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Battling polio in Nigeria

– This summer, Nigeria was set to mark 2 years without a single case of polio. In just 12 more months, the country, and the continent of Africa, stood to be declared polio free.

Unfortunately, on August 11, the World Health Organization (WHO) confirmed two new cases of polio, in the northeast of the country, in areas recently liberated from insurgents. Two children were left paralyzed. Nigeria and its international partners have mounted a response to meet this new challenge.

While this news is a setback to Nigeria’s fight to eradicate polio, it does not diminish the scale of the turnaround the country accomplished in recent years. At the core of the country’s achievement was the mobilization of government officials, healthcare workers, and millions of citizens.

McKinsey partner Scott Desmarais worked closely with these groups as the leader of a McKinsey team that supported the effort to fight polio. In this short film, Scott explains how the government went about turning the situation around in such a short time.

Interview

We also spoke with Scott and former consultant Emmanuel Magani about their experiences on the project. Until recently, Scott was based in Lagos, where he worked in developing economies for more than 20 years. Emmanuel grew up in Kano, a region crucial for the project, based in Lagos.

How did McKinsey get involved in the fight against polio?

Scott Desmarais: In 2012 we started talking with the Bill & Melinda Gates Foundation about putting together an emergency operation center (EOC) to help oversee the polio-eradication effort in Nigeria. It was very entrepreneurial. The EOC was a brand-new concept and it was a critical opportunity for our recently opened office in Lagos to support Nigeria and its international partners on this global priority. We helped launch the national polio EOC in Abuja before we even had a building, an office, or anything. We were involved until July 2015, when we rolled off our last consultants, but continue to stay close to our colleagues at the EOC.

Was the goal always to eradicate polio from Nigeria?

Emmanuel Magani: In Lagos, polio wasn’t at the top of people’s minds. Polio had been eradicated there for years—but not in the northern fringes of the country, which includes Kano, the city where I grew up. None of my relatives had it, but the signs are obvious all over town. One of the things about polio is that it usually affects kids below age five, and they are crippled for life. If you go to Kano you see many of these kids. A lot of them, unfortunately, end up as beggars on the street. Just a shot of vaccine and they could have had completely different lives.


Scott Desmarais: Yes. Nigeria had made some progress with polio. . . and then suffered some setbacks. By 2012 it had fallen behind other countries, including those at war, such as Afghanistan. It was clear that Nigeria needed to take a different approach, and the government decided it wanted to turn things around. Going nearly 2 years without any new cases was an important step toward eradication. But as the recent cases in Borno State demonstrate, eradicating polio is a war with many battles. The government and its international partners will need to continue to demonstrate their determination to persevere in the remaining areas where polio is trying to make its final stand.

Battling polio in Nigeria

Nigeria achieved nearly two years without any new polio cases between July 2014 and July 2016.

What have the EOCs achieved?

Scott Desmarais: It’s important to recognize what the Nigerian government was able to accomplish fighting polio in 3 years. Having built the EOC capability, they have been able to use that in their response to the recent cases in the northeast of the country. Nigeria was also able to leverage its learnings from its polio EOCs to rapidly establish an Ebola EOC in Lagos that successfully eradicated Ebola in only 3 months (including the WHO required 42-day period without any new Ebola cases).

What about the recent cases in the northeast of the country?

Scott Desmarais: We always knew there was a risk that polio remained in areas in the northeast of the country. Insurgent groups made some areas unreachable for vaccinators. Populations were being displaced, and moving around, many of the families were migrating to camps; some of them were coming into the capital or other cities in the region—all making it even more difficult to track progress and design new approaches to further reduce the number of missed children and to increase levels of polio immunity.


We worked with amazing doctors and specialists from Nigeria’s National Primary Health Care Development Agency, the Centers for Disease Control and Prevention (CDC), and WHO and with international polio experts to dig into the limited data that were available—and come up with innovative approaches to go out and find the children and immunize them. These included “hit and run” campaigns, where the EOCs would get a sense from the Nigerian military or the local community when it would be safe to go into specific areas and vaccinate children. Vaccinators would rush in for a day or two and vaccinate as many children as they could, and then touch base with the community to get the word out. The EOCs also found ways to set up health camps in these unstable areas. The camps would provide basic healthcare to families, which included polio vaccinations.

What were the biggest challenges your team faced?

Emmanuel Magani: Nigeria has a national health system, but what was missing was the ability to collect, analyze, and track data at the local level, in the areas where there were polio outbreaks. That meant it was harder to target vaccination campaigns. So in Kano, we were part of a team that included the federal and state governments, WHO, UNICEF, and others, and we found a way to ensure better coordination to see exactly where we should focus our efforts. This meant people had to adjust to a new way of doing things. It took a bit of back and forth to get everyone on the same page.


Scott Desmarais: Another challenge was the security situation. The EOC in Kano had only been operational for a few months when insurgents from the north murdered nine local polio volunteers, all of whom were young women administering vaccinations door to door. These volunteers were playing such an important role. Following the attacks, Nigeria’s president and some state ministers were in Kano visiting the wounded members of the vaccination team. The president walked up to one of the young women, who had been shot in the leg, thanked her for her dedication to fighting polio, and asked her, “What are you going to do next?” The young woman said, “As soon as I’m better, I’m going right back out there and rejoining my sisters on this campaign to honor those who died helping us to get rid of polio forever.”

Emmanuel, you’re an engineer by training. How did you come to work on this project?

Emmanuel Magani: In fact, I was one of the first consultants on the project, and it was one of my first projects for McKinsey. Since much of the work was happening in Kano State, it was critical to have someone who understood the Hausa language and the culture, which is different from other parts of Nigeria. The town of Kano has a Muslim majority, with a distinct culture. When we went to meetings, it wasn’t uncommon that they would start off with a prayer. It was an advantage to have someone comfortable and familiar with the cultural norms.

What moments will you remember most from this project?

Scott Desmarais: It was a privilege to work with the government and its international partners to establish the EOCs. It’s absolutely critical that we give credit where credit’s due. The Nigerian government—at both the federal and state levels—has accomplished something tremendous. We were proud to support them, the Gates Foundation, and all of our partners, WHO, UNICEF, the CDC, and Rotary International. Our team was just a supportive cog in this machine that actually went out and got the job done in the face of adversity. The relationships we have built here are very strong. I also want to recognize the large number of McKinsey colleagues who dedicated themselves to helping eradicate polio in Nigeria over the past several years.