What type of intervention and polio vaccine program would be the most effective in Nigeria?
There are two types of polio vaccine that could be used in Nigeria: the oral polio vaccine (OPV) and the injectable polio vaccine (IPV). Both have been proven to be effective in preventing polio, but there are significant differences between them. In order to plan an intervention for polio in Nigeria, we have to look at which vaccine would be most appropriate for the country.
The OPV has been used in Nigeria in the WHO plan to eradicate polio. It is simple to administer and does not require medical training. The widespread use of the OPV has been credited for the eradication of polio in most developing countries. It can be administered during mass vaccinations, such as NIDs. Mass vaccinations are currently the most popular method for dealing with polio prevention in Nigeria, and there is no indication that this will change in the near future. (Schimmer and Ihekweazu, 2006.) There are clearly benefits of the OPV and mass immunization programs, but there are also drawbacks; for example, because the OPV is made from a live virus, it can sometimes cause polio outbreaks itself, and in areas with low hygeine levels up to eight doses of the vaccine may be needed to fully protect against the virus (Roberts, 2004). As discussed earlier, the problem of poor record-taking also makes mass immunization less effective. It also makes it difficult to research the effectiveness and issues involved with mass immunization. (Renne, 2006.)
How can we examine OPV and its usage in Nigeria without accurate records? Looking at the records of other, similar countries with endemic polio could provide answers. We could also look at the records of similar countries that have eradicated polio, such as neighbouring countries in Africa. These records may not be available, so it will be necessary to begin thoroughly documenting all information regarding polio in Nigeria and its use of the OPV. Ideally (although perhaps not realistically) health workers that administer OPVs during mass immunizations also need to begin recording everything, not only for research but to avoid unnecessary repeated doses.
Another issue with NIDs and similar top-down approaches to immunization is the disruption to regular health services they can cause. There are often complaints about lack of regular healthcare during NIDs and mass immunizations, because health workers have left their regular positions and are out administering OPV door-to-door. (Renne, 2006.) Field studies that look at these disruptions would be useful in understanding how well mass immunizations work. Direct participant observation could also provide necessary information.
To plan an appropriate intervention, we should also look at other programs that could be used, such as routine immunization. Routine immunization would require an increase in the quality of public healthcare in Nigeria; it would be expensive and time-consuming, but could be very beneficial for long-term health prospects in Nigeria. Routine immunization would mean that each child would have an individual record and receive the vaccines they need from a healthcare provider; this would potentially open up the door for injectable vaccines to be used, which would decrease the risks associated with OPVs. While this prospect might seem unrealistic, it would be worthwhile to explore how other countries have implemented routine immunization, how effective it has been and what the costs were. Countries similar to Nigeria should be looked at in this area to make comparisons and explore the possibilities.
In addition to looking at countries similar to Nigeria, we should also ask if lessons and methods learned during the North American polio epidemics can be used. The North American strategy for eradicating polio involved very different means: the IPV is used in routine childhood vaccinations. Would this be realistic for any part of Nigeria? The socioeconomic status of Nigeria is very different from that of North America, and there are some different parallel issues that complicate matters (such as HIV/AIDS on a large scale, extreme poverty, and violent conflicts). The level of public healthcare quality is also much lower in Nigeria. Still, it is worth noting that mass immunizations using the OPV have not eradicated polio in Nigeria, so something must be going wrong. New interventions should look into building PHC from the bottom-up instead of using vertical strategies. If this is attempted in some of the more densely populated areas of Nigeria, we may see new outcomes. (Schimmer and Ihekweazu, 2006.)
The OPV has been used in Nigeria in the WHO plan to eradicate polio. It is simple to administer and does not require medical training. The widespread use of the OPV has been credited for the eradication of polio in most developing countries. It can be administered during mass vaccinations, such as NIDs. Mass vaccinations are currently the most popular method for dealing with polio prevention in Nigeria, and there is no indication that this will change in the near future. (Schimmer and Ihekweazu, 2006.) There are clearly benefits of the OPV and mass immunization programs, but there are also drawbacks; for example, because the OPV is made from a live virus, it can sometimes cause polio outbreaks itself, and in areas with low hygeine levels up to eight doses of the vaccine may be needed to fully protect against the virus (Roberts, 2004). As discussed earlier, the problem of poor record-taking also makes mass immunization less effective. It also makes it difficult to research the effectiveness and issues involved with mass immunization. (Renne, 2006.)
How can we examine OPV and its usage in Nigeria without accurate records? Looking at the records of other, similar countries with endemic polio could provide answers. We could also look at the records of similar countries that have eradicated polio, such as neighbouring countries in Africa. These records may not be available, so it will be necessary to begin thoroughly documenting all information regarding polio in Nigeria and its use of the OPV. Ideally (although perhaps not realistically) health workers that administer OPVs during mass immunizations also need to begin recording everything, not only for research but to avoid unnecessary repeated doses.
Another issue with NIDs and similar top-down approaches to immunization is the disruption to regular health services they can cause. There are often complaints about lack of regular healthcare during NIDs and mass immunizations, because health workers have left their regular positions and are out administering OPV door-to-door. (Renne, 2006.) Field studies that look at these disruptions would be useful in understanding how well mass immunizations work. Direct participant observation could also provide necessary information.
To plan an appropriate intervention, we should also look at other programs that could be used, such as routine immunization. Routine immunization would require an increase in the quality of public healthcare in Nigeria; it would be expensive and time-consuming, but could be very beneficial for long-term health prospects in Nigeria. Routine immunization would mean that each child would have an individual record and receive the vaccines they need from a healthcare provider; this would potentially open up the door for injectable vaccines to be used, which would decrease the risks associated with OPVs. While this prospect might seem unrealistic, it would be worthwhile to explore how other countries have implemented routine immunization, how effective it has been and what the costs were. Countries similar to Nigeria should be looked at in this area to make comparisons and explore the possibilities.
In addition to looking at countries similar to Nigeria, we should also ask if lessons and methods learned during the North American polio epidemics can be used. The North American strategy for eradicating polio involved very different means: the IPV is used in routine childhood vaccinations. Would this be realistic for any part of Nigeria? The socioeconomic status of Nigeria is very different from that of North America, and there are some different parallel issues that complicate matters (such as HIV/AIDS on a large scale, extreme poverty, and violent conflicts). The level of public healthcare quality is also much lower in Nigeria. Still, it is worth noting that mass immunizations using the OPV have not eradicated polio in Nigeria, so something must be going wrong. New interventions should look into building PHC from the bottom-up instead of using vertical strategies. If this is attempted in some of the more densely populated areas of Nigeria, we may see new outcomes. (Schimmer and Ihekweazu, 2006.)