Eradicating Viruses — Lessons from the Campaign Against Polio in India and Nigeria
Coronavirus (COVID-19) has reached pandemic levels across the world, with over half a million cases worldwide. There are early reports that vaccines are being developed, but these are unlikely to be ready for distribution for at least a year. While we do not yet know how this disease will spread over the coming months and years, it is timely to look back at efforts to eliminate other viruses to understand what makes an immunization campaign effective.
A recent review article from the International Journal of Translation Medial Research and Public Health studied polio eradication efforts in Nigeria and India. Polio is an infectious disease caused by a virus, which can lead to permanent muscle damage and disability. The original vaccine was developed in the 1950’s by Jonas Salk. While the vaccine led to a dramatic reduction in the rates of polio, public health officials have not been able to entirely eradicate the disease. Today, a handful of cases of polio reported world-wide remain, mainly in impoverished countries with limited health infrastructure.
The review article focuses on comparing the eradication of polio in India and Nigeria. Nigeria has not had any cases of wild polio since 2017, while India was declared polio-free in 2012. These two countries are useful comparisons since India is viewed as a success story, while Nigeria had more difficulty fighting the disease. The authors of the review screened over 3,000 research papers to find articles that most directly addressed the eradication of polio in Nigeria and India. From the papers that remained, the reviewers distilled the most important themes in an attempt to address why India performed better than Nigeria.
One of the clearest findings was the importance of vaccine choice. There are several formulations of the polio vaccine, though some are more effective than others. The vaccine used in Nigeria was shown to be less effective, particularly in communities that are struggling with malnutrition or poor sanitation. In comparison, India began using a more effective vaccine earlier, leading to better rates of immunization. Nigeria eventually switched to the more effective vaccine, but this delay represents lost time and resources.
While challenges with the vaccine did present a barrier for Nigeria, issues with poor health infrastructure also played a role in hindering the polio eradication effort. The Nigerian government did not have the ability to plan and implement this program, leading to misused resources or shortages of vaccines. This led to public health workers having poor motivation and inferior training, meaning that the implementation of the anti-polio campaign was less effective. India, on the other hand, developed a multi-layered campaign that included international aid organizations, government agencies, and local officials. Ultimately, they we are able to staff teams that would make multiple visits to communities to maximize rates of immunization.
This lack of proper institutional capacity in Nigeria was amplified by public attitude about vaccinations. The populace was suspicious of vaccines as a result of false rumors claiming that vaccines cause infertility. This is related to a general mistrust of government institutions, which is common in Nigeria. By contrast, India effectively mobilized community and religious leaders to become invested in the anti-polio campaign. This type of community buy-in is essential in countries that are ethnically and religiously mixed. While intangible factors such as “trust in government” may be difficult to address, they make a concrete difference in fighting infectious disease.
Coronavirus and polio are very different diseases, but there are lessons that can be learned from the experience of public health officials in Nigeria and India combatting polio. While cutting-edge medicine is an essential component of an eradication campaign, we should resist the temptation to view vaccines as the end of the story. This research shows that qualities such as institutional capacity and public opinion play a vital role in implementing an immunization program. This review is an important reminder that work must be done now to prepare health agencies and educate the public so that the Coronavirus vaccine is as effective as possible once it is ready for distribution.
This is part of a series on research that relate to the COVID-19 pandemic. Other articles in this series cover hydroxychloroquine, weather’s effect on COVID-19, the use of masks and airborne transmission.
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