Resistance to polio vaccination remains in northern Nigeria, and the region is repeatedly blamed for cross-border polio outbreaks. Authorities in one state are threatening to prosecute parents who do not immunize their children, while health workers in Borno state are partnering with traditional chiefs as they try to control a recent outbreak. Outreach strategies have netted mixed results.
Nigeria is one of three polio-endemic countries left in the world. It is a distinction that President Goodluck Jonathan called "embarrassing" earlier this month.
The president has created a new task force to eradicate the highly preventable disease by 2015. He has doubled government funding for the efforts to $30 million per year.
Health workers, however, say the real barriers remain in the minds of parents.
In 2004, community leaders in Nigeria's primarily Muslim north called for a boycott of the vaccine amid rumors that it was a Western plot to sterilize Muslim children. Scientific analyses disproved the rumors, but the damage was done. Polio cases exploded in subsequent years, as health workers struggled to reassure parents.
Nigeria's far northeastern Borno state has launched a door-to-door immunization campaign aimed at vaccinating five million children. Local media is reporting eight cases of polio there so far this year.
Borno State Health Commissioner, Dr. Alma Anas Kolo, says there was a case of polio resulting in paralysis reported just last month, a two-year-old girl named Aisha.
"Aisha's case is one in 1000," said Kolo. "What that means is that we have about 200 cases of children similar to Aisha that are undetected in her own community."
Polio is a highly infectious disease that primarily affects children under five years of age. It can cause irreversible paralysis, and even death. However, the disease can almost always be prevented by multiple doses of the oral polio vaccine.
Borno State has drafted traditional chiefs and religious leaders to spread the message about immunization.
The Shehu, or local monarch, of Borno State, Abubakar Ibn Umar Garbai Al-Amin El-Kanemi, says the government would not be giving out something dangerous.
"So therefore the question of taking polio vaccine is dangerous, please let us forget this," said El-Kanemi. "Let us interest our wards, let us interest our colleagues and everybody. All hands must be on deck for success of the campaign."
Borno shares a triangular border with Chad, Cameroon and Niger. Efforts there are key to controlling cross-border transmission. Borno state is also the base of operations for the militant Islamic sect, Boko Haram. Growing insecurity has crippled vaccination efforts in the past year.
Authorities in neighboring Kano state say they have not recorded a single case of polio this year thanks to more controversial measures. Security personnel escort health workers as they go door-to-door dolling out vaccines. Parents who refuse face jail time. The strategy has sparked national debate about the constitutionality of forcing someone to be vaccinated.
Pockets of resistance to immunization remain throughout the North, often drawing as much on ignorance, about how the vaccine works, as a generalized distrust of the government.
Tommi Laulajainen is chief polio communications officer for the U.N. Children's Fund in Nigeria. UNICEF collects data on why communities refuse the vaccine, which needs to be administered on four separate occasions to give a child full protection.
"Reasons they might state is that maybe this vaccine is not safe," said Laulajainen. "They are sometimes questioning why there are so many rounds of the polio campaign. Some of the reasons are also religiously driven and there are some of the Islamic sects that may not be totally behind the polio campaign in northern Nigeria. Some of the other reasons are also linked directly to the community's unhappiness with the government services that are available in the villages and settlements. They state that all we get is polio campaigns. Why aren't you bringing us water and better roads and health clinics."
He says traditional leaders can be very effective ambassadors, however the strategy is still underutilized and inconsistent.
"The traditional leaders are very effective in resolving refusals when they occur, but they maybe should be much more engaged in promoting the vaccinations before the actual refusals start appearing," he said.
He said UNICEF has been training mothers to become community educators and encourage their more hesitant neighbors to vaccinate their children.