Polio Success Stories
Nigeria: The Road to Zero
Today, children in Nigeria face a persistent threat of polio. But past victories against the virus, and a suite of new strategies and tactics in hand, give hope that the country can stop all forms of polio.
Less than a decade ago, Nigeria was the last country in Africa still fighting transmission of wild polio. This effort was urgent—wild polio had paralyzed over 5,000 children across the country since the start of this century1.
Finally, in 2020, Nigeria—and with it the WHO African Region—declared victory against wild polio.
But that is just half of the story.
A history of polio.
For centuries, children around the world have faced the constant threat of poliovirus, an ancient virus that can cause irreversible lifelong paralysis and even death.
But with the development of successful vaccines in the 20th century, suddenly polio became preventable, and countries began eliminating the virus one by one.
This became a truly worldwide effort when Rotary International made polio a top priority in 1985, further strengthened by the formation of the Global Polio Eradication Initiative (GPEI) in 1988, which set out to support countries who could not afford the intensive efforts required to carry out vaccination campaigns and monitor for polio on their own.
Still, complicated contexts on the ground in some meant that these vaccines were not reaching all children, and with dangerous consequences. In 2006, coverage with the oral polio vaccine in Nigeria was just 36.7%2. That same year, over 1,100 children were paralyzed by wild polio across the country.
36.7%
In 2006, coverage with the oral polio vaccine in Nigeria was just 36.7%.
+1,100
Over 1,100 children were paralyzed by wild polio across the country.
This did not deter health workers, community leaders, or government officials. Thanks to a gargantuan, cross-sector effort to reach children all across the country with polio vaccines, Nigeria reported its last case of indigenous wild polio in 2016. Four years later, Nigeria and the rest of the region were declared free from wild polio.
This was a stunning accomplishment that reflected decades of work.
But in the background, another form of polio was taking hold.
Nigeria’s first cases of variant poliovirus, a different form of polio that is just as dangerous to children as the wild virus, emerged in 2005. Variant polioviruses are a rare form of polio that can occur when the live, but weakened virus contained in the oral polio vaccine is able to circulate for long periods of time in under-immunized populations.
If not enough children are immunized against polio, that virus can mutate as it passes through the community and over time, revert to a form that can cause paralysis.
These outbreaks were largely contained through vaccination response, but the threat remained as long as any virus persisted in the environment.
And in 2021, as Nigeria and the world exhaled after a massive immunization victory against wild polio, that threat took off.
Over the course of 12 months, variant polio paralyzed 415 children across Nigeria, accounting for nearly two thirds of global cases that year3.
And case counts don’t tell the full story: because of these historically low immunization rates, this was not just one outbreak, but nearly a dozen unique emergences, or “families” of type 2 variant polio, each with the ability to spread and infect children across Nigeria and Africa.
Nigeria was once again battling to protect its children from polio, particularly in states across the north, which have long posed challenges to the eradication effort.
How did this happen?
Parts of Nigeria, particularly states across the north, have long posed challenges to the polio eradication effort.
Insecurity across the region has made it difficult to continuously reach children with polio vaccines, let alone even the most basic health services. Access issues within communities, including parents refusing the vaccine for their children, also hampered campaign quality. Together, all of this has led to a high concentration of “zero-dose children”, or children who have never received a dose of any vaccine, resulting in a highly under-immunized environment.
The COVID-19 pandemic, and the ensuing pause in vaccination campaigns in 2020., furthered this risk.
Dangers beyond Nigeria
Polio, like any virus, knows no borders. The outbreaks in Nigeria have posed a pressing threat to neighboring countries across Africa.
Since 2018, variant polio outbreaks that began in Nigeria have paralyzed over 530 children in 18 other countries.
The implications of allowing Nigeria’s variant polio outbreaks to continue – and even to grow in size and number – are massive, with the potential for further spread across the region and around the world.
But Nigeria had been here before, when the country stopped wild polio.
And the GPEI, supporting Nigeria throughout its effort, has a history of adapting to overcome new challenges.
Introducing nOPV2
Recognizing the persistent risk of variant polio outbreaks associated with the oral vaccine, in 2011 the GPEI partners began work to develop a new vaccine: the novel oral polio vaccine type 2 (nOPV2).
And in early 2021, a select group of countries began using nOPV2. Nigeria was a pioneer among them.
nOPV2 is a next-generation version of the type 2 oral polio vaccine designed to be just as safe and effective at stopping outbreaks as its predecessor, while importantly being less likely to revert to a form that can cause paralysis.
This was especially important in Nigeria, where ten unique families of variant polio were circulating together as recently as 2020. Preventing the emergence of new outbreaks would mean the country could sustainably stop the outbreaks it faced already, working hard to reach zero.
Strides toward eradication
Since rollout began in the country, health workers have administered over 471 million doses of nOPV2 to children across Nigeria, almost half of the global total as of November 20234.
And thanks to steadfast commitment from the Nigerian government, this forceful response to variant polio has helped achieve an 85% reduction in cases from the 2021 peak. Just 62 cases of variant polio have been reported across the country for 2023.
Critically, not only is the number of cases falling, but so is the virus’s genetic diversity, meaning that existing outbreaks are successfully being stopped while new outbreaks are prevented.
From 2019 to 2022, the number of active circulating families of variant polio in Nigeria fell from 7 to 2, and no new family has been detected for three years.
Borno State was the final frontier of Nigeria's fight against wild polio, in large part because of vaccine mistrust and persistent insecurity.
In 2021, when variant polio peaked in Nigeria, 38 children were paralyzed in Borno State alone. Thanks to the health workers who brought nOPV2 and other health services to children across the state, Borno has reported just one case of variant polio in 2023.
What made this possible?
nOPV2 was important, but a vaccine sitting in a vial won’t protect a child.
Efforts to maintain strong political commitment in the country, along with diligent community-based work to combat vaccine hesitancy have been equally critical to the progress Nigeria has made.
For one, the creation of Nigeria's Presidential Task Force on Polio Eradication has kept the fight against variant polio high on leaders’ agendas. It has built national pressure on local governments to carry out vaccination campaigns in their districts, and as a result been a core reason for Nigeria’s unmatched nOPV2 rollout.
Additionally, community-based work led by GPEI partners like UNICEF has been critical to reaching children in otherwise inaccessible communities and encouraging vaccine acceptance. Engaging traditional religious and tribal leaders was essential to identifying and addressing community needs. The polio program also extended beyond this one virus, providing additional routine vaccines, supplements like vitamin A, and other “pluses” like bed nets to further improve health in even the most remote areas.
Other programs like the Community Reorientation Women Network (CRoWN), supported by the Aliko Dangote foundation, have contributed by empowering women—who often make up the majority of community health workers in remote areas—to identify zero-dose children and encourage vaccine acceptance and uptake in their communities.
Beyond polio, initiatives like these are helping families in even the most remote communities to access essential health services for their children.
Breaking free
All of these tools, innovations and programs together have helped Nigeria flip the script on variant polio. Today, an end to the disease in Nigeria is within reach. But we’re not there yet.
Significant barriers remain to stopping polio transmission for good. Mistrust of immunization programs, difficulties in reaching and accessing some communities, and persistent security challenges continue to prevent the program from reaching all children with polio vaccines.
Nigeria has stopped one type of polio before. With global support and more of this same political commitment from inside the country, we can ensure Nigeria has the resources to stop variant polio too.
Help us make polio history
The GPEI has the tools, knowledge and decades of experience needed to end polio for good in Nigeria and the rest of the world. But this cannot happen without continued—and strengthened—support from partners at all levels.
This means donor countries and organizations, whose support has been essential in bringing us so close to a polio-free world, must further financial commitments.
It means that governments in Nigeria and other polio-affected countries must ensure that ending polio stays a national priority until the job is done.
And it means that everybody does their part to raise awareness and urge your leaders to support eradication to create a healthier future for children everywhere, from Nigeria to Pakistan and all around the world.
Visit the GPEI partner webpages below to learn how you can support the effort to make polio history.
Last updated January 2024.
