Cablegate: Nigeria: Status of Polio Eradication

This record is a partial extract of the original cable. The full text of the original cable is not available.

011513Z Jun 04





E.O. 12958: N/A


1. (U) The GON has agreed with the Kano State
government on terms to re-start polio immunizations.
Kano will begin catch-up immunization programs this
summer and rejoin the nationwide schedule when that
schedule resumes in September. END SUMMARY
2. (U) Polio Situation: There are now - as of May
27, 2004, 149 confirmed polio cases in 25 Nigerian
states recorded since January 1, 2004. This accounts
for 74 percent of the total global wild poliovirus
case count and 82 percent of the cases in Africa since
the beginning of 2004. As the virus is entering the
highest transmission period, post anticipates the
Nigeria case count will increase significantly. These
data indicate that immunization rounds since 2003 in
Nigeria were not of high enough quality to prevent the
spread of virus from Kano State to other states in the
3. (U) The Nigeria Demographic and Health Survey was
launched this week, revealing only 13 percent of
children 12-23 months being fully vaccinated. These
data are comparable to data collected last year by
other surveys conducted by bilateral partners. It is
important to note that the National Program on
Immunization (NPI) has discounted these data and has
yet to release the results of its own survey, which is
widely known to indicate lower coverage than the NPI
has stated in international meetings.
4. (U) Recent press reporting indicates Kano State
is on the verge of resuming polio vaccinations. Post
concurs with this information. We anticipate that
resumption of polio activities in Kano State will take
place within the context of the community-based
(PLACO) program planned for mid-June.
5. (U) The Kano Governor is in conference with a
large group of dissenters, religious leaders, opinion
leaders, etc. in Kano State - the same group he met
with to begin this stand-off. They have been in
conference for more than a day and may take some time
longer. The Governor has acknowledged that it may
take awhile to turn this around with some of them. He
won't be emerging and making his announcement until
all are convinced. Our sources in Kano anticipate
word toward the end of the week of May 31, which would
still ensure adequate time for a mid-June
implementation. The Governor has acknowledged the
safety of the Indonesian vaccines and is now just
working to convince his constituency similarly.
Reliable sources at the UN and USAID bilateral
projects all indicate that the Kano government is
looking for a "soft-landing" out of this situation.
When any word is forthcoming, we will immediately
report the information.
6. (SBU) Meetings this week: The USAID Worldwide
Polio Coordinator, Ellyn Ogden, has been in Nigeria
for 10 days, participating in meetings with donor
agencies, USAID Mission Director and Ambassador.
There is a broad recognition among partner agencies as
to the operational, managerial and political
challenges to eradication in Nigeria. While the
Minister of Health has been supportive of the program,
the National Coordinator of the NPI, Dr. (Mrs) Dere
Awosika, is considered to be a major impediment to the
success of the program. Under her leadership, there
have been negative trends in quality of the program,
poor management, transparency and accountability by
the NPI, overly centralized decision-making and
authority that hampers state and community ownership
of the program which, in turn, fosters resentment of
the national program. She is, however, well connected
in the Obasanjo government and there is no indication
that she can be removed. It was agreed that shifting
operational responsibility more directly towards
UNICEF and WHO would be a better strategy for success
in Nigeria.
7. (SBU) At a meeting of donor organizations
attended by USAID, CIDA, JICA and DFID with UNICEF and
WHO as observers, there was consensus that the donors
are frustrated by the current leadership and
management at the NPI and are ready to support a
different approach. The EU last year transferred
control of its funding from NPI to WHO, which has been
seen as both effective and a precedent for a new way
of doing business. The Canadians expressed dismay at
having contributed 46 million USD since 2000, with
poor result.
8. (SBU) WHO agreed to request a meeting between the
Minister of Health, and heads and technical
representatives of donor agencies to discuss the
increasing frustration of donors and garner support
for an increased operational role for WHO and UNICEF.
9. (U) Recognizing that UNICEF and WHO need to
strengthen their presence in Nigeria in order to
provide the supervision and technical oversight needed
to assure quality, the donors requested certain steps
be taken by the country offices. Both the UNICEF Rep,
and the WHO Rep, agreed in principle to the items
below, and will count on the donor community,
including USAID, to provide funds to implement this
new approach. Key elements of the plan include: a
joint operations unit in the eight key states
(including Kano State) that account for 72 percent of
the virus in Nigeria; a single "command" structure for
both organizations with a harmonized personnel plan;
direct hiring authority for independent monitors to
collect essential data during and after each round of
immunization and communication focal points to work
with communities to overcome resistance to the
widespread myths about the vaccine.
10. (U) All partners agreed to assist Kano when and
as requested by them, seeing the summer catch-up
campaigns as a trust-building opportunity, but one
that would have limited epidemiologic impact. During
this summer period, planning for high quality
campaigns in the fall must begin. The partners are
aware that they must focus equal, if not additional,
time and attention on all other states where there is
overall acceptance of the program. There was also
general agreement on the elements of implementation
that will require a higher degree of quality and
community involvement.
11. (SBU) During a meeting at the NPI to discuss the
current situation, the National Coordinator, Dr.
Awosika, made it clear that she favors continuing the
same methods of operation that have brought us to this
crisis situation - a position with which the donor
community disagrees.
--------------------------------------------- --
--------------------------------------------- --

12. (U) Given the increased unity among the donor
community and the willingness of WHO and UNICEF to
move the program forward in a decentralized, but
technically sound manner, with clear donor directives,
only substantial additional resources will allow the
plan to go forward.
13. (U) Post has requested 2 million USD in ESF as
our number one priority to support expansion of
community based immunization programs in Kano to
assist in this effort.
14. (U) Post will continue to provide regular reports
on progress in the effort to eradicate polio in


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