VZCZCXRO7994
PP RUEHMA RUEHPA
DE RUEHUJA #2129/01 3031221
ZNR UUUUU ZZH
P 291221Z OCT 08
FM AMEMBASSY ABUJA
TO RUEHC/SECSTATE WASHDC PRIORITY 4302
INFO RUEHOS/AMCONSUL LAGOS 0158
RUEHZK/ECOWAS COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHDC

UNCLAS SECTION 01 OF 03 ABUJA 002129 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT FOR OES/IHA DANO WILUSZ 
USAID FOR GH/HIDN ELLYN OGDEN, RICHARD GREENE 
USAID FOR AFR/SD MARY HARVEY 
CDC FOR NCIRD/GID/DEEB SUE GERBER 
 
E.O. 12958: N/A 
TAGS: TBIO KISL PGOV SOCI ECON KOCI EAID NI
SUBJECT: OCTOBER SITREP ON NIGERIAN POLIO ERADICATION EFFORTS 
 
REF: A. STATE 102802 
      ¶B. STATE 65054 
      ¶C. ABUJA 1591 
      ¶D. ABUJA 815 
 
SENSITIVE BUT UNCLASSIFIED - DO NOT DISTRIBUTE OUTSIDE USG. 
 
¶1. (U) Per reftel A action requests, U.S. Mission provides this 
first in the new series of sitreps on the Nigerian government's 
polio eradication efforts.  We suggest this sitrep be read in 
conjunction with refs C and D, which have previously reported on the 
Mission's efforts on the polio epidemic in general and our advocacy 
for eradication efforts in particular. 
 
¶2. (SBU) Summary.  U.S. Mission Nigeria Action Team on Polio held an 
interagency meeting on October 9 to assess the current situation and 
outline effective recommendations for addressing the growing concern 
regarding the spread of polio in Nigeria.  Although there are some 
promising signs, the polio situation is still dire and requires 
continued and coordinated efforts by all parties.  Polio cases, 
compared to this point in 2007, have more than tripled in 2008 from 
223 to 740 in the 24 states.  GON population projections from the 
2006 census, underestimate the current actual population, making it 
difficult for accurate assessments of eligible children reached and 
those who remained unvaccinated at the end of each vaccination 
campaign.  The team agreed on the need for continued high level 
engagement in country, within the region, and in Washington.  It was 
also agreed to focus on engaging Local Government Area (LGA) 
Chairmen and State Health Commissioners and to launch a targeted 
mass media campaign to boost awareness and social mobilization in 
the northern states.  The team will hold regular bi-weekly meetings 
to monitor the situation and make recommendations as necessary. 
Higher level advocacy efforts by the Chief of Mission will continue 
as noted in refs B - D with Governors, Emirs, and the President, 
including using opportunities to discuss polio at national forums or 
Africa regional events.  Additionally, U.S. Mission suggests that 
Department push polio onto the agenda of all regional political 
meetings.  End Summary. 
. 
Current In-Country Polio Status 
------------------------------- 
. 
¶3. (U) As of October 24, 740 polio cases have been recorded across 
24 states in Nigeria in 2008.  This compares with 229 cases in 21 
states for the same time period in 2007.  Kano State in the North 
West Zone continues to lead the country with 263 cases (compared to 
60 cases in 2007), followed by Zamfara State, also in the North West 
Zone, with 83 cases (compared with five cases in 2007).  Nigeria has 
exported polio cases to at least three other countries in Africa so 
far this year, namely the Republic of Niger, Benin Republic, and 
Burkina Faso. 
. 
Frequency and Effectiveness of Vaccination Campaigns 
--------------------------------------------- ------- 
. 
¶4. (U) Supplemental Immunization Activities (SIAs) have been 
conducted over the past several years, which involve the delivery of 
OPV through a house-to-house strategy to all children under five. 
In 2006 the SIA was modified to Immunization Plus Days (IPD) 
strategy, which includes the delivery of OPV at fixed posts (usually 
at a primary health clinic) and other child survival interventions 
such as insecticide treated bednets, de-worming medicines, and 
paracetamol syrup.  While the strategy appears sound, the effect has 
not yet been fully realized as quantities of injectible antigens and 
add-ons are usually not in sufficient supply to match the target 
group. 
 
¶5. (U) Monitoring by GON and partner representatives during the 
recent IPD mass campaign (August 23-26), reflect 94% coverage, 
though this should be interpreted with caution as target figures 
greatly underestimate the actual number of children under five.  The 
percentage of children missed during the last several campaigns 
continues to hover around 6%.  In Kano, during the August 2008 
campaign, for example, 7% of children were reportedly not reached. 
Forty-nine percent of those were due to non-compliance, 8% due to 
households not visited, and 43% reportedly due to children's 
absence.  In November an Integrated Measles Campaign (IMC) is 
planned to follow-up on the Measles campaigns held in December 2005 
in Northern States, and December 2006 in Southern States. 
Specifically, the campaign will be held in Northern States between 
26-30 November and in Southern States between 10-14 December. 
Integration of OPV and Vitamin A with measles vaccine are planned 
during those efforts. 
 
 
ABUJA 00002129  002 OF 003 
 
 
¶6. (U) U.S. Mission notes that surveillance data, which are 
generally considered to be the most reliable and representative, are 
dramatically at odds with both the administrative and monitoring 
data available.  (Note: the surveillance data indicates children who 
have shown sudden onset of paralysis.  End Note).  Despite having 
conducted 17 rounds of immunization campaigns in Kano since 2006, 
only 19% of children in the state are seen in the surveillance 
system report as having been fully immunized with three or more OPV 
doses.  In addition, the surveillance system data indicate that 34% 
of children from Kano State have never received polio vaccination. 
This means the vast majority of children in Kano remains vulnerable 
to one or more of the three types of polio and potentially 
contributes to the disease's transmission.  Moreover, 
vaccine-derived polio virus continues to appear in at least nine 
northern states.  The Sultan of Sokoto, leader of Nigeria's Muslim 
community, played a prominent role in administering OPV at the 
launch of the most recent IPD.  Similarly, traditional leaders such 
as the Emir of Zazzau, the Executive Governors of Jigawa and Kebbi 
States played visible and supportive advocacy roles in the August 
campaign.  However there are still some reservations with some state 
officials and LGA chairmen in Kano State. 
. 
Upcoming Vaccination Campaigns and Challenges 
--------------------------------------------- 
. 
¶7. (SBU) The next polio round will be included within the Integrated 
Measles Campaign (IMC), where children between 9-59 months will be 
given measles vaccine, while those from 0-59 months and 6-59 months 
will receive oral polio vaccine and vitamin A, respectively.  The 
IMC is scheduled for November 26-30 in the north and December 10-14 
in the south.  Separate polio campaigns in the interim are not 
planned in the northern states, primarily due to lack of support 
from the Nigeria's National Primary Health Care Development Agency 
(NPHCDA) with the exception of outbreak mop-ups and Local 
Immunization Days (LIDs), held in LGAs with low routine immunization 
coverage. 
 
¶8. (SBU)  On October 17, the Executive Director of NPHCDA was 
abruptly removed from her position and replaced by a senior 
technical manager in the East Asia Division of the World Bank, Dr. 
Mohammed Ali Pate, a move universally welcomed.  The Minister of 
Health convened a Joint Meeting of the Polio Eradication Initiative 
Task Force (PEITF) and the ICC in Abuja on October 20-21, including 
about a dozen state commissioners of health.  The meeting provided a 
venue for very frank discussions over current IPD results and 
planning for the IMC.  The USG, DFID, WHO and Rotary International 
representatives spoke forcefully and succinctly highlighting the 
need for effectiveness and measures of accountability for IPD 
campaigns. 
 
¶9. (U) Another major challenge is the lack of public information on 
the spread of the virus leading to the mobilization of all sectors 
to eradicate the disease.  WHO Nigeria, one of the four implementing 
partners of the Global Polio Eradication Initiative (WHO, CDC, 
UNICEF, and Rotary International are the others) has recently 
launched a useful monthly newsletter under the banner "Count Down to 
Polio Eradication in Nigeria."  The intended audience includes the 
GON, implementing partners, health workers, public and private 
sector organizations, and communities.  The newsletter gives a 
breakdown of the polio situation on a state-by-state basis and the 
status of the polio eradication campaign and publicizes upcoming 
polio-related events and serves as a platform to entice other 
stakeholders to join the campaign.  This needs to be augmented with 
an a "thumbs up/thumbs down" type of advocacy tool for rating the 
performance of individual states both to replicate best practices 
and induce more action in the fight against polio.  U.S. Mission, in 
conjunction with other donor partners, is exploring the introduction 
of such a tool through cooperation with a reputable local media 
organization. 
 
¶10. (U) Related to the public information deficit is the need for a 
frank national communications and social mobilization review.  While 
a review in this area was led by UNICEF in July 2007, it did not 
lead to a clear and specific plan of action for improving public 
awareness and social mobilization.  The review needs to be updated 
by the FMOH, NPHCDA and development partners to enable the crafting 
of a more effective social mobilization strategy.  Administrative 
obstacles and distractions within the GON are additional challenges 
that need to be overcome if the fight against polio is to be 
successful.  These include overcoming the turf battles to date 
between the NPHCDA directorate and the Polio Eradication Initiative 
(PEI) Task Force -- the appointment of a new Executive Director for 
NPHCD is a step in the right direction.  In addition, bureaucratic 
delays at the state and local government levels on the release of 
 
ABUJA 00002129  003 OF 003 
 
 
financial resources need to be overcome.  Finally, there needs to be 
much better engagement with the GON Millennium Development Goals 
Office, which has recently emerged as a major funder of PEI 
activities.  U.S. Mission will continue to discuss ways to overcome 
these challenges with appropriate GON interlocutors. 
. 
The Role of Religious, Traditional and Elected Leaders 
--------------------------------------------- --------- 
. 
¶11. (U) Engagement of religious, traditional and elected leaders at 
all levels of government is increasing.  As noted above, the Sultan 
of Sokoto, Nigeria's titular Islamic leader, publicly participated 
in the August immunization round by commissioning the campaign in 
Sokoto State and overseeing vaccination of children with OPV at his 
palace.  Other traditional leaders, including the Emir of Kano, the 
Emir of Zazzau, and the Emir of Ilorin (who immunized his recently 
born twins in a public forum) and several Governors of Northern 
States (i.e. Jigawa, Kebbi, Kwara, and Niger) are taking a more 
public and active role in increasing immunization acceptance in 
their respective states.  Challenges remain at the local level where 
LGA chairmen need to play a more active role in eradication efforts. 
 LGA chairmen need to demand better accountability from immunization 
teams in their territory, introduce performance evaluations into 
hiring decisions for PEI activities, and demonstrate leadership 
through personal involvement in the IPDs.  (Note:  The Ambassador 
and Mission Polio Action Team are encouraging all USG officials 
visiting affected Nigerian states to pay courtesy calls on state 
commissioners of local government and LGA chairmen and encourage a 
more concerted effort within their respective administrative 
purview. End Note). 
. 
Comments and Recommendations 
---------------------------- 
. 
¶12. (SBU) Advocacy by the Ambassador, other Mission officers and the 
international donor community (including through the May 25 WHO 
resolution) with a range of Nigerian officials right up to the level 
of President Yar'Adua (ref c) have helped drive home the point that 
Nigeria must take immediate and sustained action to eradicate polio. 
 There have been some promising responses by the GON, but as yet no 
sustained follow-through.  This is due in part to factors related to 
the broader political challenges facing the Yar'Adua Administration 
and is reflected in press stories criticizing the lack of progress 
on many priorities. 
 
¶13. (U) The Mission will continue its advocacy efforts and intends 
to look for ways to encourage greater accountability from State 
Commissioners of Health and the state branches of NPHCDA, which are 
responsible for routine immunizations and play a critical role in 
implementing polio mass vaccination campaigns.  The Mission also is 
deploying several senior staff from CDC and AID to continuously 
follow-up the situation on the ground in the northern states. 
Quicker disbursements of program funds at the state and local 
government levels are essential and post will advocate this at the 
federal level.  We will also encourage targeted mass media campaigns 
(radio, TV, and print media) to build community awareness about 
vaccine preventable diseases in general and polio in particular. 
U.S. Mission is also promoting increased advocacy efforts with new 
partners such as the Gates Foundation and recommends that these be 
increased strategically to match bilateral and multilateral efforts. 
 Advocacy work by OES, AID, and CDC with Washington offices of key 
partners such as UNICEF and WHO is recommended to increase the 
responsiveness of their respective country missions, and the 
Department can help to place polio eradication onto the agenda of 
international political meetings. 
 
¶14.  (U) This cable has been coordinated with Consulate Lagos. 
 
SANDERS