Four years ago, Nigeria reported its last case of wild poliovirus. As the last country in Africa to do so, it marked a significant milestone for the African continent in the fight against a debilitating and sometimes life-threatening disease.
That milestone satisfies a criteria that a country or region must not have any incidents of wild poliovirus for at least three years before it can be certified free of the virus. The African Regional Certification Commission is set to declare the continent free of wild poliovirus on Tuesday.
For millennia, the wild poliovirus has reduced the quality of life for millions of children around the world.
Polio is a highly infectious disease that can spread through contaminated water or food, usually affecting children under 5, with around 1 in 200 infections resulting in permanent paralysis. Of those paralysed, 5-10% die due to crippled breathing muscles.
At one point in the 1980s, 1,000 children died every day from polio.
While global efforts to tackle this disease have led to its near total eradication, Pakistan and Afghanistan remain endemic.
And in developing countries like Nigeria, the fight to end polio has been made all the more difficult due to a historically underfunded health care system and other socio-economic factors like religion, income, education, and wealth inequalities. In Nigeria and around the world, frontline polio workers have been instrumental in the eradication of wild poliovirus.
One of these frontline workers is Lami Isah Kyadawa, a 48-year-old woman who supported polio Immunization Plus Days (IPDs) for almost 12 years before joining the Volunteer Community Mobilizer (VCM) network in December 2015 as a mobilizer for Kyadawa Ward, Gada LGA in Sokoto State, Nigeria.
"[The] eradication of polio means that my country Nigeria is finally free of the wild poliovirus and our children will be safe from being crippled by the virus," Kyadawa told Global Citizen. "It makes me proud to know that I was part of those that ensured the eradication of polio came to pass in Nigeria and now we can focus on improving routine immunization and other diseases."
In 2008, Nigeria had just 38 cases of wild poliovirus and by 2009, that number had climbed to 258. By 2012, Nigeria accounted for more than half of all polio cases worldwide.
"Even though I personally didn’t get infected with polio, my life has changed in fighting for polio to be eradicated," Kyadawa said. "I lost one of my eyes in an accident on my way back from mobilizing for a polio campaign from Kyadawa to Gidan Chiwake, a settlement along the borders of Illela, [Sokoto State]."
When it comes to carrying out her work, Kyadawa’s job is not easy as she works in a region that is heavily superstitious, with low levels of formal education across the populace.
"Community members were initially refusing to comply with getting their children vaccinated either due to religious misconceptions or the belief that it was a form of contraceptive to stop their children from being able to bear many children," she explained. "Children have been crippled by polio due to their parents’ refusal to accept polio vaccination for their children."
Much like with COVID-19, eradication is the ultimate way to solve the problem of polio as the virus’ transmission pattern puts communities at risk, even if they only have one case.
"As long as a single child remains infected, children in all countries are at risk of contracting polio," the World Health Organization reports. "Failure to eradicate polio from these last remaining strongholds could result in as many as 200,000 new cases every year, within 10 years, all over the world."
The fight to contain polio has been multidimensional and multi-generational. It dates back to 1789, when British physician Dr. Michael Underwood attempted the first known clinical description of polio, and continued in 1955 when Dr. Jonas Salk developed the first vaccine for polio — an injectable, inactivated polio vaccine (IPV) — and in 1988, the world came together when the World Health Assembly created the Global Polio Eradication Initiative (GPEI).
The global fight against polio has yielded great results. Cases of wild poliovirus have decreased by more than 99% since 1988, from an estimated 350,000 cases annually to just 33 reported cases in 2018, according to the WHO. This accomplishment took the contributory efforts of various levels of government, the private sector, the medical industry, health care workers, and frontline polio volunteers, especially in developing countries.
This is evident in Kyadawa’s work.
"My average day as a frontline worker starts with mapping out households to visit to raise awareness on any selected topic from my flip chart for the day, and in the course of this mapping, I track pregnant women and children under 1 to be referred or reconnected with the nearest facility for routine immunization and antenatal care (ANC). On average, I visit 15-20 households in a day," she told Global Citizen.
Kyadawa also works with female caregivers to educate them on different topics like the use of long-lasting insecticidal nets (LLIN) to prevent malaria, essential household practices, handwashing, exclusive breastfeeding, and more. If the compound she is visiting has up to five households in it, Kyadawa conducts a compound meeting in place of the one-on-one appointments.
The result of the work that frontline polio workers like Kyadawa have done is that no wild poliovirus case has been detected anywhere in Nigeria — and therefore Africa — since 2016. For context, wild poliovirus paralysed more than 75,000 children across the continent in 1996.
"[The] eradication of polio means so much to my community because they are happy Nigeria is now categorized as one of the wild polio-free countries," Kyadawa said. "It is now that they appreciate the efforts of the government and partners who have made this possible."
But the battle is not entirely won.
The COVID-19 pandemic has hampered the work that frontline workers are doing to ensure that wild polio never returns.
"COVID-19 has definitely impacted my work because of the lockdown in some parts of the country," Kyadawa said. "I had to reduce the intensification of my awareness raising and compound meetings; we could not identify children during naming ceremonies as large gatherings were prohibited; and it also affected mobilization for routine immunization as people are always at home, businesses were shut down, schools closed, and some hospitals too."
But that doesn’t mean there aren’t lessons to be learned from the fight against polio when it comes to the fight against COVID-19.
According to Kyadawa, it is best to follow advice from health professionals and the government; to ensure personal and environmental hygiene to protect us from contacting most diseases and be healthy; to ensure all pregnant women have access to antenatal care; and that children under 1 are vaccinated through routine immunization. Bringing traditional and religious leaders into the conversation is also important in underdeveloped and marginalised communities, she added.
For people like Kyadawa, the eradication of wild polio in Nigeria is not just a victory for their communities, it's a victory for the world at large.
"[One of the cases I worked on was] a pregnant woman I tracked during the course of my weekly mobilization and I referred her to a facility to begin her antenatal care. [After] she started, I continued to monitor her visits until she delivered the child at the facility," Kyadawa said, describing her favourite memory as a polio worker.
"After the delivery, I visited her home to congratulate her and educated both mother and father on the importance of routine immunization at the right time," she added. "They made sure that the child received all the necessary vaccines, including polio, and after the last visit, the husband personally came to thank me for caring about the well-being of his child."
Quotes from Lami Isah Kyadawa have been translated and edited for clarity.