Governmental and Non-governmental Agencies in the Fight against Polio - Case Study Example

Polio By Student’s name Code+ course name Professor’s name University name City, State Date Epidemiology Polio is a disease which causes significant morbidity especially in the third world countries. Since the invention of vaccines in the 1950s incidences of polio have become rare even though they are still reported in Africa and South East Asia particularly in Nigeria and Pakistan. Since 1988 there has been a concerted effort to eradicate polio led by the Rotary Foundation, UNICEF and the World Health Organization (Peters, 2005, p. 89-94). These efforts have resulted in a reduction of polio cases by up to 99% from 1988 to 2001. Several regions of the world such as Europe, the Americas, the Far East and Australia have been declared polio free. Most of South East Asia is also polio free which leaves only about 20% of the world population living in countries with polio (Merrill, 2010, p.65). Nevertheless while polio has been declared eradicated in many countries there are still instances of it resurfacing in times of conflict. Its reemergence in Syria and Nigeria is one such example. Ecology Polio has no cure and therefore the only hope for its eradication is vaccination so as to prevent infections until the chain stops. Persons of all ages are susceptible to polio infection though for the most part children under five are the most vulnerable (American Society for Microbiology, 2006, p. 78-82). Its transmission is usually through person to person contact, or though bodily fluids. Since it is transmitted through bodily fluids secretion and excretions, communities which have poor hygiene and sanitation are more susceptible to cases of polio. Polio usually enters the body through the mouth and multiplies in the intestines. Faeces are therefore highly contagious and if they get into the community’s water can infect many children that are not vaccinated (Renne, 2010, p. 224). Many people may have polio in their intestines yet never be paralyzed but still able to transmit the disease to people who come into contact with their faeces. Immune deficiency, injury, pregnancy, strenuous exercise, tonsillectomy and intramuscular injections increase a person’s vulnerability to paralysis after infection. It is usually seasonal in climates that are temperate. Many infections will usually occur in the summer and autumn. Tropical areas will usually have fewer differences in times of transmission (Manasco, 2013, p. 134) Causes of Polio The polio virus can only live in the human body and will die if exposed to the outside world for a few minutes. It will usually be spread through faeces particularly in the third world countries where hygiene and sanitation facilities are either missing or insufficient. Contaminated water which may be used by the community or which may be used in growing or washing of food coupled with direct contact with an infected person may result in the transmission of the virus. Due to its highly contagious nature a person who is living with another person that has the virus will more likely than not have the virus in his intestines and can spread it for many days without symptoms (Kirton, 2009, p. 218-219). Global Burden of Polio Polio has been reduced in the world by 99% since 1988 to 2012. In seeking to understand the global burden of polio it is critical to take into account the factors which have made polio endemic in the remaining 1%. The global burden of polio now remains in a few countries in South East Asia, East Africa, and West Africa with rare cases occurring in other countries such as China and Syria. These are regions and countries which are mostly rural and which do not have effective public health programs (Wilson, 2009, p. 87). The major reservoirs of polio in the world which are Northern India and Northern Nigeria have weak governance and poor infrastructure, poverty, illiteracy, social and political unrest. Providing vaccination to such populations is problematic due to lack of infrastructure. This result in lack of immunity in the children of these areas a s compared to their counterparts in other regions such as Europe and the Americas. Standard Approaches to Prevention and Control William Hammon’s research of 1950 on the use of gamma globulin containing antibodies was one of the major ways for preventing and controlling polio through a vaccine. It is useful reducing severity in an infected person, prevention and to halt infection. A vaccine works by inducing immunity to polio through production of antibodies to counter the virus if a person is later infected (Hays, 2005, p. 46-50). There is yet to be invented a cure for polio and all that is available for persons infected is just relieving of symptoms. Treatment will usually include antibiotics, occupational, physical therapy and in some instances even surgery. Polio in Nigeria Epidemiology Nigeria is among several countries such as Afghanistan, Pakistan, Somalia, Bangladesh, and North Korea among others which still bear the brunt of endemic polio. The Rotary Foundation, UNICEF and WHO have all been very active in Nigeria in seeking to prevent and control endemic polio in Nigeria. Success in eradicating polio in Nigeria has been varied. Polio cases in Nigeria have reduced from a high of 556 in 1988 to less than 100 cases in 2010. While this shows progress it is not as good as other similar countries such as Ghana and Kenya which reduced polio by up to 95% during the same period (Draper, 2011, p.327-328). In recent times polio has seen reemergence especially in Northern Nigeria as 11 cases were reported in 2011. The instance of a few cases of polio in Nigeria is a symptom that the polio virus is still very active and could infect even more people in coming years. Countries such as India and Pakistan have also experienced a rise in cases of polio infections. Nigeria in particular has very high rates of polio in its rural Nouthern populations where 34 cases were reported in 2011 (Ryan, 2014, p.88). Ecology The ecology of Nigeria is tropical and hence this means that polio is better transmitted in the country. In tropical countries as opposed to temperate ones, polio is transmitted throughout the year which makes it spread even faster. In temperate countries stopping the chain of transmission would be relatively easier given that the virus would not be active in certain months and hence may be eradicated (Jackson & Baker, 2005, p.56-57). The northern part of Nigeria is structurally undeveloped which makes it easier for the polio virus to be transmitted. Most of the Somali and Niger hinterland is rural and lack basic sanitation and health facilities which have increased the susceptibility to polio. Lawlessness in Northern Nigeria has also contributed greatly as an ecological driver of polio infections. Children in such areas are likely to be immune-deficient which increases their susceptibility to infection. Such children may also be exposed to strenuous labor conditions making them even more vulnerable (Kaslow, Stanberry & Leduc, 2014, p. 90). Burden of Polio The tropical countries of the world bear the brunt of the global burden of polio. West Africa, East Africa and South East Asia account for 85% of polio incidences of the world. In West Africa Nigeria is the largest reservoir of polio followed by Niger (Youngerman, 2008, p.157-160). There are different factors which account for the burden of polio in the tropical countries. Tropical countries have high rates of infection due to the climate which allows the virus to multiply throughout the year. Nevertheless it has to be asserted that the biggest cause of the high rates of incidence of polio in these countries is the lack of proper sanitation facilities (Peters, 2005, p. 89-94).Nigeria bears a huge burden of polio in West due to its mostly rural population half of which do not have good sanitation facilities making them very susceptible to polio transmission and infection. Nigeria has a high incidence and burden of polio due to its lawless North which makes it hard to develop policies of eradication. Tropical countries due to their climates are likely to have populations with active polio in their system even if they do not show symptoms. Prevention and Control Efforts The control and prevention efforts that have been undertaken by Nigeria have had varied success. The fight against polio has been supported by three main groups; the international organizations such as WHO, Rotary Club and UNICEF, the government and non-governmental organizations. In order to control and prevent the spread of polio in the country, the Nigerian government has been actively involved in educating the public and setting up the necessary public sanitation and health facilities in order to control the epidemic (Bisen & Raghuvanhi, 2013, p.103). The non-governmental organizations such as the Muslim Religious Council have been very much involved in efforts towards fighting polio. The Muslim Religious Council has set up awareness campaigns in the rural areas especially in the North of the country and also in the populous neighborhoods of the city. One of the critical prevention and control measures which have been taken is the stepping up of vaccinations especially in the areas most susceptible to polio. In conjunction with UNICEF, and WHO the Nigerian government has been offering vaccinations for children for up to three times before they are five years (Dry & Leach, 2010, p. 133-137). The Nigerian government set up the polio eradication plan 2014. The plan is aimed at enhancing cooperation between non-governmental organizations and the government in fighting polio. It sets out the policies and roles that have been assigned to the different stakeholders towards the eradication of polio. Strategies include setting up of task forces, better security in the Northern areas in order to enhance vaccination campaigns and better use of human resources and technology. Successes and Failures of these Measures Many of the prevention and control measures put in place by the government, the non-governmental organizations and the international organizations should be lauded. However, the use of these strategies has also had mixed results due to differences in the circumstances of the different regions of Nigeria. The successes have so far been far from satisfactory with the failures being more glaring. The awareness and vaccination drives supported by UNICEF and who have largely been effective though only in terms of awareness. Nevertheless the effort must be lauded since it has resulted in a significant drop in the number of infections from 2002 (Artenstein, 2010, p.79-81). The setting up of sanitation facilities has been effective only to a degree in the cities and has been a complete failure in the rural areas of the North. Many states in the North still have frequent epidemics of the polio virus despite the erection of sanitation facilities. The task forces set up by the government while having good goals and targets for achievement failed to take into account the contexts in which they were operating. Many of the goals and objectives set out to be achieved by these task forces were largely unachieved or ineffective in the long run. Vaccination campaigns which have been undertaken in the North in collaboration with UNICEF, WHO and Rotary Club have been a success in so far as far as reducing the incidence of polio. However, security measures undertaken have largely been unsuccessful with 9 vaccine administrators killed in 2012 (Sleeman, 2011, p. 309-311). Reasons for the Success or Failures of these Measures These measures have been successful or failed mainly because of the contexts in which they were implemented. The vaccination drives and campaigns in the South have largely been successful due to the high rates of literacy and awareness. These campaigns have not been so successful in the north due to high rates of illiteracy among the populace. The initiatives for sanitation have also not been so successful due to the ecology of the North. Most of the North is dry and sparsely populated. Awareness campaigns are not easy to conduct in this area since it is not easy to get an audience. Northerners move with their herds and hence a significant number will not be available to take part in these initiatives such as vaccination or awareness drives. Task forces have been ineffective in the main due to the corrupt nature of government officials and sectarianism (Peters, 2005, p. 89-94). Officials have been known to divert resources to other causes in a bid to gain favor. Poor response times of the government towards providing security have also been a critical aspect in derailing the eradication drive. Many health workers do not want to work in the North where their security from militant attacks is not guaranteed. This makes the implementation of any programs difficult not only for the government but also the other stakeholders (Merrill, 2010, p. 65). Recommendations Going Forward There are several avenues which may be pursued by Nigeria now and in the future towards the control and prevention of Polio. The Nigerian government has to take into account; contexts and the costs which are involved and their cost effectiveness and efficiencies in achieving the desired outcomes. Given that Nigeria is a developing country with little financial resources the strategy that has to be opted for must be affordable in order to ensure it does not stall. The avenues which would be most cost effective going forward are awareness programs, enhanced vaccination programs, increased security and better collaboration between the government and stakeholders. Awareness Programs Awareness programs may be the cheapest and most cost effective programs of any that could be adopted. Awareness programs though initially expensive due to requiring a lot of human resources may turn out to be very cheap in the long run. Awareness programs as currently constituted in Nigeria are not cost effective. Government awareness programs are bloated with many taskforces having duplicate roles. I would be cost effective to centralize the taskforces and carry out awareness programs progressively rather than at once. This would save on resources and finances needed. Awareness programs by the international organizations and nonprofit organizations will play a huge role in the eradication of Polio since they are not funded by the exchequer. Awareness has potential to be so cost effective since when persons are taught polio awareness the virus carrying population will decrease (American Society for Microbiology, 2006, p. 78-82). For instance if people are educated on the need for better hygiene the chain of transmission is slowed down and can be stopped for the long term. Enhanced Vaccination Programs Enhanced vaccination programs may be very effective in the fight towards the eradication of polio. At present most of the areas of the north do not have working vaccination programs. Most of the current programs include only one dosage of the vaccine. One dosage of the vaccine is clearly not enough to combat the polio virus which has been evolving over the years and has become resistant to a single dosage of the vaccine (Renne, 2010, p. 224). Enhanced vaccination programs would be cost effective since they would ensure that the community at large gets herd immunity. With herd immunity the chain of transmission of the virus may be stopped and polio may be eradicated in a short time. Since vaccination is only conducted on children between the ages of 1 and 5, it would be cost effective to vaccinate at least 3 times for the regions with the greatest burden. Enhanced Security Security is one of the most debilitating factors that have made the fight against polio very expensive. In order to have a more cost effective program, security especially in the northern states has to be beefed up. Better security brings with it cost effectiveness in the fight in terms of both enhancing infrastructural development and allowing for personnel to be deployed in the most affected regions. The government ought to deal decisively with the militant menace or to ensure the security of personnel. If personnel deployed by the government and the non-profit organizations feel safe, they will serve to ensure better quality of service in the fight for polio eradication. Infrastructural development in terms of the building of sanitation and health facilities can only be possible in a situation of security and peace (Manasco, 2013, p. 134). Making the northern regions would thus serve to ensure that awareness and sanitation programs can be implemented for long term results in the development of herd immunity. Collaboration There is a need for better collaboration between the governmental and non-governmental agencies in the fight against polio. Better collaboration between the government and agencies will reduce costs as it will result in lesser duplication of roles. The government may opt to focus on security and awareness programs leaving the non-governmental agencies to perform vaccination drives and construct and maintain sanitation and public health facilities (Kirton, 2009, p. 218-219). This would be cost effective since it would ensure that every agency focuses on what it is best at doing therefore doing it better than they are currently. Collaboration would also result in lesser corruption and this may serve to attract donors to contribute to the eradication efforts. With collaboration better expertise can be injected into the process since when the non-governmental agencies are let free to operate their own programs they may bring their much needed expertise to bear in the process making it more effective (Wilson, 2009, p. 87). Bibliography American Society for Microbiology. 2006, Applied and Environmental Microbiology, [Washington], American Society for Microbiology., vol. 67, no. 5, pp. 78-82. Artenstein, A. W. 2010, Vaccines a Biography, Journal of Public Health, vol. 98, no. 13, pp. 79-81. Bisen, P. S., & Raghuvanhi, R. 2013, Emerging Epidemics: Management and Control, Tropical Diseases Journal, vol16, no. 7, pp. 103. Draper, A. S. 2011, Polio, The Polio Journal, vol. 62, no. 3, pp. Dry, S., & Leach, M. 2010, Epidemics Science, Governance and Social Justice, Earthscan, vol. 5, no. 7, pp. 133-137. Hays, J. N. 2005, Epidemics and Pandemics: Their Impacts on Human History, ABC-CLIO, vol. 97, no. 6, pp. 46-50. Jackson, B. A., & Baker, J. 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Sleeman, J. 2011, Cry for Health, Volume 1, Health, The Casualty of Modern Times, vol. 22, no, 3, pp. 309-311. Wilson, D. J. 2009, Polio, ABC-CLIO, vol. 54, no. 8, pp. 87. Youngerman, B. 2008, Pandemics and Global Health, Molecular Cell Biology, vol. 13, no. 17, pp. 157-160. Read More