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“In India’s poorest rural families, goat rearing is an important source of income.”
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An Encouraging Visit
Nigeria advances the fight against polio
In a visit to Africa’s most populous nation, I witnessed remarkable progress against polio, with lessons for the fight against infectious diseases worldwide.
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With continued hard work and investment the world is on a path toward something pretty incredible, the eradication of polio. In the past two decades, polio cases around the world have been reduced by 99 percent. If we can get rid of the last 1 percent, polio will become the second major infectious disease, after smallpox, that has ever been completely eliminated. There are still gaps in funding for polio eradication, and new outbreaks could reverse some of the progress made so far. But if polio is eliminated, never again will a child be crippled by this terrible virus.

We have a chance to get there because of some great efforts, particularly by the Global Polio Eradication Initiative, which involves the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention (CDC) and the United Nations Children's Fund (UNICEF). The Gates Foundation is very involved in supporting polio immunization campaigns and other efforts to educate parents and communities about the importance of immunization. We’re also supporting work to improve polio surveillance and to develop better vaccines and anti-poliovirus drugs.

Northern India and northern Nigeria are two areas where polio continues to be a problem. I visited northern India in May this year to see the progress there. I was very excited to visit northern Nigeria in June, because the progress there since my last visit in February 2009 has been especially impressive. As of July 14th, only five cases due to wild polio viruses were reported in Nigeria this year, versus hundreds last year.

I spent most of my first day in Kano, one of the northern states most vulnerable to polio. I met with community leaders, visited a local health center and stopped in at an informal school where students study the Koran in Arabic. On the streets and most everywhere else we went, I noticed so many young children around. Nigeria has more people by far than any other African country, and more than 40 percent of them are under the age of 15. That makes polio immunization a big challenge. Kano had just begun a campaign to immunize more than 6 million children under the age of five.

Part of the challenge is overcoming fear and suspicion. In Kano in the past, false rumors linked immunization to sterility and HIV. Community leaders told me that because polio vaccine is free and brought to people in their homes, some people think there must be something wrong with it. Community leaders play a critically important role in helping to overcome mistrust, and a big focus of anti-polio efforts is on informing these leaders and enlisting their support.

Another ironic thing I noticed was that because polio cases have been dramatically reduced, it’s more difficult to know whether local immunization campaigns are reaching everyone they need to reach, particularly sub-populations that may be more at risk. Without many actual cases, you have to rely on other ways of monitoring immunization rates, and the different measures are sometimes quite inconsistent. I think we need to look at how to help get more reliable data to guide our efforts and ensure they’re effective.

Also of concern is the risk that progress against polio in Kano might be undermined by the virus filtering back in from neighboring countries and other parts of northern Nigeria. Increasingly, the problem needs to be approached on a regional basis.

The school we visited was very interesting. It didn’t really look like a school. There were no classrooms, just children sitting on the street, against a wall or under a tree, holding slates with Arabic script written on them. I asked one of the boys to recite the lesson from his slate, and he did.

That night in Abuja, the Nigerian capital, I had dinner with government officials including the Minister of Health, Onyebuchi Chukwu. It was interesting to learn about some of the creative approaches being used to inform Nigerians about the importance of immunization. Pro-immunization messages are being embedded in the plotlines of popular TV entertainment programs, for example. One of Nigeria’s largest mobile phone service providers has agreed to send out about 25 million free text messages on polio and health.

The next day I had a number of meetings including a session with several state governors and one with Nigeria’s new President, Goodluck Jonathan. Commitment from Nigeria’s leaders has been crucial in advancing the nation’s fight against polio.

A recurring theme I picked up from the people I talked to was the importance of using what we’ve learned and accomplished in the drive against polio to fight other illnesses such as infant diarrhea, respiratory ailments and malaria. I do believe that polio eradication helps strengthen routine immunization, which has the potential to save the lives of large numbers of children.

Wherever I go, I always find that saving children’s lives is a universal concern. I was very impressed with Nigeria’s progress against polio. I tried to encourage everyone to not let up.

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