How Boko Haram Is Keeping Polio Alive In Nigeria | KERA News

How Boko Haram Is Keeping Polio Alive In Nigeria

Sep 14, 2016
Originally published on September 14, 2016 8:44 am

Nigeria has to get rid of polio — again.

Last year, the World Health Organization declared the country to be "polio-free." That milestone meant the disease was gone from the entire continent of Africa, a major triumph in the multibillion-dollar global effort to eradicate the disease.

But that declaration of "polio-free" turned out to be premature.

Three new cases of polio have been confirmed in areas liberated from Boko Haram militants, prompting health officials to launch a massive campaign to vaccinate millions of children across four countries in West and Central Africa.

Before the cases were found, the world appeared extremely close to making polio the second human disease after smallpox to be eradicated. There had been fewer than two dozen polio cases in 2016, clustered in Pakistan and Afghanistan.

Then health officials in Nigeria found three paralyzed kids inside parts of Borno state that had been held by the Islamic militant group Boko Haram.

Dr. Chima Ohuabunwo, an epidemiologist who has been working with the U.S. Centers for Disease Control and Prevention in Nigeria for the past five years, says Boko Haram has cut off parts of Borno state, in Nigeria's northeast, from the rest of the world.

"There's been no direct in and out movement of persons, or access to health care, for the past two to three years," Ohuabunwo says.

Earlier this year, he says, half of Borno state was a no-go zone. Government health care workers and international relief groups, including polio vaccination teams, could be attacked or killed if they tried to enter those areas. At the same time, Boko Haram was pillaging farms and destroying health clinics.

"Of about 38 secondary health care facilities in the entire state, 16 were totally burnt down by these insurgents," Ohuabunwo says.

It's only after recent military offensives by the Nigerian army into Boko Haram territory that health officials were able to find the three kids who'd been paralyzed by polio. One was a 4-year-old girl in a family that had escaped and made it to a displaced persons camp.

The immediate concern is to make sure all children in Borno state are vaccinated, but parts of the state remain under the militants' control. So polio immunizers have set up vaccination posts on the roads just outside the Boko Haram-controlled areas.

"We only get access to the children when there's some incursion by the military and they [the children] come out," Ohuabunwo says. "We have prepared health teams called border post teams who sit and wait. As soon as the children come out, we get them, assess them, administer vaccines."

In addition to these roadside vaccinators, Nigeria is conducting three mass polio immunization campaigns across accessible parts of Borno state. The goal is to vaccinate every child they can find under age 5. One mass campaign was held in August. Another starts next week, and a third launches in October.

"One of the problems with polio is that the infections that lead to paralysis are just the tip of the iceberg," says Dr. Walt Orenstein, a professor of medicine at Emory University who has worked for years on polio eradication efforts.

"Generally less than one in 200 infections actually leads to paralysis."

This means there is probably a lot more polio virus floating around in the Boko Haram-controlled parts of northeastern Nigeria than has been detected. The World Health Organization is concerned about the virus spilling over into Cameroon, Chad and Niger, so WHO is planning additional emergency polio vaccination campaigns in those neighboring countries.

The security situation makes it nearly impossible to eradicate polio in militant-controlled parts of West Africa. But Orenstein points out that it has been done elsewhere, in lots of other complicated conflicts, and he's confident that eventually polio will be defeated in northern Nigeria, too.

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RENEE MONTAGNE, HOST:

A terrible childhood disease that was thought to have been finally eliminated throughout Africa is back. Less than a year ago, Nigeria, along with the entire continent, was declared polio-free by the World Health Organization. Now, several new cases of polio have been confirmed in areas recently liberated from the Islamist terror group Boko Haram. NPR's Jason Beaubien reports.

JASON BEAUBIEN, BYLINE: The world had never appeared closer to eradicating polio than it did this summer. There had been fewer than two dozen cases anywhere in the world in 2016, and all of them were clustered in Pakistan and Afghanistan. Then, health officials found three paralyzed kids in Borno State in the northeast of Nigeria. Chima Ohuabunwa, an epidemiologist who's been working with the Centers for Disease Control and Prevention in Nigeria for the last five years, says Boko Haram had cut off much of Borno State from the rest of the world.

CHIMA OHUABUNWA: There's been no direct in-and-out movement of persons or access to healthcare for the past two to three years.

BEAUBIEN: Earlier this year, he says, half of Borno was a no-go zone. Government health care workers and international relief groups, including polio vaccination teams, would be attacked if they tried to enter those areas. At the same time, Boko Haram was pillaging residents' farms and destroying local health clinics.

OHUABUNWA: To give you an example, out of about 38 secondary health care facilities, 16 were totally burnt down by these insurgents.

BEAUBIEN: Ohuabunwa says that it's only after the Nigerian military drove the Boko Haram fighters out of the areas of Borno State that health officials were able to find the three kids who'd been paralyzed by polio. But parts of the state remain under the militants' control, so polio immunizers have had to set up vaccination posts on the roads just outside the Boko Haram territory.

OHUABUNWA: When they get access to the children when there's some encroachment by the military and they come out, we have prepared health teams called border post teams who sit and wait. And as soon as they come out, we get them, assess them and administer vaccines, and other partners provide other health services and humanitarian services to these children.

BEAUBIEN: Including giving them food because, he says, many of the kids are severely malnourished. In addition to these roadside vaccinators, Nigeria is conducting three mass polio immunization campaigns across the accessible parts of Borno State. The goal is to vaccinate every child they can find under the age of 5. One of the mass campaigns was held in August. Another starts next week, and a third will be launched in October.

WALT ORENSTEIN: One of the problems with polio is that the infections that lead to paralysis are the tip of the iceberg.

BEAUBIEN: Walt Orenstein is a professor of medicine at Emory University, and he's worked for years on polio eradication efforts.

ORENSTEIN: Generally, less than 1 in 200 infections actually leads to paralysis.

BEAUBIEN: So there's probably a lot more poliovirus floating around in that area than has been detected. The World Health Organization is concerned about the virus spilling over into Cameroon, Chad and Niger, so the WHO is also planning additional polio vaccination campaigns in those neighboring countries. The security situation makes it nearly impossible to eradicate polio while militants control those parts of West Africa. But Orenstein says the virus has been eliminated in most other conflict zones around the world. And he's confident that eventually it'll be defeated in northern Nigeria, too. Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.