Polio: A Victory Without Scars

Poliomyelitis, or polio for short, is a highly contagious infectious viral disease that affects mainly children under five years of age. It is caused by the poliovirus, a member of the genus Enterovirus which belongs to the Picornaviridae family. The virus enters the human body through the mouth and is spread by an infected person through faeces. As the virus is also present in the throat, it can spread through the phlegm or mucus of infected persons when they cough or sneeze.

There are different types of the polio disease ranging from the asymptomatic type to the severe type causing paralysis. People who have the asymptomatic type rarely show any signs (about 72% of cases) but are nonetheless able to infect other people with the virus. About 25% of those infected show symptoms that are flu-like symptoms which usually resolves between 1-10 days. The symptoms experienced include fever, headache, sore throat, fatigue, nausea, neck stiffness, pain in the arms and legs. A small number of people infected show severe symptoms due to a damage done to the spinal cord and the brain stem. It is in this group of people that paralysis is often observed – about 1% of polio cases.

Polio does not have a known treatment, hence the emphasis on prevention by way of vaccination. There are three different strains of the wild poliovirus (WPV). These are type 1, type 2 and type 3. All the three are capable of causing serious symptoms and should all be protected against. The polio vaccine, developed in the 1950s, is the main protective measure against the poliovirus.

Organised global efforts for the eradication of all types of poliovirus in the world began in 1988 when the World Health Assembly adopted a resolution for the worldwide eradication of polio. This led to the launch of the Global Polio Eradication Initiative, led by national governments, the World Health Organisation (WHO), Rotary International, the US Centres for Disease Control and Prevention (CDC), the United Nations International Children’s Emergency Fund (UNICEF), and later joined by the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance. Wild poliovirus cases have decreased by over 99% since 1988, from an estimated 350,000 cases in more than 125 endemic countries then to 175 reported cases in 2019.

In 1996, more than 75,000 children were said to have been paralysed by the wild poliovirus across countries in Africa. This called for renewed and sustained efforts on the part of the national governments of African countries and other development partners.

At the end of 2003, Nigeria, India, Pakistan, Niger, Afghanistan and Egypt were the only countries in the world that remained polio-endemic. The last reported case in India was in the state of West Bengal on January 13, 2011. The WHO gave the directive to remove India form the list of polio-endemic countries on February 25, 2012. Nigeria, however, suffered a setback in 2003 in the fight to eradicate the poliovirus. This was occasioned by a passionate resistance to the oral polio vaccination programme in some parts of Northern Nigeria. Certain clerics had claimed that the vaccination programme was an attempt to reduce the population of the North by including antifertility ingredients in the oral vaccine. By 2013, Nigeria was one of the only three countries which were polio endemic. The other two were Pakistan and Afghanistan.

Since 2016, however, no new cases of wild poliovirus have been reported in Nigeria. The stage was then set for the country’s certification as being polio free. On December 9, 2019, the Africa Regional Certification Commission (ARCC) for wild polio eradication began a two-week field visit to Nigeria in a bid to verify the absence of poliovirus and to ensure that the disease surveillance was done according to certification standard. The commission had already accepted the documentation submitted by 43 African countries at the time of the visit to Nigeria as part of the process to certify the African region free of all types of the poliovirus. The second phase of the visit was carried out in March 2020.

The primary requirements for the region’s certification are that no wild poliovirus transmissions are detected for a minimum of three consecutive years in all the region’s countries and that a high-quality certification standard of acute flaccid paralysis surveillance is in place in all countries for those three years. Countries must also maintain high immunisation coverage for the oral polio vaccine, have a robust national polio outbreak preparedness and response plan and a functional National Polio Certification Committee.

The ARCC accepted Nigeria’s documentation on polio eradication having verified that the reality on ground agrees with the records. In June 2020, the WHO accorded the country a wild polio-free status. Then in August, two months later, Africa as a whole was certify polio-free.

The economic impact of the polio disease has immense dimensions. According to the WHO, the polio eradication efforts have saved the world more than US$27 billion in health costs since 1988, and it is estimated that a further US$14 billion savings would be realised by 2050. This is a remarkable achievement when compared with the cost countries incur to keep controlling the virus indefinitely.

With the public health challenges posed by the poliovirus being brought under control, the permanent damages done to its victims linger on. The socioeconomic implications for victims of its paralyzing power is far from being addressed. In a country where unemployment rate is on the increase, few chances are provided for those who are physically incapacitated. As of the second quarter of 2020, the unemployment rate in Nigeria stands at 27.1%. This implies that over 21 million Nigerians are unemployed. Of this number, a large percentage have one form of training or the other.

It is a more worrying situation for a number of paralytic polio victims, most of whom have no training or skill sets with which to compete for jobs. While majority have to wait on their state governments and benevolent individuals for support, a few have the moderate luck of being engaged by Non-Governmental Organisations and charities. Like other physical challenges, the paralytics are being treated like unneeded species as a whole. Only recently has the bill for the protection of physically challenged people scaled to being a law. But beyond making laws, there remains huge work to be done.

As the government of the day keeps asserting its commitment to bringing many out of poverty, this group of people whose enemy – the poliovirus – is said to have been stamped out, needs to be freed from the shackles which the enemy left in its wake. Empowerment for them should go beyond offering them mobility aids. There should be a structured system for both formal and informal education for this class, as each may choose his or her own preferred path.

Individuals who have had their limbs paralysed should not in any way be looked upon as, and treated as, being less than humans. A huge bank of talents, creativity and economic power is being lost by not treating them like fellow compatriots.

In all efforts made to address unemployment, adequate attention should continually be given to those who have been paralysed by the poliovirus. The virus may have been eradicated, but the attendant social, economic and psychological effects still live with us.

Adebowale Bello is a trained physiologist, public health writer and a keen observer of global trends.

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