Integration, community engagement, and polio eradication in Nigeria
Authors: Seye Abimbola
Journal: The Lancet Global Health (2014)

Similar to recent qualitative analyses,1Ghinai I Willott C Dadari I Larson HJ Listening to the rumours: what the northern Nigeria polio vaccine boycott can tell us ten years on.Glob Public Health. 2013; 8: 1138-1150Crossref PubMed Scopus (92) Google Scholar, 2Abimbola S Malik AU Mansoor GF The final push for polio eradication: addressing the challenge of violence in Afghanistan, Pakistan, and Nigeria.PLoS Med. 2013; 10: e1001529Crossref PubMed Scopus (55) Google Scholar Tara Mangal and colleagues showed in their quantitative study (February, p e90)3Mangal TD Aylward RB Mwanza M et al.Key issues in the persistence of poliomyelitis in Nigeria: a casecontrol study.Lancet Glob Health. 2014; 2: e90-e97Summary Full Text Full Text PDF Scopus (38) Google Scholar 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,1Ghinai I Willott C Dadari I Larson HJ Listening to the rumours: what the northern Nigeria polio vaccine boycott can tell us ten years on.Glob Public Health. 2013; 8: 1138-1150Crossref PubMed Scopus (92) Google Scholar, 2Abimbola S Malik AU Mansoor GF The final push for polio eradication: addressing the challenge of violence in Afghanistan, Pakistan, and Nigeria.PLoS Med. 2013; 10: e1001529Crossref PubMed Scopus (55) Google Scholar they omit from their discussion two important implications of their results for strengthening the poliomyelitis eradication initiative in Nigeria.First, OPV refusal rates were consistently lower for routine immunisation than for supplemental campaigns.3Mangal TD Aylward RB Mwanza M et al.Key issues in the persistence of poliomyelitis in Nigeria: a casecontrol study.Lancet Glob Health. 2014; 2: e90-e97Summary Full Text Full Text PDF Scopus (38) Google Scholar Thus, the OPV programme should mimic routine immunisation by delivering the vaccine with other priority interventions—eg, for malaria, diarrhoea, pneumonia, malnutrition, and sanitation—for which demand is greater in view of their prominence as common causes of childhood mortality in Nigeria.4National Population Commission (NPC) and ICF MacroNigeria demographic and health survey 2008. National Population Commission and ICF Macro, Abuja2009Google Scholar This strategy takes the focus away from poliomyelitis and reduces the likelihood of rejection because of suspicions that OPV is for reasons other than poliomyelitis eradication.2Abimbola S Malik AU Mansoor GF The final push for polio eradication: addressing the challenge of violence in Afghanistan, Pakistan, and Nigeria.PLoS Med. 2013; 10: e1001529Crossref PubMed Scopus (55) Google ScholarSecond, the results of the study by Mangal and colleagues suggest a rethink of the community engagement strategies that initially increased acceptance of OPV in northern Nigeria.1Ghinai I Willott C Dadari I Larson HJ Listening to the rumours: what the northern Nigeria polio vaccine boycott can tell us ten years on.Glob Public Health. 2013; 8: 1138-1150Crossref PubMed Scopus (92) Google Scholar, 2Abimbola S Malik AU Mansoor GF The final push for polio eradication: addressing the challenge of violence in Afghanistan, Pakistan, and Nigeria.PLoS Med. 2013; 10: e1001529Crossref PubMed Scopus (55) Google Scholar, 3Mangal TD Aylward RB Mwanza M et al.Key issues in the persistence of poliomyelitis in Nigeria: a casecontrol study.Lancet Glob Health. 2014; 2: e90-e97Summary Full Text Full Text PDF Scopus (38) Google Scholar This can be achieved by moving beyond key political and traditional leaders and actively engaging community structures, such as village health committees, that can stimulate demand and distribute information on the importance and availability of OPV, thereby boosting vaccine acceptability from the bottom up.5Nasiru SG Aliyu GG Gasasira A et al.Breaking community barriers to polio vaccination in Northern Nigeria: the impact of a grass roots mobilization campaign (Majigi).Pathog Glob Health. 2012; 106: 166-171Crossref PubMed Scopus (31) Google Scholar However, communities should be mobilised not only for poliomyelitis vaccination but also for overall maternal and child health services.I declare no competing interests. Similar to recent qualitative analyses,1Ghinai I Willott C Dadari I Larson HJ Listening to the rumours: what the northern Nigeria polio vaccine boycott can tell us ten years on.Glob Public Health. 2013; 8: 1138-1150Crossref PubMed Scopus (92) Google Scholar, 2Abimbola S Malik AU Mansoor GF The final push for polio eradication: addressing the challenge of violence in Afghanistan, Pakistan, and Nigeria.PLoS Med. 2013; 10: e1001529Crossref PubMed Scopus (55) Google Scholar Tara Mangal and colleagues showed in their quantitative study (February, p e90)3Mangal TD Aylward RB Mwanza M et al.Key issues in the persistence of poliomyelitis in Nigeria: a casecontrol study.Lancet Glob Health. 2014; 2: e90-e97Summary Full Text Full Text PDF Scopus (38) Google Scholar 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,1Ghinai I Willott C Dadari I Larson HJ Listening to the rumours: what the northern Nigeria polio vaccine boycott can tell us ten years on.Glob Public Health. 2013; 8: 1138-1150Crossref PubMed Scopus (92) Google Scholar, 2Abimbola S Malik AU Mansoor GF The final push for polio eradication: addressing the challenge of violence in Afghanistan, Pakistan, and Nigeria.PLoS Med. 2013; 10: e1001529Crossref PubMed Scopus (55) Google Scholar they omit from their discussion two important implications of their results for strengthening the poliomyelitis eradication initiative in Nigeria. First, OPV refusal rates were consistently lower for routine immunisation than for supplemental campaigns.3Mangal TD Aylward RB Mwanza M et al.Key issues in the persistence of poliomyelitis in Nigeria: a casecontrol study.Lancet Glob Health. 2014; 2: e90-e97Summary Full Text Full Text PDF Scopus (38) Google Scholar Thus, the OPV programme should mimic routine immunisation by delivering the vaccine with other priority interventions—eg, for malaria, diarrhoea, pneumonia, malnutrition, and sanitation—for which demand is greater in view of their prominence as common causes of childhood mortality in Nigeria.4National Population Commission (NPC) and ICF MacroNigeria demographic and health survey 2008. National Population Commission and ICF Macro, Abuja2009Google Scholar This strategy takes the focus away from poliomyelitis and reduces the likelihood of rejection because of suspicions that OPV is for reasons other than poliomyelitis eradication.2Abimbola S Malik AU Mansoor GF The final push for polio eradication: addressing the challenge of violence in Afghanistan, Pakistan, and Nigeria.PLoS Med. 2013; 10: e1001529Crossref PubMed Scopus (55) Google Scholar Second, the results of the study by Mangal and colleagues suggest a rethink of the community engagement strategies that initially increased acceptance of OPV in northern Nigeria.1Ghinai I Willott C Dadari I Larson HJ Listening to the rumours: what the northern Nigeria polio vaccine boycott can tell us ten years on.Glob Public Health. 2013; 8: 1138-1150Crossref PubMed Scopus (92) Google Scholar, 2Abimbola S Malik AU Mansoor GF The final push for polio eradication: addressing the challenge of violence in Afghanistan, Pakistan, and Nigeria.PLoS Med. 2013; 10: e1001529Crossref PubMed Scopus (55) Google Scholar, 3Mangal TD Aylward RB Mwanza M et al.Key issues in the persistence of poliomyelitis in Nigeria: a casecontrol study.Lancet Glob Health. 2014; 2: e90-e97Summary Full Text Full Text PDF Scopus (38) Google Scholar This can be achieved by moving beyond key political and traditional leaders and actively engaging community structures, such as village health committees, that can stimulate demand and distribute information on the importance and availability of OPV, thereby boosting vaccine acceptability from the bottom up.5Nasiru SG Aliyu GG Gasasira A et al.Breaking community barriers to polio vaccination in Northern Nigeria: the impact of a grass roots mobilization campaign (Majigi).Pathog Glob Health. 2012; 106: 166-171Crossref PubMed Scopus (31) Google Scholar However, communities should be mobilised not only for poliomyelitis vaccination but also for overall maternal and child health services. I 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 Nigeria – Authors' replyWe 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.1 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. Full-Text PDF Open Access