Delivering polio vaccine within a complex humanitarian emergency response in Nigeria
The polio outbreak response in Nigeria and across the Lake Chad basin is being run within the context of a broader humanitarian emergency response, as north-east Nigeria is classified within WHO as a Grade 3 emergency. But what does this actually mean?
To find out more, the Global Polio Eradication Initiative (GPEI) spoke to Rob Holden, WHO Overall Incident Manager and Pascal Mkanda, regional polio coordinator for WHO’s Regional Office for Africa, who talk about working as ‘one WHO’, combining resources, playing off comparative advantages, a unique ability to work in areas not accessible by other agencies or partners, and ensuring Africa remains on track for polio-free certification.
GPEI: WHO and its partners are engaged in a polio outbreak response in north-eastern Nigeria, but it is being conducted within a broader humanitarian emergence response in the region. Why?
Rob Holden: I think the very first thing to say is that nothing is going to detract from Africa’s goal of becoming polio-free. All countries across the continent have worked incredibly hard to bring Africa to the brink of being polio-free, and this outbreak will be stopped rapidly and the region will be rapidly certified. The most effective way to achieve this, in the current emergency context, is to actually conduct the outbreak response within the broader humanitarian response. And there are many reasons for this. Firstly, it makes sense from an operational point of view. The GPEI has a vast infrastructure and staff on the ground. So have we. It makes sense to coordinate and align our efforts. But most importantly is the humanitarian aspect of the response. We cannot just deliver polio vaccine to populations who have not had access to basic healthcare or even food in months. We have to ensure that the populations receive what they actually need. Yes, there is a polio outbreak and they need vaccines to protect them from this virus. But over and beyond that, they need much more at the moment.
Pascal Mkanda: Rob is right. If you think about the current situation on the ground: the main areas affected by the humanitarian emergency are Borno, Yobe, Adamawa and Gombe states. Approximately 50% of the population is affected by this emergency. There are almost two million internally displaced persons, along with approximately 155,000 refugees in Chad, Cameroon and Niger. Access to health services has been drastically compromised, with half of the population not having access to any basic health services. This is significantly increasing the threat of disease outbreaks, and is resulting in high levels of morbidity due to common ailments such as malaria, acute respiratory infections, diarrhoea, and others. Acute malnutrition is increasing, leading to further medical complications and exacerbating severity of common ailments. In total, seven million people are in urgent need of humanitarian assistance. We cannot deliver aid in isolated silos. We have to try to deliver the full package of what the populations and communities need most urgently. It makes sense operationally, it makes sense politically, it makes sense from a public health point of view and from a cost-effectiveness point of view. But most importantly, it makes sense from a humanitarian point of view. It’s really the only way to operate.
Rob Holden: Incidentally, this is also how the polio outbreak responses were successfully run recently in the Middle East and the Horn of Africa.
GPEI: How does it concretely work on the ground?
Rob Holden: It’s very challenging. One thing is to get medical supplies of aid on the ground. The other is to ensure that it actually reaches those groups of people that it needs to. And in an area affected by lack of infrastructure, large-scale population movements or inaccessibility due to insecurity, it makes it very challenging regardless of whether you want to deliver polio vaccine or an oral rehydration table. But at the same time, since our challenges are the same, so are our solutions. So we tap into one another’s networks and make sure we work hand in hand and as we reach populations we reach them with a more comprehensive package of aid.
Pascal Mkanda: It means that in the first instance within WHO, we – meaning the emergencies and polio teams – work hand in hand on a day-to-day basis. At all levels of the organization, whether at global, regional, national, state-level or at Local Government Area level. Who has what staff and capacity on the ground, and where? What do they need? What can one group or the other provide rapidly? What is the latest information or data that your teams can share, to help maximise the impact of the response? This day to day interaction is critical for planning and operational purposes. We are operating as ‘one WHO’.
Rob Holden: And this same internal modus operandi is then extended to other partners. Of course we work with the government on the ground. But as importantly, we work in this way with other UN agencies and NGOs on the ground, to ensure we contribute in a strategic and targeted way, complementing each other’s works rather than duplicating it. Much has been learned since the 2004 Tsunami in Southeast Asia, in terms of coordinating complex emergency humanitarian response among the humanitarian sector. Everyone recognizes that everyone has the same challenges, and our response must be the same. That is the aim, though for sure in such complex settings as north-eastern Nigeria it is very difficult. But the fact is: we have a network of more than 2,000 staff and volunteers on the ground. They have vast know-how, including of the local environment. As a result, we are able to operate in locations where at the moment no other agency or partner is able to operate. This puts us in a hugely advantageous position, and the overall response must capitalise on that.
GPEI: What exactly is WHO’s role then in this coordinated humanitarian response?
Rob Holden: WHO’s remit and technical expertise is of course to support the Government and its leadership in strengthening the provision of basic health services. The provision of evidence-based technical guidance is a key strength of our organization. That is one of our main areas of focus, in support of the Government at all levels, to address the primary healthcare crisis that has emerged, and try to close this gap in service provision. As such, we work closely with the State Ministry of Health in Borno, to coordinate the health sector response, with particular focus on reaching areas and populations most acutely in need. This includes delivery of basic health services such as vaccinations, enhancing surveillance for epidemic-prone diseases, providing life-saving interventions to manage common ailments among children, adult and the elderly, and improving maternal and child health services at the community and facility level including mentoring of health workers. We then are in a constant state of evaluating the impact of the interventions, which allows us to put in place corrective measures based on these analyses.
Pascal Mkanda: Populations in complex emergencies are more vulnerable to diseases such as polio. That is why a strong focus is placed on putting in place robust disease surveillance and investigation mechanisms, to rapidly identify any major outbreaks of any disease and enable a rapid and robust response. In that sense, the polio outbreak will be a real proof-point for how the broader response is working. It was identified and is now being responded to. An emergency within an emergency, as it were. Progress and success addressing it will tell us a lot about how the overall humanitarian response is being implemented. And of course as WHO, it is about maximising our comparative advantage within the broader response. We help deliver health interventions. At the same time, organizations such as the World Food Programme for example help deliver food. The polio team provides of course the polio vaccine. But the point is: all these different programmes and organizations all have their own staff and infrastructure on the ground. It is all in our interest to deliver our ‘products’ as it were to the populations who need them the most. So by working together, we can increase our reach and make the biggest impact. That’s the overall aim and it’s really the only way to work.
GPEI: Thank you both for your time.