Integration, community engagement, and polio eradication in Nigeria – Authors' reply
Authors: T D Mangal, R B Aylward, N C Grassly
Journal: The Lancet Global Health (2014)

We thank Seye Abimbola for highlighting some of the implications arising from our analyses of oral poliovirus vaccine (OPV) use in Nigeria. Community engagement and demand generation are vital to the success of the poliomyelitis eradication programme. Our analyses suggest that efficacy of OPV in Nigeria, even in the northern states, is sufficient to interrupt wild poliovirus transmission if high coverage is achieved consistently.1Mangal TD Aylward RB Mwanza M et al.Key issues in the persistence of poliomyelitis in Nigeria: a case-control study.Lancet Glob Health. 2014; 2: e90-e97Summary Full Text Full Text PDF Scopus (38) Google Scholar Therefore, Nigeria has the means necessary to finish the job; the major setbacks during 2012 were a result of low campaign quality, rather than low vaccine efficacy.2Grassly NC Fraser C Wenger J et al.New strategies for the elimination of polio from India.Science. 2006; 314: 1150-1153Crossref PubMed Scopus (218) Google Scholar We discussed in our report the potential to improve vaccine acceptance and increase demand for OPV by engaging people within communities to deliver health education. Our analysis focused on all reported sources of health education within a community—ie, not only traditional leaders but also the local media and relatives. Obtaining health information via religious leaders strongly affected the probability that a child had received OPV, but health workers and town announcers also had a substantial effect on the probability of a child being vaccinated against poliovirus. Because targeted social mobilisation is an effective way to increase vaccine acceptance in high-risk communities, this strategy is now the focal point for many new initiatives. Examples include appointing survivors of poliomyelitis to raise awareness and using traditional birth attendants to educate mothers and promote vaccine acceptance.3Etsano A Shuaib F Mkanda P et al.Progress toward poliomyelitis eradication: Nigeria, January 2012–September 2013.MMWR Morb Mortal Wkly Rep. 2013; 62: 1009-1013PubMed Google Scholar, 4National Primary Health Care Development Agency2012 Nigeria polio eradication emergency plan. Nigeria Federal Ministry of Health, Abuja2012Google Scholar Abimbola correctly notes that rates of refusal of OPV were low during routine immunisation campaigns, a finding that is to be expected because caregivers who are actively attending health facilities are more likely to accept vaccines. An integrated approach to child health—ie, combining OPV delivery with interventions for other childhood diseases during supplementary immunisation activities—has been initiated in Nigeria with the establishment of health camps.3Etsano A Shuaib F Mkanda P et al.Progress toward poliomyelitis eradication: Nigeria, January 2012–September 2013.MMWR Morb Mortal Wkly Rep. 2013; 62: 1009-1013PubMed Google Scholar These temporary primary health-care facilities have been launched in areas with continued poor performance of vaccination programmes and are just one of several new initiatives to target children with insufficient immunity. Such innovative strategies, coupled with strengthened community engagement, will be crucial to break poliovirus transmission in Nigeria. We declare no competing interests. Key issues in the persistence of poliomyelitis in Nigeria: a case-control studyAlthough high refusal rates, low OPV campaign awareness, and heterogeneous population immunity continued to support poliomyelitis transmission in Nigeria at the end of 2012, overall population immunity had improved due to new OPV formulations and improvements in programme delivery. Full-Text PDF Open AccessIntegration, community engagement, and polio eradication in NigeriaSimilar to recent qualitative analyses,1,2 Tara Mangal and colleagues showed in their quantitative study (February, p e90)3 that, despite achievements in top down political engagement at the national and sub-national levels, vaccine refusal and scant information on the importance and availability of oral poliovirus vaccine (OPV) at the community level continue to impede poliomyelitis eradication efforts in northern Nigeria. However, in addition to contextual factors that account for vaccine refusal,1,2 they omit from their discussion two important implications of their results for strengthening the poliomyelitis eradication initiative in Nigeria. Full-Text PDF Open Access