This record is a partial extract of the original cable. The full text of the original cable is not available.

261444Z May 06

UNCLAS SECTION 01 OF 02 ABUJA 001252 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: PGOV EAID SOCI NI
SUBJECT: POLIO CONTINUES NIGERIA ADVANCE; WHAT TO DO NOW? 
 
REF:  ABUJA 404 
 
¶1. Summary.  Polio in Nigeria by most measures continues to 
worsen -- and Nigerian travelers are carrying the virus 
abroad.  In five Nigerian states there are four times as 
many cases of polio as in the same period in 2004.  More 
than 40% of the children in those states have not received 
one dose of the oral polio vaccine.  As of May 12, Nigeria 
had 250 cases of wild poliovirus in 15 states, compared to 
113 for the same period in 2005 in 14 states.  Nigeria 
accounted for 79% of the world's wild poliovirus cases in 
2006, and for 98% of the cases in Africa.  Nigeria's polio- 
eradication campaign has made progress in reducing the 
virus's geographic extent within the country, from 325 
infected Local Government Areas in 2004 to 63 since December 
2005, but polio has proved difficult to defeat in its 
remaining strongholds.  The GON recently adopted a new 
strategy, supported by donors, of Immunization-Plus Days. 
These offer additional health services during polio 
campaigns using a combination of fixed immunization points 
and house-to-house vaccinator teams.  End summary. 
 
¶2. Despite substantial international assistance, polio in 
Nigeria by most measures continues to worsen -- and Nigerian 
travelers are carrying the virus abroad.  In five northern 
Nigerian states there are now four times as many cases of 
polio as in the same period in 2004.  More than 40% of the 
children in those states have not received a single dose of 
the oral polio vaccine. 
 
The Current Situation 
--------------------- 
 
¶3. As of May 12, Nigeria had 250 cases of wild poliovirus in 
15 states, compared to 113 for the same period in 2005 in 14 
states.  Nigeria accounted for 79% of the world's wild 
poliovirus cases in 2006, and for 98% of the cases in 
Africa.  Some states in northern Nigeria are recording a 
higher incidence of polio than at the same time in each of 
the previous three years.  While 22 of Nigeria's 37 states 
did not report cases of polio in the past six months, 
Nigeria overall had triple the number of cases it did at 
this time last year.  Five states - Bauchi, Jigawa, Kaduna, 
Kano, and Katsina - accounted for 80% of all cases of polio 
in Nigeria in 2006 and 56% of all cases worldwide. 
Nigeria's polio-eradication campaign has made progress in 
reducing the virus's geographic extent within the country. 
The number of infected Local Government Areas declined from 
326 in 2004 to 217 in 2005 and 63 since December 2005, but 
polio has proved difficult to defeat in its remaining 
strongholds.  The Global Polio Eradication Initiative 
cautioned recently that the five states' high level of polio 
transmission could require an additional 12 to 18 months of 
intensive efforts to interrupt the spread of the virus. 
 
¶4. Nigerians also are spreading the virus abroad as they 
travel.  A Nigerian citizen reinfected Indonesia with polio. 
Indonesia's case was imported from Kano, based on the 
evidence of genetic sequencing.  Recent cases in Yemen were 
introduced by a Nigerian, Somalia imported polio from 
Nigeria, and a Nigerian carried polio to Sudan.  Alarmingly, 
for every reported case of polio, there are 10 carriers, who 
do not demonstrate any clinical symptoms. 
 
The Government of Nigeria changes its strategy 
--------------------------------------------- - 
 
¶5. Polio in Nigeria is worsening despite international 
donors' best efforts.  A U.S. Department of Health and Human 
Services officer assigned to the World Health Organization 
(WHO) discussed this situation with economic officer on 
March 29.  Some public-health officials suggest the strategy 
of going door to door is not working because this misses the 
same children repeatedly.  Polio is spreading in Nigeria 
because of gaps in the household strategy.  The house-to- 
house strategy should be continued, but there is a need to 
adopt a strategy for those families who hide their children 
from vaccination teams.  Immunization coverage in the states 
around Kano State has improved, leaving a clustering of the 
virus in Kano, where the unvaccinated population is so large 
that the virus has a pool in which to sustain itself.  Kano 
city, for example, has a population of about 4 million.  The 
WHO official recommended targeting the cluster and isolating 
the virus even more, but most other donors did not support 
that. 
 
¶6. Fighting polio is costly.  The cost of a national 
immunization round, including vaccine, is $13,070,265.  The 
cost of a sub-national immunization day is less, depending 
on how many states participate.  Nigeria's national 
immunization day (NID) for January was delayed, and NID 
rounds were carried out in February and March.  Some donors 
and the Government of Nigeria (GON) contend that routine 
immunization first must be improved before a heavy push is 
made against polio, although the donor community and 
immunization experts are not in full agreement on this.  The 
WHO views regular NIDs as simply "treading water" at high 
cost -- at a time when money for multiple immunization 
rounds is decreasing.  The GON urges that routine 
immunizations be carried out.  Building up Nigeria's routine 
immunization program will take five to seven years, the WHO 
official said. 
 
¶7. The GON has since adopted a new strategy, supported by 
donors, of Immunization-Plus Days (IDPs).  These offer 
additional health services during polio campaigns using a 
combination of fixed immunization points and house-to-house 
vaccinator teams.  IDPs will better address children's 
health in Nigeria by offering measles vaccinations, vitamin 
A injections, treatment for worms, and insecticide-treated 
bed nets to combat malaria.  IDPs are scheduled for May 25 
to 29 and June 29 to July 5 for 11 high-risk states, in 
which more than 10% of children are missed or receive no 
dose of polio vaccine. 
 
¶8. Ambassador met on May 17 with Edugie Abebe, interim 
coordinator of Nigeria's National Program on Immunization. 
Dr. Abebe discussed the factors causing Nigeria's polio- 
eradication campaign to falter, including "community 
fatigue," too many NIDs, a general loss of confidence in 
immunization, and a perceived excessive emphasis on polio. 
The latter sentiment is linked to northern Nigerians' 
perception that the polio campaign neglects other community 
needs such as combating measles, malaria, diarrheal 
diseases, and general poverty.  Abebe then detailed the 
GON's expectations for the IDP program. 
 
Comment 
------- 
 
¶9. Some malams and imams in northern Nigeria continue to 
preach against vaccinations, hampering polio-eradication 
efforts.  At the same time, the emirs -- the north's 
traditional leaders -- do not have sufficient political 
strength or credibility to successfully counter the messages 
of the religious critics.  The emirs have been distracted in 
recent months by their opposition to President Obasanjo's 
third-term initiative.  Embassy Abuja will report the GON's 
and international donors' evolving strategy to address the 
challenge of polio in Nigeria. 
CAMPBELL