US embassy cable - 04ABUJA971

UNCLAS SECTION 01 OF 02 ABUJA 000971 
 
SIPDIS 
 
SENSITIVE 
 
DEPT FOR AF/W, USAID/W FOR AFR/AA, CONSTANCE NEWMAN, 
AFR/WA, MICHAEL KARBELING, GH/AA, ANN PETERSON, GH/CH 
SURVIVAL, HOPE SUKIN, OES/IHA 
 
E.O. 12958: N/A 
TAGS: PGOV, EAID, SOCI, NI 
SUBJECT: NIGERIA: STATUS OF POLIO ERADICATION 
INITIATIVE (PEI) 
 
REF: A) ABUJA 924 AND B) ABUJA 846 
 
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SUMMARY 
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1. (U) The GON has agreed with the Kano State 
government on terms to re-start polio immunizations. 
Kano will begin catch-up immunization programs this 
summer and rejoin the nationwide schedule when that 
schedule resumes in September.  END SUMMARY 
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CURRENT ACTIVITIES 
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2. (U) Polio Situation:  There are now  - as of May 
27, 2004, 149 confirmed polio cases in 25 Nigerian 
states recorded since January 1, 2004. This accounts 
for 74 percent of the total global wild poliovirus 
case count and 82 percent of the cases in Africa since 
the beginning of 2004.  As the virus is entering the 
highest transmission period, post anticipates the 
Nigeria case count will increase significantly.  These 
data indicate that immunization rounds since 2003 in 
Nigeria were not of high enough quality to prevent the 
spread of virus from Kano State to other states in the 
country. 
3. (U) The Nigeria Demographic and Health Survey was 
launched this week, revealing only 13 percent of 
children 12-23 months being fully vaccinated. These 
data are comparable to data collected last year by 
other surveys conducted by bilateral partners. It is 
important to note that the National Program on 
Immunization (NPI) has discounted these data and has 
yet to release the results of its own survey, which is 
widely known to indicate lower coverage than the NPI 
has stated in international meetings. 
4. (U) Recent press reporting indicates Kano State 
is on the verge of resuming polio vaccinations.  Post 
concurs with this information.  We anticipate that 
resumption of polio activities in Kano State will take 
place within the context of the community-based 
(PLACO) program planned for mid-June. 
5. (U) The Kano Governor is in conference with a 
large group of dissenters, religious leaders, opinion 
leaders, etc. in Kano State - the same group he met 
with to begin this stand-off.  They have been in 
conference for more than a day and may take some time 
longer.  The Governor has acknowledged that it may 
take awhile to turn this around with some of them.  He 
won't be emerging and making his announcement until 
all are convinced.  Our sources in Kano anticipate 
word toward the end of the week of May 31, which would 
still ensure adequate time for a mid-June 
implementation.  The Governor has acknowledged the 
safety of the Indonesian vaccines and is now just 
working to convince his constituency similarly. 
Reliable sources at the UN and USAID bilateral 
projects all indicate that the Kano government is 
looking for a "soft-landing" out of this situation. 
When any word is forthcoming, we will immediately 
report the information. 
6. (SBU) Meetings this week:  The USAID Worldwide 
Polio Coordinator, Ellyn Ogden, has been in Nigeria 
for 10 days, participating in meetings with donor 
agencies, USAID Mission Director and Ambassador. 
There is a broad recognition among partner agencies as 
to the operational, managerial and political 
challenges to eradication in Nigeria.  While the 
Minister of Health has been supportive of the program, 
the National Coordinator of the NPI, Dr. (Mrs) Dere 
Awosika, is considered to be a major impediment to the 
success of the program.  Under her leadership, there 
have been negative trends in quality of the program, 
poor management, transparency and accountability by 
the NPI, overly centralized decision-making and 
authority that hampers state and community ownership 
of the program which, in turn, fosters resentment of 
the national program. She is, however, well connected 
in the Obasanjo government and there is no indication 
that she can be removed. It was agreed that shifting 
operational responsibility more directly towards 
UNICEF and WHO would be a better strategy for success 
in Nigeria. 
7. (SBU) At a meeting of donor organizations 
attended by USAID, CIDA, JICA and DFID with UNICEF and 
WHO as observers, there was consensus that the donors 
are frustrated by the current leadership and 
management at the NPI and are ready to support a 
different approach.  The EU last year transferred 
control of its funding from NPI to WHO, which has been 
seen as both effective and a precedent for a new way 
of doing business.  The Canadians expressed dismay at 
having contributed 46 million USD since 2000, with 
poor result. 
8. (SBU) WHO agreed to request a meeting between the 
Minister of Health, and heads and technical 
representatives of donor agencies to discuss the 
increasing frustration of donors and garner support 
for an increased operational role for WHO and UNICEF. 
9. (U) Recognizing that UNICEF and WHO need to 
strengthen their presence in Nigeria in order to 
provide the supervision and technical oversight needed 
to assure quality, the donors requested certain steps 
be taken by the country offices.  Both the UNICEF Rep, 
and the WHO Rep, agreed in principle to the items 
below, and will count on the donor community, 
including USAID, to provide funds to implement this 
new approach.  Key elements of the plan include: a 
joint operations unit in the eight key states 
(including Kano State) that account for 72 percent of 
the virus in Nigeria; a single "command" structure for 
both organizations with a harmonized personnel plan; 
direct hiring authority for independent monitors to 
collect essential data during and after each round of 
immunization and communication focal points to work 
with communities to overcome resistance to the 
widespread myths about the vaccine. 
10. (U) All partners agreed to assist Kano when and 
as  requested by them, seeing the summer catch-up 
campaigns as a trust-building opportunity, but one 
that would have limited epidemiologic impact. During 
this summer period, planning for high quality 
campaigns in the fall must begin.  The partners are 
aware that they must focus equal, if not additional, 
time and attention on all other states where there is 
overall acceptance of the program. There was also 
general agreement on the elements of implementation 
that will require a higher degree of quality and 
community involvement. 
11. (SBU) During a meeting at the NPI to discuss the 
current situation, the National Coordinator, Dr. 
Awosika, made it clear that she favors continuing the 
same methods of operation that have brought us to this 
crisis situation - a position with which the donor 
community disagrees. 
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USG COMMITMENT AND NEED FOR ADDITIONAL RESOURCES 
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12.  (U) Given the increased unity among the donor 
community and the willingness of WHO and UNICEF to 
move the program forward in a decentralized, but 
technically sound manner, with clear donor directives, 
only substantial additional resources will allow the 
plan to go forward. 
13.  (U) Post has requested 2 million USD in ESF as 
our number one priority to support expansion of 
community based immunization programs in Kano to 
assist in this effort. 
14. (U) Post will continue to provide regular reports 
on progress in the effort to eradicate polio in 
Nigeria. 
 
CAMPBELL