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Vital Signs with Dr. Sanjay Gupta
Effort to Vaccinate Children from Polio in Nigeria Examined. Aired 2:30-3p ET
Aired October 24, 2015 - 14:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
[14:31:30] DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: We're in northern Nigeria to document what was once thought impossible, the potential end of polio here in Africa. And here in remote state, that means vaccinating some 3 million children in some of the world's hardest reached areas. We decided to go along for the right.
This is VITAL SIGNS. I'm Dr. Sanjay Gupta.
We arrived just as the brief rainy season sets in. Pockets of this arid landscape are now turning green. And these rivers are becoming even harder to cross. In northern Nigeria, most villages are off the grid, without healthcare. Isolation has enabled the wild polio virus, or WPV to survive here decades after its eradication in most of the world. This is also a region where insecurity thrives. A more than five-year insurgency by ISIS aligned Boko Haram continues to have devastating consequences.
DR. SUE DESMOND-HELLMANN, CEO, GATES FOUNDATION: Better health care and better security are absolutely linked. It is not surprising that the three countries on earth where we're still grappling with polio are those countries who have had a lot of unrest.
GUPTA: Gates Foundation CEO Dr. Sue Desmond-Hellmann is in the capital of Abuja to see Nigeria's polio eradication efforts firsthand. The foundation has contributed billions towards the incredibly ambitious goal of wiping the disease off the face of the earth in the next few years. Eradicating a disease, it's only ever happened once before. It was in 1980 when small pox was eliminated. But with polio it's within reach once again.
Since the global initiative began in 1988, polio cases worldwide have been reduced by 99 percent. The remaining endemic countries, conflict within Nigeria, Afghanistan, and Pakistan. The last push will be a challenge, says Dr. Desmond-Hellmann, but by no means should conflict be an excuse.
DESMOND-HELLMANN: I can tell you that the people of Nigeria, Afghanistan, Pakistan deserve to be polio free as much as any other place on earth. And so some of the lessons being learned in Nigeria in these conflict areas and very tough areas in the north and northeast of Nigeria are being brought to Pakistan now.
GUPTA: Health care workers have been under threat before. In 2013, nine vaccinators were killed in Kano in two separate shootings. But taking on the last of the virus in Africa means taking the vaccine to every one of Kano state's 3 million children despite the potential risk. Work done by nearly 7,000 teams of vaccinators working five days a week delivering up to nine rounds of immunizations, and this is just one of six states targeted in the campaign.
Outside of the settlement, Lisa can't help but smile at the size of the crowd. She remembers a time not too long ago when vaccine drives like this were much smaller and community members were at times downright hostile. An early criticism of the program was a legitimate one.
UNIDENTIFIED FEMALE: They used to collect oral polio vaccine, but routine immunization, no.
GUPTA: You see, this is a place where basic health services are lacking. So now as part of a polio hard to reach initiative, Lisa's team does more, a lot more.
DESMOND-HELLMANN: These polio assets, what the country has learned, what the collaborators and partners have learned, can help translate into routine immunizations. These assets translated into stopping Ebola. And so I think the hoped for outcome which is to stop polio and start to strengthen the health care infrastructure have come to be real.
[14:35:00] GUPTA: When you come into these communities, how do they receive you?
KULCHUMI HAMMANYERO: We don't have a problem with that. People actually welcome because we have the interventions.
GUPTA: What are we looking at here?
HAMMANYERO: This is actually a map for the last campaign.
GUPTA: Close to the settlement, Kulchumi Hammanyero from the World Health Organization shows me exactly what going door-to-door, house to house in rural Nigeria really means.
So the check, that's a good thing. That's what you're looking for.
HAMMANYERO: It means all the children will receive immunization.
GUPTA: If the child or the parents refused, what would you write then?
HAMMANYERO: We put an "r" and "x." It means rejection.
GUPTA: If it say "rx," that means they refused the vaccine?
HAMMANYERO: They have refused.
GUPTA: How big of a problem is that?
HAMMANYERO: It's a big issue, because, for us, there's no child we want to leave unimmunized.
GUPTA: If you leave even one child un-vaccinated that could be a problem.
HAMMANYERO: Yes, of course. It means that child could be a potential case for WPV.
GUPTA: She knows the consequences. In 2003, the former governor of Kano halted the campaign. There were widespread rumors the vaccine would cause HIV, infertility in women, that the polio vaccine was a western conspiracy. Without the campaign, the virus took off, a few cases quickly spreading into hundreds across Africa.
Next, what it took for the vaccine program to finally take hold, and what the rest of the world can learn from Nigeria.
[14:40:02] GUPTA: 1950s America, the post war economy brought on by the famous baby boom in an unbridled optimism in the American dream. But there was also a dangerous epidemic afoot where every summer during the so-called polio season, the hopes of new parents would take a backseat to their fears of the disease. Hospital wards were filled with iron lungs. Insurance companies were selling polio policies for newborns and public pools were closed for the season.
At its height in 1952, polio would infect nearly 60,000 children in the United States. More than 20,000 were left paralyzed. More than 3,000 children died from the disease. And while many infected show no symptoms at all, there's one case of paralysis out of every 200. It was the fear of paralysis that drove the country into unprecedented action.
UNIDENTIFIED MALE: Poster boy Larry McKenzie are featured as a fashion show sparks the polio drive at the Waldorf.
GUPTA: And 80 million people donated to Jonas Salk's research to develop a vaccine. And when that incredible medical breakthrough came in 1955 --
UNIDENTIFIED FEMALE: A major medical hurdle was crossed with the discovery by Dr. Jonas Salk of the anti-polio vaccine, which was to spread a mantle of protection over millions of American children.
GUPTA: Thousands volunteered in the largest peacetime effort of its kind to make sure the vaccine was distributed. And children's lives were saved.
DESMOND-HELLMANN: I don't think that we can do too much to celebrate the man who conquered polio or all the women and men who are continuing to work to eradicate polio. For me being a doctor, being able to prevent a disease is precious and special. So, at the Gates Foundation, we consider a vaccine to be such an asset, because instead of spending money and people suffering, we, in fact, prevent the disease before it ever occurs. That's a beautiful thing.
GUPTA: Today, polio is confined to three countries on earth. And one of those countries, Nigeria, has been polio free for one year.
DESMOND-HELLMAN: And 99 percent of polio has been solved. That's enormous progress, enormous gains.
GUPTA: Enormous gains thanks to the science of vaccines coupled with the power of collective action.
DESMOND-HELLMANN: You know, the world's only eradicated one disease ever, smallpox. And it is true we're better for that. So not only will people face terrible paralysis, but also the world will have learned how to use vaccinations, how to improve systems so we can use those learnings to combat other diseases.
GUPTA: So just what is a vaccine?
Simply put it contains ingredients that resemble a disease but in a killed or weakened form that doesn't make you sick. What it does is stimulate your own immune system into producing antibodies that give you immunity to a disease without ever having it in the first place.
Preventing disease before it occurs as shown it in the fight against polio, vaccines are effective, safe and incredibly important. The science should be unassailable. And a list of vaccine preventable diseases is long. Hepatitis b, measles, mumps, pneumonia, polio, rubella, tetanus, and more, all prevented by vaccines, vaccines that have prevented some 6 million deaths a year worldwide.
HAMMANYERO: This is house to house polio campaign.
GUPTA: But science often loses the zeal argument to ideology. And that was the case in Nigeria. Remember those check marks we saw in Kano state? They weren't always so easy to get.
There's a lot of reasons for people to be suspicious, right? Does the vaccine make us sick? Shouldn't I be focusing on other things instead of just the vaccines of just basic health things? Aside from religion, how do you combat those perceptions? Those are real issues.
HAMMANYERO: Sometimes, just engage them in conversation. Sometimes we engage in dialogue with them, we talk with them. Sometimes it works. Sometimes they will need to be higher traditional leader.
GUPTA: She says a turning point when respected traditional leaders like the emir of Kano put their full backing into the vaccine program.
How helpful has the support of the emir been?
HAMMANYERO: Fantastic. Actually the emir has demonstrated to the whole world he is fully in support of what we have been doing. And we are taking a bottle of OPD, the whole of it, put it in his mouth, and swallowed it. And he told the people, look, this is safe. It's not going to kill me. It's going to kill your children. And I'm your leader.
[14:45:04] GUPTA: There's this picture of you taking the oral polio vaccine. Can you tell me what was happening at that time? What you were trying to achieve?
LAMIDO SANUSI, EMIR OF KANO: I was trying to achieve a number of things, first of all, to show them it's not harmful. That's why I took that OPD in their presence and then told them my children had taken it.
And then, secondly, reminded them of the law that has not been applied before, but which now apply which provides for imprisonment for up to seven years for a parent who refuses to have his child vaccinated.
GUPTA: Have you ever had any doubts about the vaccine yourself? How did you go about educating yourself?
SANUSI: The level of Islamic education is that we do understand that getting treatment or getting prevention does not in any way contradict or is a conflict of Islamic law. But when you've got people who aren't educated and you're introducing new things, especially if you now have politicians or scholars who misapply and misinterpret religion, it becomes very easy to convince people that anything foreign is harmful, education is bad, western education is bad, vaccinations is bad, you know, and basically an Islamic -- so it takes time to deal with that.
GUPTA: The myths about vaccines aren't unique to Nigeria. In the United States, vaccination raids from measles has dropped, leading in outbreaks in New York, California, and 11 other states in 2014. In Seattle, headquarters of the Gates Foundation, the city's polio vaccination rates are actually lower than in Kano state.
You've probably heard some of the stories from the United States where parents are refusing vaccinations for their children. They say there's concerns about the links to autism and things like that, things that have the no been ever proven scientifically. What do you think about that? When you -- sitting over here and implementing the programs you're talking about, what do you think about when you hear what's happening in the United States?
SANUSI: All over the world, you have all sorts of people who hold on to beliefs and who follow charismatic leaders and charlatans and people they think know better and who don't know better. And I do hope that it will not be used as a model or as a basis, because that is one of the arguments here. People say even in America, not everybody accepts these vaccinations. So it's not about a lack of education. But it is a lack of education. So, no, I think it's strange that should happen there. But I -- it's not something that I think should be a model for us.
GUPTA: The model, says the emir, should be based on science. So what are the real facts about vaccines? We'll take on some of the most common myths.
[14:51:19] GUPTA: Vaccines prevent an estimated 6 million deaths worldwide every year. Even still, common myths about vaccines are stopping some parents in their tracks. So it's time to set the record straight, backed up by science.
First myth -- vaccines cause autism. There's no proven link. In fact, the study that made that claim was retracted. The researcher was discredited and lost his medical license.
The second common myth about vaccines is that they contain poison. Vaccines are safe, and that is proven. You're actually 100 times more likely to be struck by lightning than to have an allergic reaction to a vaccine. And only one child in a million has a serious adverse reaction.
And the third myth, the diseases are extinct. This is a big one, and the reason why vaccinations need to continue. Polio, once all but contained, came roaring back after vaccines were banned in Nigeria in 2003. It's the same reason why children in the United States, for example, are still vaccinated for polio even though a naturally occurring case hasn't been recorded there since 1979.
Back in Nigeria at a health clinic, mothers patiently wait in line. Babies in their laps, re-immunization cards in their hands. The more people that are vaccinated, the less chance a disease has to spread. You see, vaccinations aren't just about protecting one person. They are about protecting entire communities. It's public health in its truest sense.
It seems simple enough, but northern Nigeria is vast. Kano state is vast. In the district alone, there are nearly 68,000 children under five years of age. All of them need immunizations.
What is the most challenging part of the job for you?
HAMMANYERO: For me it's ensuring that we don't miss any time. Missing a child means we are not going to get the desired coverage. Missing a child means that there's a potential case for a polio virus.
GUPTA: This home is painfully close to that clinic, just two kilometers away. It's something he thinks about often when he thinks of his son.
"I have this thought," he says, "if he had received, say, five or six doses, he would have been immune from this ailment." He received two of the oral polio vaccinations, painfully close to the four doses recommended for complete immunity. His health challenge began exactly a year ago. He started with fever, he says. A day later, he woke up in the morning with weak limbs. We were told he had contracted polio.
"He is facing a challenge," he says. "He'll also have problems in the future because his hand up until now when he walks, he falls down just like that."
She is expecting another child. "By God's grace, she says, when I give birth, I'll take the baby to the clinic. The baby will surely be immunized whether it's a girl or boy."
In a district that now has a coverage rate of around 85 percent, they hope he will be the last case to slip through the cracks, the last case of polio in Nigeria. Since him, there hasn't been a case in just over a year. But that hope comes with a heavy dose of caution.
[14:55:03] With polio, I mean, is there going to be a finish date? Is there a point where you're going to say, OK, mission accomplished?
HAMMANYERO: When we see there are no polio viruses, no WPVs, you know, all our indicators are showing that we have covered the grounds, then we can announce, OK, we have reached a setting point, but we are not out of the woods.
GUPTA: How big of a deal will that be, though? When that day happens, how important will it be?
HAMMANYERO: I think it's a celebration for the world. Everyone is going to celebrate. Once you get Nigeria liberated from white polio virus and you have interrupted transmission I think in the whole of Africa, you have achieved a very great feat for the whole of Africa and I think for the whole world.
GUPTA: How optimistic are you?
HAMMANYERO: In terms of?
GUPTA: Of that celebration coming sometime soon?
HAMMANYERO: Well, with the pace we are going, I think we would reach -- the end of the tunnel is not too far away.
GUPTA: It is truly remarkable what has happened here. More than 3 million children have been vaccinated by more than 7,000 teams, many of the teams coming back to these villages on multiple occasions. But I think the real lesson is what happens when doubt gives way to ambition, when skepticism gives way to science.
Thanks for watching VITAL SIGNS. I'm Dr. Sanjay Gupta.