The global drive to eradicate polio has made Nigeria home to the most extensive polio programme in Africa. WHO and other stakeholders have made significant and sustained polio-related investment over the years that have created valuable infrastructure, a cadre of highly experienced human resources and strong community networks that fulfilled a wide range of public health functions which served as the backbone for Nigeria's Coronavirus disease (COVID-19) pandemic response.

After Nigeria officially announced the first case of the COVID-19 pandemic on 27 February 2020, the Nigeria Centre for Disease Control (NCDC) activated a National Emergency Operations Centre (EOC), a model first introduced in the Nigeria polio programme with significant input from WHO. Extensive experience and investments from years of EOC operations as well as experience in response to a range of other outbreaks, provided a springboard to NCDC for a well-coordinated national preparedness and response to the COVID-19 pandemic. WHO substantially supported the multi-sectoral National COVID-19 EOC, which NCDC led with inputs from other government and non-government actors, and facilitated the activation of EOCs at sub-national levels.

WHO scaled up COVID-19 surveillance by supporting the government to leverage the existing polio infrastructure at state level including the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) system, which WHO helped establish for polio surveillance. WHO facilitated integration of COVID-19 surveillance modules into AVADAR, enabling health workers to make free calls through a closed user group platform for surveillance reporting. More than a 7 128-strong network of community health agents conducted surveillance activities and facilitated tracking and follow-up of more than 6655 contacts. The NCDC also leveraged this network in deploying the Surveillance Outbreak Response Management and Analysis System (SORMAS). SORMAS, an open-source mobile and modular web application, was deployed initially during previous polio and Ebola Virus Disease outbreaks but was updated to include COVID-19 contact tracing. The already available and experienced polio workforce enabled the rapid national scale-up of SORMAS to all local government areas.

One key feature that Nigeria's polio programme had were long-standing and far-reaching community engagement teams. Their well-established relationships with local and community leaders enhanced successful public health advocacy efforts in sensitizing more than 11 700 religious and community leaders, in addition to 50 689 community volunteer informants who were a valuable resource for risk communication against anti-vaccine messages and information on infection prevention and control.

The critical roles that the WHO-funded polio assets and networks played in tackling the COVID-19 pandemic have contributed to Nigeria implementing successful measures to control the COVID-19 pandemic. Following an initial uptick in cases after the official outbreak announcement, Nigeria implemented strict protocols that limited the number of total cases, easing pressures on medical facilities, and kept overall death rates low. Reductions in new confirmed cases allowed the country to begin a rapid but careful reopening of the economy in August 2020. Nigeria experienced a second pandemic wave between December 2020 and February 2021, but the country mounted an effective response to limit the spread. Overall, the country has only recorded 784 cases per million population as of 21 March 2021, compared to the average of 3 056 cases per million in the Africa region.[1]

Furthermore, polio structures also provide expertise to deliver vaccines urgently to children who have missed out on vital vaccines during the pandemic.

The diversity of interventions in Nigeria's COVID-19 pandemic response through the WHO polio-funded infrastructure and human resources demonstrates vital contributions toward resilient health systems and the advancement of future national and global health security.

[1] Our world in data. Total confirmed COVID-19 deaths and cases per million people, Nigeria/Africa. Available online at https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million?country=~Africa

Photo caption: Immunization at the IDP camp.

Photo credit: WHO