Polio: The Rotarian Conversation with Tunji Funsho

From the November 2015 issue of The Rotarian

In the summer of 2014, Tunji Funsho met a little girl with polio. In his more than 40 years as a physician, he had never had a patient who had just been diagnosed with the virus. The girl turned out to be one of Nigeria’s last children to contract the disease, and the encounter made a powerful impression on Funsho, chair of Rotary’s Nigeria PolioPlus Committee.

Nigeria marked one year without a case of wild poliovirus in July 2015. The next month, Africa as a whole followed suit. This remarkable achievement means that soon there may be only two countries where polio is endemic: Pakistan and Afghanistan.

Rotary and our partners have made incredible gains in the fight to eradicate the disease in Nigeria, but what will it take to knock out polio worldwide?

The Rotarian spoke with Funsho about what our progress means for his country, for Rotarians, and for children everywhere. Funsho, a cardiologist who is a fellow of the Royal College of Physicians of London and a member of the Rotary Club of Lekki Phase I, also talked to us about meeting the family of that little girl. He filled us in on the “unique and innovative solutions” – such as health camps that provide primary care along with polio vaccinations – that Rotary and its partners have devised to help Nigeria eradicate polio. And he laid out what it will take for Nigeria and Africa to be certified polio-free in 2017.

“It is too soon to celebrate,” Funsho says. “The world needs to keep polio eradication a high priority to ensure the disease does not return within our borders.”

THE ROTARIAN: Do you ever allow yourself to think about the moment when polio is eradicated completely? What do you think that will be like?

FUNSHO: A polio-free world is still difficult to imagine. We have had visionaries tell us how much we are going to save in human lives and human disability. But it is only recently that it has begun to dawn on me how great an achievement it will be.

We had a discussion with the chairman of the Polio Survivor Group in Nigeria about how to help polio survivors with wheelchairs. There are sizes – small, medium, and large. It struck me that at some point, we’ll no longer need smalls. And gradually, we’ll no longer need mediums, and finally, we’ll no longer need larges. When we eradicate polio, all the efforts we have made and all the agonies we have faced – both among the people with polio and those of us who are working to assist them – will be over.

TR: The human cost of polio can never be measured. But what about the actual costs? How much will we save once polio is gone for good?

FUNSHO: There is an estimate of $40 billion to $50 billion in savings by 2035. That’s a tremendous amount of money that will go to other important health needs. The world will be a much healthier place for everybody.

TR: Last year, Nigeria used the infrastructure that was created to fight polio to stop transmission of Ebola. In what ways will the polio infrastructure be used in the future?

FUNSHO: While we have to find a way of transitioning to a Nigeria without polio, one of the first concerns is not to distract from precisely what we need to do to get there. But we don’t want to wake up once polio is eradicated and ask, “What is going to happen to all the resources that we have built up over the years?” We must ensure that funding continues until the end, and that funders don’t take their eyes off the ball as far as primary health care is concerned – in particular, routine immunization. The key to the endgame strategy is to ensure that routine immunization continues.

We have tremendous numbers of mobilized volunteers at the local level, and because of the close interaction between them and the communities – because we have created trust – new health interventions will be much easier.

Every child born from now on has to be covered. And we cannot rely on our supplementary immunization activities, or SIAs, to do that. We need to have a combination of SIAs and a high level of routine immunization coverage.

Our primary health care facilities are still not as good as we want them to be. They are not available to most people. They are not easily accessible. If we support and strengthen the routine immunization structure, that would be a great legacy to leave behind to tackle other childhood diseases.

TR: How will you reach that goal?

FUNSHO: We have tremendous numbers of mobilized volunteers at the local level, and because of the close interaction between them and the communities – because we have created trust – new health interventions will be much easier. These are people who are from the communities, who are respected people, so they can come and say, “Look, we brought you this program. It will make your child healthier,” whether it has to do with immunization, hygiene, hand washing, or childbirth. Those interventions will now be easier, and we want to ensure that we continue to utilize these workers.

We plan to start advocating with the president and in the National Assembly to increase the budget for primary health care, so that routine immunization continues and other childhood diseases are covered.

TR: Last year, you said you were optimistic that by the end of 2014, we would see our last case of polio in Nigeria. What did Nigeria do differently in 2014 to make that happen?

FUNSHO: One of the major things we did is to reappraise regularly every initiative we have. The Emergency Operations Centers (EOCs) became much more proactive. Issues are dealt with as they occur. When there is a National Immunization Day, there is a review every day in the local area, and that review is relayed to the state EOC, and if the issues cannot be resolved at the state EOC, they are immediately transmitted to the national EOC.

In real time, issues can be addressed. They don’t wait until after the NID. There is much more accountability. There are management support teams; these are senior officers, including Rotarian officers. The management support team leader is expected to supervise the work of everybody. He knows who is supposed to be there and what they are supposed to be doing. And if they are not doing it, then he calls them to order right there and then, and either makes them do what they are supposed to do, or if they are not available to do those jobs, he takes measures to ensure that the job is done.

Our difficulty previously was that the quality of the SIAs was not very good. Either the vaccinators were not properly trained, or they were trained but were changed at the last minute, and those who actually went into the field were not the trained personnel. So the quality of the culture and system has improved tremendously.

TR: Who funds the Emergency Operations Centers?

FUNSHO: They are funded by a grant from the Bill & Melinda Gates Foundation. The Gates Foundation provided the funds for the buildings, for the equipment, and the operational costs, but every other thing is done by the partners [Rotary, the World Health Organization, UNICEF, and the U.S. Centers for Disease Control and Prevention]. I suspect, having seen the efficacy of that system, if the government undertakes another major health intervention, they would use the EOCs.

If there are people who ordinarily would not bring their children out for the polio vaccine, when they know there are drugs to be obtained for cough and diarrhea, they do bring their children out.

TR: How were Rotary and its partners able to convince government officials in Nigeria that polio eradication is so important?

FUNSHO: Through direct Rotary involvement, and also the involvement of our high-profile partners. The Gates Foundation and the Dangote Foundation, working together for polio eradication, have memorandums of understanding with the Kano State government and Bauchi State government, and they are going to Sokoto State, to strengthen routine immunization and support polio work. They have been putting pressure on the government, and they have a lot of leverage.

But now there may be this feeling that, well, we don’t have polio anymore. Why should we continue to provide financial support? So we want to raise a team of Rotarians who are based in Abuja to start lobbying the National Assembly for a budget that will ensure that we continue to support polio eradication at the level we are supporting it now, and to increase funding for primary health care, particularly routine immunization. Then we will work with the president to do the same.

TR: You told a story about meeting a man who refused the polio vaccine for his child, saying he didn’t even have food for his family. What are some other reasons people give for refusing vaccinations, and how do you respond?

FUNSHO: Some of the specific reasons they give are not actually reasons. People use it as an opportunity to address what we call “felt needs.” It is not that they have anything against the polio vaccine itself, but they use the platform of rejection to get something. Like water: “Look, we haven’t had water for years. What is so much more important about these drops than water?” Or, “We have malaria, and we go to our health centers and there are no antimalarial drugs.” As much as possible, we have dealt with that challenge by having health camps where people can get help for these problems, and at the same time, their children get immunized. Most of the camps are supported by UNICEF, but Rotary takes four states every year and supports about 80 to 100 health camps. We have been able to decrease the number of children missed as a result of vaccine rejection.

TR: Now that Boko Haram doesn’t control any territory in Nigeria anymore, are there still challenges in hard-to-reach or insecure areas?

FUNSHO: Yes. The challenges are in the areas that are on the border with Chad, where the terrorists cross the border and then go back. Working with security agencies, we are able to tell when an area is unlikely to face any such incursions, and the permanent health teams will run in there, do the immunizations, and come out again. It isn’t like before, when it was a no-go area. In those areas that Boko Haram occupied, you couldn’t go there at all. That kept a lot of children from being immunized. But immunization activities took place in the camps for internally displaced persons; we set up health camps there too. So, if there are people who ordinarily would not bring their children out for the polio vaccine, when they know there are drugs to be obtained for cough and diarrhea, they do bring their children out. Now they gradually are going back to their homes.

Rotary doesn’t start something it doesn’t finish. So we want to encourage Rotarians to stay the course and contribute to the polio eradication fund, and create awareness and advocate for the government and private sector to continue to support the program until the work is done.

TR: Last year, you met a little girl who had contracted polio and was one of the last cases in Nigeria. As a physician, that must have been heartbreaking. How has that experience affected your work?

FUNSHO: That was my first contact with a child who had just been infected with the poliovirus. It was profound. It was with a lot of difficulty that we finally got the head of the family to come and meet with us. Most who were meeting with the family were looking at them from a technical point of view – they needed to take stool samples, investigate how many OPVs [oral polio vaccine doses] the child had had, and so on. The element of compassion that Rotary brings to the table was not there. We wanted to go there purely looking at the human side, asking, how has this problem affected the family?

I was born in that locality, so I speak the language. I know the culture well. We were able to sit with them like family members, discussing the issues this child’s illness has brought to the family, to the mother, to the siblings, and what her future will be like. That was a defining moment for me in my work.

TR: How confident do you feel about Pakistan and Afghanistan today as compared with how you felt about Nigeria a year ago? Do you think they’re close to being where Nigeria was a year or two ago?

FUNSHO: Looking at the trend of the transmission and the increased geographical restriction of the virus, one can say with confidence that yes, Pakistan’s trend looks like Nigeria’s trend. The number of cases has dropped dramatically from more than 300 last year to 29 [as of press time]. If they can sustain what they’ve been doing, I think they, too, should be able to come to the point where they may see their last case of polio next year.

TR: On a personal level, how does the campaign today feel different from 5 or 10 years ago?

FUNSHO: The analogy would be like trying to push a rock up a hill. When you’re down at the bottom, in the valley, you just ask yourself, do I have the strength to do this? But you keep going, and when you get to the pinnacle, you heave a sigh of relief because you know that if you have the strength to go up, you will have the energy to come down. That is the feeling one has now – that we have done most of the hard work. We have made our mistakes, and we have learned from those mistakes. And moving forward, things should be much, much easier.

TR: What would you say to Rotarians about the work that still needs to be done? What can an individual Rotarian do today to help end polio?

FUNSHO: First of all, we should congratulate all Rotarians, both old and new, because they have become part of history. We’ve come a long way to get to where we are. Rotary doesn’t start something it doesn’t finish. So we want to encourage Rotarians to stay the course and contribute to the polio eradication fund, and to take time to support efforts in their areas. If you are in a polio-endemic country, support your primary health care centers to ensure that children continue to be immunized. If you are in a non-endemic country, support the programs of those countries that are still endemic, particularly with funding, and create awareness and advocate for the government and private sector to continue to support the program until the work is done.

Reaching this milestone has put us in the frame of mind to believe that we can tackle any health issue – that there is no health issue that is beyond a solution. That’s a great legacy.

Be a part of history. Learn what you can do to help finish the job of polio eradication at endpolio.org.

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