Isaac Adewole on healthcare delivery in Nigeria: getting to zero polio cases

Students and staff members at the College of William and Mary gathered in Andrews Hall Friday, Oct. 18, to listen to professor Isaac Adewole speak about his experiences as a former Nigerian minister of health. The event constituted part of the College’s ongoing Global Health Speaker Series, which is sponsored by the Wendy and Emery Reves Center for International Studies and the Center for African Development.

Adewole was named minister of health in November 2015 by Nigerian President Muhammad Buhari and served until May 2019. He is also a professor of obstetrics and gynecology at his alma mater, the College of Medicine, University of Ibadan in western Nigeria, where he has been involved in multiple research projects related to cancer and HIV/AIDS. He is currently an adjunct professor of medicine at Northwestern University’s Feinberg School of Medicine.

Adewole’s talk centered around the past experiences of and potential opportunities within Nigeria’s healthcare infrastructure, particularly regarding the recent effort to eradicate poliomyelitis, or polio, as an endemic disease in the country.

He began his talk by describing Nigeria’s importance in sub-Saharan Africa, as it is home to the continent’s largest population and economy.

“It’s a country of contrast,” Adewole said. “Whatever you want, you will find in Nigeria. When things go well in Nigeria, it goes well in Africa. When it doesn’t, then potentially there could be problems.”

“It’s a country of contrast,” Adewole said. “Whatever you want, you will find in Nigeria. When things go well in Nigeria, it goes well in Africa. When it doesn’t, then potentially there could be problems.”

Adewole then outlined the Nigerian healthcare system and illustrated the country’s three tiers of coverage. According to Adewole, primary care is quickly accessible to Nigerian residents. Secondary care involves larger, more comprehensive hospitals, and tertiary care consists of teaching hospitals. Adewole ultimately predicted that the future of Nigerian healthcare will rest more on investment in preventative healthcare rather than in curative care, particularly as the Nigerian population is projected to increase by 146 percent by 2050 — at which point it will rival the United States’ population.

He then discussed ongoing efforts to achieve universal health coverage in Nigeria, and referenced weak primary healthcare systems, financial barriers and poor collaboration between the three tiers of coverage as primary obstacles to its successful implementation. According to Adewole, an integrated, multi-sectoral approach emphasizing primary care investment is necessary to attain universal health coverage.

Transitioning to his experiences with polio and his country’s efforts to eradicate the disease, Adewole looked back on the fateful day that presented his greatest challenge as a healthcare official.

“One evening in July 2016, I got a phone call [from the World Health Organization],” Adewole said. “They said, ‘Honorable Minister, I have bad news for you. … We have a polio case in the northeast.’ And that was my worst night as a minister. By that time, we were programmed to be certified polio-free within two years.”

Adewole then briefly provided an overview of poliomyelitis and described its expansive history affecting countries throughout the international community. While 70 percent of those infected by poliovirus do not exhibit symptoms, severe cases may suffer from meningitis or paralysis. The disease is especially prevalent in children.

Polio is still endemic in Pakistan, Afghanistan and Nigeria, but Nigeria has yet to record any new cases this year. Adewole attributed this achievement to the concerted vaccination effort that involved the Nigerian government, military and religious leaders in Borno State, where the 2016 outbreak first occurred. Because residents of Borno have insufficient access to medical care due to regional political instability, the federal government took extensive measures to vaccinate children against polio. Adewole described their use of the Nigerian military to deliver vaccines in the area, coupled with support from local religious leaders and innovative monitoring technology.

For Monica Dibley ’23, the talk proved to be an enlightening glimpse into infectious disease control in Nigeria.

“Honestly, I didn’t know too much about the polio outbreak in Nigeria or in Pakistan and Afghanistan, so it was really surprising to learn about it and [how it has] been more or less eradicated in Nigeria,” Dibley said.

Anton Sheridan-Kuchmek ’23 was especially intrigued by how Adewole and his colleagues handled the precarious situation.

“The most interesting thing was how they worked with the religious leaders in the northeast to coordinate everything and bridge the gap between cultural and government disparities, since it’s such a diverse nation,” Sheridan-Kuchmek said.

Adewole lastly touched on the “endgame strategy” to eliminate polio in Nigeria. He said the combined use of inactivated polio vaccine and oral polio vaccine are key in strengthening routine immunization. Furthermore, security challenges that impede access to vaccination and supervision remain, and political action is needed to mitigate these existential conflicts.

Adewole finished his talk by reflecting on the lessons he learned from his work to eradicate polio in Nigeria. He cautioned others from declaring Nigeria polio-free without proper scientific documentation and in closing, encouraged the partnership of public health officials and political, traditional and religious leaders to continue vital vaccination efforts.