SPECIAL REPORT: Inside Sokoto’s fight against polio vaccine hesitancy

Little Karima held her father, Muhammad Nasiru’s arm, struggling to keep pace with him. Her flowing gown obscures her uneven gait –the way she swings one leg and limps with the other.

The father raised her gown as they walked some more, exposing her dusty legs from knee to ankle. One of Karima’s legs is stiff and bent.

Until mid-last year, Karima’s legs were straight, and she already walked well at one year and six months old. But her gait began to change. One of her legs had become stiff, and the little girl was limping.

Karima’s test result shows she has contracted the CVDPV, a strain of the Wild Polio Virus (WPV). [Picture_ Qosim Suleiman]At the time, the Surveillance Focal Person at the Primary Healthcare Centre, Kajiji, Shagari Local Government Area (LGA), Sokoto State, Mubarak Umar, suspected a case of polio. He took the girl’s samples –faeces and urine– and those of other children in the neighbourhood and sent them to the Ibadan National Polio Laboratory (Ibadan NPL) for a test.

Karima’s result came back positive for circulating Vaccine-Derived Poliovirus type 2 (cVDPV2), a strain of the Wild Polio Virus (WPV) currently endemic in Nigeria. The cVDPV2 is found among populations with low herd immunity. It has caused more polio cases annually than the wild poliovirus since 2017, according to the World Health Organisation (WHO).

Although Nigeria had been declared polio-free since 2020, the country has battled the spread of the cVDPV2 variant in the North-west states, including Kebbi, Sokoto and Zamfara. The situation has persisted due to low routine immunisation coverage, population movement and vaccine hesitancy.

Mr Nasiru insisted all of his children, including Karima, were vaccinated and didn’t know how his daughter contracted the disease. But multiple sources, including immunisation officers and traditional rulers in the community, said Mr Nasiru’s household was known for rejecting vaccinations. Karima’s test results, seen by our reporter, indicate ‘unknown’ for all other vaccines she ought to have taken at that age.

The refusal of vaccines remains one of the biggest challenges facing the eradication of polio, the Sokoto State’s Immunisation Officer (SIO), Bashar Garba, told PREMIUM TIMES.

Although there have been more suspected cases in other LGAs, Mr Garba said vaccine hesitancy is more prevalent in metropolitan areas, comprising three LGAs — Sokoto North, Sokoto South and Wamakko. They have recorded the highest level of non-compliance in polio vaccine administration.

“There was a campaign we implemented in Kano and other northern states, and Arkilla Ward in Wamakko LGA emerged as the leading ward with the highest number of rejections and non-compliance,” he said, explaining how much of a problem the situation poses.

Vaccine hesitancy isn’t without a consequence. Last year, Sokoto recorded at least 20 cases of the cVDPV2. At least six of them were recorded in the Kajiji ward of Shagari LGA.

However, government- and citizen-led initiatives, including UNICEF-employed Volunteer Community Mobilisers (VCMs), traditional rulers, and other volunteers, have formed a line of defence in communities, helping to track and identify unvaccinated children and report suspected polio cases.

RI service provider, Abdullahi Liman, opening a vaccine carrier box at the Primary Healthcare Centre Kajiji, Shagari LGA, Sokoto state. [Picture_ Qosim Suleiman]In Shagari LGA, for instance, Routine Immunisation (RI) providers have now increased immunisation outreaches to nearby villages from once to twice a week.

Abdullahi Liman, an RI provider at PHC Kajiji, said they used to administer routine immunisation at the hospital on Tuesdays and conduct outreach once a week.

However, since cases of cVDPV2 surged last year, all 28 providers covering over 200 settlements in Shagari LGA now conduct at least two outreach visits a week.

Another challenge is the manpower shortage, which Mr Garba said the state government was already addressing. According to him, some health workers were recently hired but have yet to be posted to health centres.

The RI providers also work with community leaders to ensure vaccine acceptance, sometimes setting up shop at the community leaders’ palaces.

One official who supervises immunisation data told PREMIUM TIMES that adding one more weekly outreach visit helped increase coverage in Shagari to 88 per cent last year, a feat he said would be impossible if they conducted only one outreach visit a week.

One Friday morning in February, a group of women draped in blue Hijabs that carry inscriptions of Nigeria’s coat of arms on the left and UNICEF on the right, clutched vaccine carrier boxes, and marched through communities in Sokoto North LGA, in search of newborns and their mothers.

Their first stop was the Fakon Idi area, where they spread a mat under a tree and set up to attend to mothers and infants.

A mother, Asmau Adamu, presented her five-day-old, wrapped in several layers of clothes, to one of the women known as VCMs, an inscription boldly written at the back of their blue hijabs.

+++VCMs at Fakon Idi area, Sokoto North LGA, are getting ready to immunise infants in the area. Picture: Qosim Suleiman

An RI service provider, Hafsat Isa, unlocked the vaccine carrier box, drew up doses into an injection and inserted it into the arm of Mrs Adamu’s child. She then opened the child’s mouth and dropped doses of another vaccine on his tongue. Before returning the child, another VCM scribbles something into a card presented by the mother.

Mrs Adamu collected her child and stood from the mat as another mother, Asmau Mustapha, took her place, presenting her own child to the VCM for a similar routine.

“They explained that the vaccines would prevent the child from having polio and other diseases,” Mrs Adamu told PREMIUM TIMES.

Across Sokoto State, the VCMs and RI providers work with community leaders and influential figures to identify and track households that refuse vaccines.

RI service provider, Hafsat Isa, administering a vaccine to a girl at the Primary Healthcare Centre Kofar Rini, Sokoto North LGA, Sokoto State. [Picture: Qosim Suleiman]Ms Isa, who works at the Primary Healthcare Centre Kofar Rini, Sokoto North LGA, said the VCMs are instrumental in tracking households that haven’t brought their newborns for vaccinations. They also note households that refuse vaccines and report them to community leaders.

“When we talk to them (the traditional leaders) and give them the names of the parents, they will go to the house and tell them to bring their children for vaccination,” she told PREMIUM TIMES. “Even when they want to reject vaccines, he’ll encourage them to do it.”