POLIO: Our true story — Dr. Faisal Shuaib

How Nigeria developed software now in use in 9 countries

•Deployment of Satellite Imagery, Military, health workers 

By Joseph Erunke

Once you signed up to be a public officer,yourresponsibility is no longer to your nuclear family,itis to the greater generality of Nigerians,NPHCDAboss, Dr Shuaib.

Nigeria joined the rest of other countries with polio-free status on Tuesday, 25 August 2020,having been declared free of the disease by the World Health Organisation, WHO, thus marking a significant milestone in the fight against the infectious diseases in the country.

It was a great success for the country. Nigerians have been rolling out drums to celebrate the feat since the declaration. However, they are unaware that the Executive Director/Chief Executive Officer of the National Primary Health Care Development Agency, NPHCDA, who piloted the campaigns for eradication of the infectious disease, Dr Faisal Shuaib, was the architect of the country’s success. This is because the man at the centre is not known for self-praise. Shuaib himself developed an Audio-Visual Acute Flaccid Paralysis Detection and Reporting, AVADAR, an innovative technology using a mobile short message service (SMS)-based software being used to improve the quality and sensitivity of Acute Flaccid Paralysis (AFP) surveillance in Nigeria. The technology is being currently used in nine African countries.

Those who know him would not be surprised at the pride he has brought to the country within his short stay in office given that he has always distinguished himself wherever he finds himself. A graduate of the famous Ahmadu Bello University in Zaria, DrShuiab also holds a Doctor of Public Health degree from the University of Alabama in Birmingham USA, where he graduated with distinction.

Prior to his appointment by Nigeria’s President, Muhammadu Buhari, in January 2017, he was a Senior Programme Officer at the Bill and Melinda Gates Foundation (BMGF) in Seattle, USA and was charged with the responsibility of developing and implementing strategies on polio outbreak response activities including ensuring certification standard surveillance for Acute Flaccid Paralysis in Africa. 

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A no stranger to the eradication of diseases, DrShuaib served as the Incident Manager/Head of the Nigeria Ebola Emergency Operation Centre during the July – October 2014 outbreak of Ebola Virus. 

In this position, he coordinated a team of over 1,000 health workers and volunteers across the country in response to the outbreak. Together with his team, they rolled out a successful scientific campaign to contain the spread of the Ebola virus across the country, and eventually Nigeria was declared Ebola free. 

Upon assuming the role of Executive Director and Chief Executive Officer of NPHCDA, coupled with the support of the Melinda Gates Foundation and the Department for International Development of the United Kingdom, they deployed geospatial technology in the vaccination process especially in the heavily affected Northern parts of Nigeria, with the involvement of local authorities and the use of GIS-based maps from the Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) programme, which enhances the ability of frontline healthcare workers to accurately identify settlements and track children below five years to be immunised with polio vaccines. 

He also instigated collaboration with all partners whilst appealing to parents to visit health facilities across the country to ensure the clean health bill as over 50 million children were vaccinated the past few years. After four years without a case and with over 95 per cent of Africa’s population having been vaccinated, one of the conditions of the ARCC, Africa has been declared wild polio free. 

Dr. Shuaib in this interview, speaks on the secret that led him to this success. He also spoke on other issues. Excerpts:

Congratulations for driving Nigeria out of the polio problem. How are you feeling now with this success?

It is not just me alone that did it, it is every Nigerian. Every Nigerian contributed in one way or the other. So congratulations to all of us. We were just lucky to be in charge of the agency that is tasked with that responsibility to eradicate Polio. We are paid to work for Nigerians, we are paid to work for the people, so people should not be thanking us,it is our work. We should thank Nigerians for cooperating to get the job done. If Nigerians had not cooperated, then there was no way we would have been successful, so it is really that on our part, we did the best that we could to make sure that we crossed the finish line in spite of so many setbacks. In spite of the challenges of insecurity, we were able to do it. Nigerians brought out their children. Parents, mothers, father’s brought out their children, different people worked at different levels to get us here. So we should be very proud as a people that we were able to succeed.

We have to continue vaccination against polio because we still have the threat of polio importation from Pakistan and Afghanistan since they are still endemic to wild polio viruses

How were you able to achieve this feat within the short period of time?

I think Polio eradication is not something that we can achieve within a short period of time, what we have done is to sustain the progress that has been established but beyond that, we also brought in innovative ways of doing business, innovative ways of making sure that we finish. We added more doggedness, we added thoroughness, we never allowed the spirit to die  when we suffered the setback in 2016 in wild polio viruses. When it was reported in Borno State, there was no accessibility of communities due to the insurgency. So  insurgencywas the very reason communities were inaccessible and because they were inaccessible, our frontline workers could not get in and vaccinate the children, so the virus was still circulating in those areas especially the Lake Chad region. So, after the 2016 setback, we realised that we had to go settlement by settlement, community by community to make sure that children were vaccinated, so we worked with traditional leaders, religious leaders, community based organisations and the military to make sure that we were able to identify all the communities that had not been previously reached and finally got to those communities. So we used technology such as the Geographic Information System, GIS to be able to develop High Resolution Maps that clearly delineated where settlements were and we used satellite imagery to be able to identify also what looked like inhabited areas and places that are not inhabited. For example, using satellite imagery, you can tell is a significant area in which case you would realise that somebody is still living in those areas or it could be that there are places where people could not live based on settlement being scattered. So using those high resolution maps and the satellite imagery, we could tell where the communities were and then we used the military to access those communities. 

And then, we also deployed what we called AVADAR- an (Audio-Visual Acute Flaccid Paralysis Detection and Response software, this is a software that was developed by a Nigerian and it is currently being used in nine African countries. It is being developed by the WHO. What this app does is it reminds community based health workers about looking out for anything that looks like Polio, so every week, there is a video that comes and once you have the software, on your phone, there is  videothat comes every week, that shows a polio-like case and then ask the community informant health workers to press either yes or no if they have seen such a case within the last one week. So once the person presses ‘yes’, then it sends a signal to a server and from the server, it sends the signal to the disease surveillance and notification officer for that local government area indicating that there is a health worker or a community informant in one part of the state who is outside the accessible area and then the disease informant and notification officer will have to find his way to that place and meet up with the community informant and ask for the child and examine him to see if it is a polio-like case, then they will take two specimens to test to confirm whether it is polio or not. Even the health worker presses ‘no’ and says there is no such case, it is still important because what it shows is that we are looking and we have not found any.

Even while celebrating the eradication of polio in the country, you had expressed worry that the disease may come back if measures adopted to drive it away are not sustained, how really do you want the country to go about it now?

The most important work that is left for us to do now is to sustain what we have obtained, to sustain the achievement and to sustain the achievement will require  to continue to deploy the resources that have made us achieve this. So we have to continue some level of supplemental activities, that is some campaigns. If we use the campaigns, they won’t be as frequent as they used to be,but most importantly is the routine immunization. We have to continue vaccination against polio because we still have the threat of polio importation from Pakistan and Afghanistan since they are still endemic to wild polio viruses. So in order for our children to continue to resist the virus if it comes to Nigeria, then immunity has to be high enough to ensure we don’t have a new circulation in any community.

What will that take, sir?

It  will take us to progressively building our routine immunization systems. Right now, the most recent survey in Nigeria, thereabout in December, 2019,showed that we have been able to increase our routine immunization coverage to 71 percent. Three years ago, it was just about 33 percent, so we have gone more than double routine immunization coverage as a result of the work that we have done with the Federal Ministry of Health, with our development partners, with our donors, working with traditional institutions and religious bodies, stakeholders, the Nigerian Governors Forum, our first ladies and a host of critical stakeholders, our parent and others are key.

It appears  that there has been suspense to routine immunization since the outbreak of COVID-19 in the country, what are the ways out of this?

Well, we have been able to more than double the coverage, that is unprecedented and by global standard, we have performed above our expectations, so we have exceeded some historical trends but of course, with the lockdown, people could not access our facilities and couldn’t go for routine immunization, so you are right. But it was just not routine immunization, other health facilities declined and of course, people were afraid that if they go to health facilities, they would probably be infected with the virus. So we experienced a decline in all PHC services but since the lockdown was lifted, we have started seeing that the coverage is  going up. People are now going back to the normal thing they were doing before and the health workers are no longer afraid because they have face masks and the people in the community are wearing their face masks and they feel more comfortable. And now, there is the realisation that COVID-19 is not a death sentence like when it was first reported in February and March. So we anticipate that the coverage will increase in few months and we are already seeing the signs that people are going back to the communities and to the health facilities to get their vaccines and other primary health care services and other antenatal and nutritional services.

May we know the number of people that were victims to the polio disease while it lasted in the country?

For certain, at some point, we had thousands of cases of paralyses as a result of wild polio viruses. One thing that we can say is that probably every year, we had close to five to eight thousand people being paralysed or getting infected by the virus. We were not able to pick  everybody. At least, in the 80s and 90s,the infection rate was maybe around five to six thousand but in the end, we had thousands of people that got paralysed. We are talking about the last few decades but it gradually came down. All you had to do was to look at any street in northern Nigeria especially in urban areas and you could see many people who were paralyzed and either using crutches or wheelchair, that should give you the idea of the prevalence of  Polio. Most of the people that you see that are crippled were due to polio. So it has take a toll on our people, it has reduced productivity, it has led to illiteracy because some of these people could not go to school and has reduced their ability to earn a living because they are caught up in that vicious circle of illness, disease, illiteracy and poverty. So that is one of the drawbacks of polio.

When you were taking  these battle against polio on behalf of the country, given that you were always outside in spite of the many demands from home, especially family, how were you copping with all these?

My working life with polio has spanned several decades, right from the late 1990s when I worked with the Nasarawa State Ministry of Health, then I joined the WHO as a surveillance office and became the state coordinator of WHO’s activities in Nasarawa State. At some point, I was the acting zonal coordinator of WHO. At some point, while we achieved the polio-free status in Nasarawa State, we improved routine immunization. I now decided to go for further studies, I went to the United States to study, I came back to Nigeria and again, joined the Federal Ministry of Health and worked as the Senior Technical Adviser to then, Minister of State for Health. I was also the Chief Operations Officer and Deputy Incident Manager of National Polio. So I was the pioneer Chief Operations Officer of the then established National Polio Emergency Operations Centre, which was charged with the responsibility of finishing the job of polio eradication when polio was declared a disease of global health importance. When we thought to have eradicated polio, I then left Nigeria to join the Bill and Melinda Foundation as a staff in Washington because that was what I was doing before I was appointed as executive director of the National Primary Health Care Development Agency.  Through all of these, it took a lot of hardwork but that is the significance of public service, it is a sacrifice. Once you signed up, you have to sacrifice your time, you have to sacrifice some of the usual pleasures or leisure and sacrificing your time also means that you acknowledge that you are no longer a father to a few kids, you are now a face to many kids across the country. You are a father, you are a brother to all Nigerians. So your responsibility is no longer to your nuclear family, it is to the greater generality of Nigerians. So you have to give even more of yourself to be able to perform that role. So, it is a role that yes, has taken its toll but it is a role that I feel honoured and privileged to be part of. 

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