Health officials in Nigeria are celebrating an impressive milestone: The country has gone one year without a single case of polio. The world is now one step closer to making polio the second human infectious disease – after smallpox – to be eradicated with an effective vaccination campaign.

Nigeria is now on the brink of eradicating the paralyzing disease, which predominately affects children under five. Polio (poliomyelitis) is a highly infectious disease, which invades the nervous system and can at times paralyze a victim in a matter of hours. The disease is caused by a virus that spreads through unhygienic environments. One in 200 infections leads to irreversible paralysis and 5% to 10% among those paralyzed die.

There are only three countries where polio remains endemic – Afghanistan, Nigeria and Pakistan. If no cases are reported in the following weeks and the World Health Organization (WHO) confirms previously affected areas are free of the virus, Nigeria is expected to be removed from the list of countries where polio is endemic.

“This is such a testament to people who walk hours and hours to vaccinate a child. This is really for them,” WHO spokesperson Sona Bari told IFLScience.

She explains that Nigeria will need to go another two years without a recorded case of the disease before the WHO declares it polio-free. This important milestone didn’t even seem possible just a few years ago, in what Bari describes as “a long and difficult journey.” Polio reached a three-year high – with more than 100 cases – in 2012. The increase in cases was mostly driven by rumors about the vaccine and political instability.

In 2003, some northern states imposed a year-long ban on the vaccine as some state governors and Muslim clerics alleged the vaccine contained HIV and was intended to be spread among Muslims to sterilize the population. While community leaders did eventually promise to support vaccination campaigns in 2009, the terrorist group Boko Haram began their insurgency at the same time. Health workers were regularly attacked, with the last being in 2013 when nine polio vaccinators were shot dead in a health clinic in the northern Nigerian city of Kano.

Bari attributes recent progress to the strong political commitment from the government, who increased their domestic funding for polio almost every year since 2012, but she points out that this success isn’t just down to the ministry of health.

“Community health workers and community leaders in Nigeria were significant to turning around the difficult situation,” Bari said. “There are traditional leaders in Nigeria who command enormous influence and respect. They formed a platform to make sure vaccination was accessible to all children and that made an enormous difference, because in many communities they are the people you listen to.”

^{Lining up for vaccination. Image credit: Pierre Holtz for UNICEF via Flickr (CC BY 2.0)}

The security risks in the northern states meant health workers had to use a wide variety of new strategies to challenge the myths being spread about the vaccine and encourage families to vaccinate their children. Local leaders, supervisors and vaccinators walked through areas that were simply not on the map to reach children who had not been provided with any significant health service before.

“They identified tens of thousands of communities who had never existed on the map before and were able to vaccinate them,” Bari explained.

Health workers were driven by the question: What does the community want? They tailored their response and integrated trust-building activities and community engagement. Health workers set up health camps that were able to “bring people in and implement a wide variety of health interventions.”

Though the progress in Nigeria is significant, health officials warn against thinking the job is done. Vaccination levels need to be constantly monitored and kept to a high enough percentage to keep the virus at bay. Bari says both Pakistan and Afghanistan can learn from the creative initiatives health workers and community members undertook in Nigeria. She says Pakistan and Afghanistan are trying to put in place a much more rigorous accountability system, where heads of districts are responsible for ensuring children in their area are vaccinated, and ensure their programs are tailored and incorporate community engagement. 

“We are on track for the world to be polio free by 2018. If Africa can stay on track, then I think Pakistan and Afghanistan will follow closely," Bari said