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.

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).

Sokoto’s Polio burden

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.

Community vanguards to the rescue

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.

Sokoto’s Polio burden

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.

Community vanguards to the rescue

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.

Sokoto’s Polio burden

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.

Community vanguards to the rescue

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.

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