghanistan and Nigeria.

When you set out to eradicate polio, you faced a world in which 3 types of poliovirus were paralyzing children in over 125 countries. Many Rotarians are aware that the one of those viruses, the type 2 wild poliovirus, paralyzed its last victim in India in 1999. Most Rotarians are NOT aware, however, that for the first time in history we have not seen the type 3 poliovirus anywhere in the world for more than 6 months. This not only gets us close to eradication, but it opens the door to using even more effective polio vaccine formulations to finish the job.

As of today, the number of polio cases in Afghanistan, Nigeria and Pakistan is down 40% compared to the same time in 2012.

The number of polio 'reservoirs' in Afghanistan, Nigeria and Pakistan today is down 50% compared to the same time in 2012. The number of surviving polioviruses in the world is at its lowest in history.

As the Polio Independent Monitoring Board said in its most recent report in June, 'Poliovirus has been knocked down but it is certainly not knocked out.'

The last poliovirus is continuing to move and just last month spread into the Horn of Africa where nearly half a million children had not been vaccinated in the last 4 years due to the suspension of mass immunization campaigns in south/central Somalia.

it is the programme that uses NEW tactics to rapidly stop new polio outbreaks such as the vaccination of the entire population in the first couple of mass polio immunization response rounds as you see here in Mogadishu where the President of Somalia himself was the first in line; and

The Independent Monitoring Board also knew that at least 750,000 children are still inaccessible to vaccinators in the remaining polio-infected areas of the world


Supplementary Immunization activities (SIAs)
Mop Up activities
Permanent health teams (PHT)
Fire-walling
Routine immunization activities


Presidential task force on Polio Immunisation

Set up by the president February 2012
Chairman - Minister of state for health
Operated by the NPHCDA through the Emergency Operating centre

Polio Eradication & Endgame Strategic Plan 2013-18

But we need a plan, so in May the World's Ministers of Health gathered in Geneva and launched a bold new Polio Eradication & Endgame Strategic Plan' that was developed by the polio partners and Rotary over the previous 12 months.

Scope of polio campaigns, Africa
This new plan - agreed by 194 Ministers of Health - reaffirms the world's confidence in Rotary's vision of a polio-free world. It addresses the real costs of vaccinating more than 250 million children worldwide, multiple times every single year, interrupting poliovirus transmission and protecting polio-free countries, and especially in Africa. This 5.5 billion budget also includes the real costs of conducting active surveillance for polio, every single day, in over 70 countries and preparing for polio-free certification in nearly 200 countries .

The plan also looks beyond polio, into adapting the program's infrastructure to deliver other health services to the world's most vulnerable children.

Financing the endgame plan
This new endgame plan does come with a daunting 5.5 billion dollar budget, but just last May dozens of longstanding and new donors reaffirmed their confidence in Rotary's vision by pledging over 4 billion dollars in financing for the polio eradication and end time strategic plan. It's been a very long time coming, but we can finally see the PolioPlusfinish line.

'The polio programme of today is not the programme that will complete polio.'



But it's one thing to see the finish line and a very different thing to get across it. In fact, in its last report, the Polio Independent Monitoring Board stated that 'The polio programme of today is not the programme that will complete polio'.

The Board was well aware that changes were needed to overcome the new challenges we face: challenges like the horrific attacks on health workers in Nigeria and Pakistan over the past 6 months; challenges like the limited access to children in south/central Somalia; challenges like the reduced effectiveness of the oral poliovirus vaccine in some settings; challenges like collecting that 4 billion dollars in pledges and closing the remaining 1.5 billion dollar funding gap; and challenges like those vaccine-derived polioviruses that sometimes cause new outbreaks.



So what is the new programme that will complete polio?

It is the programme that is laid out in the new Endgame Plan:

it is the programme that introduces NEW tools like a dose of inactivated polio vaccine - or IPV - into routine immunization programmes globally to really boost the immunity of children against polio;

it is the programme that uses NEW strategies, to reach children in areas where health workers are being intimidated, attacked and even killed by those who seek to stop children from receiving basic health care;

Involving Grassroots NGOs

FOMWAN

We face a formidable enemy in the battle to finish polio. In the coming months this virus will seek to discourage, demoralize and depress us by exploding in a new outbreak in Somalia, or by spreading anew across international boundaries, or just by taking a short plane ride and paralyzing children in another, distant location. To beat it we must have the full support of every Rotarian, such as these heroes who helped out in Chad, which recently ago celebrated its one-year anniversary of being polio-free;

Rotary's promise: a polio-free world

This is who we are: an organization working in concert with our partners to keep a promise we made to children everywhere, the promise of a polio-free world. We have the plan, we have the people and we have the vision. Let's get to work and wipe out polio once and for all.