Polio in Nigeria

Since 1988, the Global Polio Eradication Initiative (GPEI)—an international partnership of government and private institutions—has reduced the number of reported polio cases worldwide by more than 99 percent, successfully eliminating polio from much of the globe. Yet Nigeria remains one of the most entrenched reservoirs of poliovirus in the world. Continued transmission in 7 of Nigeria’s northern states has led to reintroduction of the virus in at least 12 African countries previously declared polio free, repeatedly dashing hopes that global targets for eradication—first in 2000, then in 2005—could be met. Recurrent setbacks, including a resurgence of cases in 2011, have introduced an element of skepticism that the global campaign can ultimately be successful. A remarkably frank and hard-hitting evaluation from the GPEI Independent Monitoring Board expressed concerns in late 2011 that polio “will not be eradicated on the current trajectory. Important changes in style, commitment and accountability are essential.” And some public health experts express concern about the opportunity costs of continuing a campaign with a price tag of $1 billion annually to eradicate a disease that, however devastating, is not among the top 20 killers in the developing world.

The Nigerian experience has underscored the complexity of the eradication endeavor and vividly demonstrates the fragility and reversibility of gains made to date. “Nigeria,” according to GPEI’s independent monitoring board, “is at risk of losing everything it had gained.” Now, with a new target date for global eradication set for the end of 2012, the stakes are extremely high: beyond the human costs of additional flare-ups, further postponement of the target date may undermine the sense of opportunity, urgency, and focus necessary to achieve eradication. Concern that this new target may be missed has spurred an urgent “now or never” push by GPEI members to apply the lessons of the last decade and ensure that Nigeria will be polio free by 2013.