Minna, 23 August, 2023 - In the remote Nigerian village of Bororo-Kambari, five-year-old Fati Isah and her two siblings are lining up with other children their age and younger, preparing to be vaccinated against polio. “My mother says immunization is important and we should receive the vaccine,” she says proudly.

In their village, located in Katcha Local Government Area (LGA) in Niger state in north-central Nigeria, 2 509 687 children benefited from an 18-day mass vaccination campaign, which ended on 16

August 2023, to boost their immunity against Circulating Variant Poliovirus (cVPV2).

This marked the first time that fractional inactivated poliovirus vaccines (fIPV) had been administered in Nigera. The vaccine, administered into the right upper arms of children, boosts the immunity of both previously vaccinated and zero-dose children. 

Rearing its ugly head 
Nigeria was declared free of wild polio in 2020, but the transmission of the circulating vaccine-derived poliovirus type 2 (cVPV2) strain of the paralysing disease remains a concern in the country.

Nigeria notified  1028 cases in 2021, and a further 170 cases in 2022. To date this year, 51 cases have been notified in six states, with clear geographic confinement to the three states of Kebbi, Sokoto and Zamfara. 

Niger State notified four cases in 2022, but no cases so far this year. This state is of particular concern as 14 out of its 25 LGAs are plagued by insecurity, which impacts negatively on provision of immunization and health services. 

To interrupt cVDPVD2 transmission, the National Primary Health Care Development Agency (NPHCDA), with support from World Health Organization (WHO) through Global Polio Eradication Initiative (GPEI) partners, is leading efforts to eliminate all forms of poliovirus.

Fast-tracking polio elimination
In consultation with the Government of Nigeria, the GPEI partners agreed to conduct a routine immunization intensification with both the fIPV vaccine and novel oral polio vaccine type 2 (nOPV2), targeting 13 high-risk and security-compromised states. The campaign conducted in batches has so far been implemented in nine states in Nigeria.

According to preliminary data, 4 779 260 children have received the fIPV vaccine and 27 465 727 the nOPV2 vaccine in the nine states, while 111 341 zero-dose children have been reached for the first time. In addition,  930 434 children in insecure settlements were among those vaccinated.  

“Nigeria has made commendable progress, with a 70% reduction in the number of cVDPVD2 notifications in 2023 compared to a similar period in 2022. This progress is mainly due to the country’s use of innovative strategies to reach high-risk populations in inaccessible settlements and other vulnerable groups,” says WHO Representative in Nigeria, Dr Walter Kazadi Mulombo. 

He reiterated that WHO will continue to support the country with experienced personnel to conduct effective immunization drives, particularly in outbreak areas.

Up to the task
In Niger state, the campaign was crucial to interrupt cVDPV2  and to reach zero-dose children, says Dr Ibrahim Ahmed Dangana, executive director of the Niger State Primary Health Care Development Agency: “WHO is a fundamental partner supporting the state to implement the campaign, including planning for extensive vaccination coverage in security-compromised areas.”

He added that concerted efforts had been made, in collaboration with security agencies, and traditional and religious leaders, to reach all children in the insecure parts of the state. Upscaling efforts to reach unimmunized children in insecure settlements is a critical element of the campaign, implemented through innovative approaches. These include hit-and-run outreaches by vaccinators, negotiated access through intermediaries, recruitment of health workers from insecure areas, engagement of nomadic teams,  as well as collaboration between the government and local security and vigilante groups.

In Niger state, the campaign targeted 2 620 295 children aged from six weeks to 59 months for vaccination with fIPV, and 2 758 197 eligible children from birth to 59 months to receive nOPV2 vaccines. The preliminary report indicates that 1 290 394 children received fIPV vaccines and 1 281 509 nOPV2 vaccines, while  42 799 zero-dose children were reached for the first time with the pentavalent vaccine through the integration campaign.  

To ensure successful implementation, vaccine centres were set up in front of the houses of community leaders and health facilities, while mobile teams operated from churches, mosques, marketplaces and other public outreach sites across the state to expand the drive’s reach as far as possible.

Prior to the campaigns, WHO supported Niger state with comprehensive training of over 3000 health workers and relevant stakeholders on all aspects of vaccination, including injection safety protocols, and provided technical guidelines to primary health facilities.

“We take the vaccines to hard-to-reach and nomadic settlements no child is missed. Some of the communities are very remote and we need to cross rivers or travel long distance on bikes or on foot to get the vaccines to the children,” says vaccinator Aisha Isah.

“We also integrated missing routine immunization  into the campaign to cover zero-dose or missed children, because many of the villages are remote and far from health facilities.” 

Welcoming the vaccinators to his community, the traditional head of Kambari, Mohammed Isah Kambari, helped ensure that all children younger than five in his community were vaccinated.

“We would like to see regular outreach efforts to ensure that all our children are vaccinated against diseases. It would save the parents from spending on the children, and prevent our children from dying of preventable diseases,” he says.

Technical Contacts:
Dr Alhassan Hamisu Dama; Email: alhassanh [at] who.int
Dr Asma’l Zeenat Kabir; Email: kabiras [at] who.int