Vital Sings: Vaccines

Airdate: June 29, 2020.

Dr Sanjay Gupta: 00:34

We’re in Northern Nigeria to document what was once thought impossible … the potential end of polio, here in Africa. Here in remote Kano State, that means vaccinating some 3 million children, in some of the world’s hardest to reach areas. We decided to go along for the ride.

Dr Sanjay Gupta: 00:53

This is Vital Signs. I’m Doctor Sanjay Gupta.

Dr Sanjay Gupta: 01:02

We arrived just as the brief, rainy season sets in. Pockets of this arid landscape are now turning green, and these rivers are becoming even harder to cross.

Dr Sanjay Gupta: 01:17

In Northern Nigeria, most villages are off the grid … without healthcare. Isolation that has enabled the wild polio virus … or WPV, to survive here decades after  its eradication in most of the world.

Dr Sanjay Gupta: 01:34

This is also a region where insecurity thrives. A more than five year insurgency by ISIS aligned, Boko Haram, continues to have devastating consequences.

Dr Sue D.H.: 01:45

Better healthcare and better security are absolutely linked. It is not surprising that the three countries on earth where we’re still grappling with polio, are those countries who have had a lot of unrest.

Dr Sanjay Gupta: 02:00

Gates Foundation CEO, Doctor Sue Desmond-Hellman, is in the capital of Abuja, to see Nigeria’s polio eradication efforts, first hand.

Dr Sue D.H.: 02:09 Yes.

Dr Sanjay Gupta: 02:10 The foundation has contributed billions toward the incredibly ambitious goal, of wiping the disease off the face of the earth in the next few years.

Dr Sanjay Gupta: 02:19

Eradicating a disease … it’s only ever happened once before. That was in 1980, when smallpox was eliminated, but with polio, it’s within reach  once again.

Dr Sanjay Gupta: 02:31

Since the global initiative began in 1988, polio cases worldwide have been reduced by 99%. The remaining endemic countries … conflict-ridden Nigeria, Afghanistan, and Pakistan.

Dr Sanjay Gupta: 02:45

“The last push will be a challenge”, says Doctor Desmond-Hellman, “but my no means should conflict be an excuse.”

Dr Sue D.H.: 02:53

I can tell you, that the people of Nigeria, Afghanistan, and Pakistan, deserve to be polio  free as much as any other place on earth.

Dr Sue D.H.: 03:03

Some of the lessons that are being learned in Nigeria … in these conflict areas, and very tough areas in the north and northeast of Nigeria, are being brought to Pakistan now, so that we can say, “Look. We want to reach every child, no matter where they are”, and, “How do we work with leaders? How do we work with community leaders, religious leaders … to ensure that every child, no matter where they are” … Because we believe all lives have equal value.  This matters to us. Unrest is not an excuse.

Dr Sanjay Gupta: 03:36

Healthcare workers, like  Abraham Issa, have been under threat before. In 2013, nine vaccinators were killed in Kano, in two separate shootings, but taking on the last of the virus in Africa, means taking the vaccine to every one of Kano States 3 million children, despite the potential risk.  Work done by nearly 7,000 teams of vaccinators, working five days a week, delivering up to nine rounds of immunizations … and this is just one of six states targeted in the campaign.

Issa: 04:14

But today’s crowd is-

Dr Sanjay Gupta: 04:17

Outside of Kachia settlement, Issa can’t help but smile at the size of the crowd. She remembers a time not too long ago, when vaccine drives like this were much smaller, and community  members, were at times, down right hostile, and all the criticism of the programme, was a legitimate one.

Issa: 04:37

They used to collect oral polio vaccine, but routine immunisation, no.

Dr Sanjay Gupta: 04:43

You see, this is a place where basic health-services are lacking. Now, as a part of the polio hard-to-reach initiative, Issa’s team does more … a lot more.

Issa: 04:53

I was telling them about the importance of routine immunisation, antenatal care … the importance of personal  hygiene.

Dr Sue D.H.: 05:01

These polio assets … what the country has learned, what the collaborators and partners have learned … can help translate into routine immunizations. These assets translated into stopping Ebola.

Dr Sue D.H.: 05:15

I think the hope for outcome … which is stop polio and start to strengthen the healthcare infrastructure, have come to be real.

Dr Sanjay Gupta: 05:25

When you come into these communities, how do they receive you?

Kulchumi H: 05:29

Most-

Dr Sanjay Gupta: 05:29

Do they  welcome you?

Kulchumi H: 05:31

Yes. For the hard-to-reach, we don’t have problem with that. People actually will come in, because we have all the interventions.

Dr Sanjay Gupta: 05:37

What are we looking at here?

Kulchumi H: 05:40

This is actually a mark for the last campaign … the last-

Dr Sanjay Gupta: 05:43

Close to Kachia Settlement, Kulchumi Hammanyero, from the World Health Organisation, shows me exactly what going door-to-door … house-to-house, in rural Nigeria, really means.

Dr Sanjay Gupta: 05:54

So the check … that’s a good thing. That’s what you’re looking-

Kulchumi H: 05:57

It’s a very good thing. It means all the children there,  received immunization.

Dr Sanjay Gupta: 06:01

If a child, or the parents refused, what would you write then?

Kulchumi H: 06:06

If the child or the parent refuses, we put and R and an X. It means rejection.

Dr Sanjay Gupta: 06:11

If it says RX, that means they refused the vaccine.

Kulchumi H: 06:15

They have refused.

Dr Sanjay Gupta: 06:16

How big a problem is that?

Kulchumi H: 06:17

It’s a big issue, because for us there is no child that we want to leave un-immunized.

Dr Sanjay Gupta: 06:22

If you leave even one child un-vaccinated, that could be a problem.

Kulchumi H: 06:26

Yes, of course. It means that that child could be the potential  case for WPV.

Dr Sanjay Gupta: 06:32

Hammanyero knows the consequences. In 2003, the former governor of Kano halted the campaign. There were widespread rumours the vaccine would cause HIV, infertility in women … that the polio vaccine was a western conspiracy. Without the campaign, the virus took off … a few cases quickly spreading, into hundreds across Africa.

Dr Sanjay Gupta: 06:58

Next, what it took for the vaccine  programme to finally take hold, and what the rest of the world can learn from Nigeria.

Dr Sanjay Gupta: 07:09

1950s America … the post-war economy brought on by the famous Baby Boom, and an unbridled optimism in the American Dream. But, there was also a dangerous epidemic afoot, where every summer … during the so-called, polio season, the hopes of new parents would take a backseat to their fears of the disease.

Dr Sanjay Gupta: 07:31

Hospital wards were filled with iron lungs. Insurance companies were selling polio policies for newborns, and public pools were closed for the season.

Dr Sanjay Gupta: 07:40

At its height in 1952, polio would infect nearly 60,000 children in the United States. More than 20,000 were left paralysed. More than 3,000 children died from the disease.

Dr Sanjay Gupta: 07:53

While many infected with the polio virus show no symptoms at all, there is one case of paralysis out of every 200.  It was the fear of paralysis, that drove the country in to unprecedented action.

3^rd Party Video: 08:05

Poster-Boy Larry  and Poster-Girl  Moore are featured, as a fashion show sparks the polio drive at the Waldorf.

Dr Sanjay Gupta: 08:14

8 million people donated to Jonas Salk’s research to develop a vaccine. When that incredible, medical breakthrough came in 1955-

3^rd Party Video: 08:23

A major medical hurdle was crossed with the discovery by Doctor Jonas Salk, of the anti-polio vaccine, which  was to spread a mantle of protection over millions of American children.

Dr Sanjay Gupta: 08:34

Thousands volunteered, in the largest peace-time effort of its kind, to make sure the vaccine was distributed, and children’s lives were saved.

Dr Sue D.H.: 08:43

I don’t think that we can do too much to celebrate the man who conquered polio, or all the women and men who are continuing to eradicate polio.

Dr Sue D.H.: 08:53

For me, being a doctor … being able to prevent a disease, is precious and special. At the Gates  Foundation, we consider vaccines to be such an asset, because instead of spending money, and people suffering, we in fact, prevent the disease before it ever occurs. That’s a beautiful thing.

Dr Sanjay Gupta: 09:16

Today polio is confined to just three countries on earth, and one of those countries … Nigeria, has been polio free for one year.

Dr Sue D.H.: 09:25

99% of polio has been solved. That’s enormous progress  … enormous gains.

Dr Sanjay Gupta: 09:32

Enormous gains, thanks to the science of vaccines, coupled with the power of collective action.

Dr Sue D.H.: 09:39

You know, the world’s only eradicated one disease, ever … smallpox, and it is true that we’re better for that. Not only will people not face terrible paralysis, but also, the world will have learned how to use vaccinations … how to improve systems, so that we can use those learnings to combat other diseases.

Dr Sanjay Gupta: 10:00

Just what is a vaccine? Simply put, it contains ingredients that resemble a disease, but in a killed or weakened form, that doesn’t make you sick.

Dr Sanjay Gupta: 10:10

What it does, is stimulate your our immune system into producing antibodies that give you immunity to a disease, without ever having it in the first place.

Dr Sanjay Gupta: 10:21

Preventing disease before it occurs, as shown in the fight against polio, vaccines are effective, safe, incredibly important. The science  should be unassailable, and the list of vaccine-preventable diseases is long. Hepatitis B, measles, mumps, pneumonia, polio, rubella, tetanus, and more. All prevented by vaccines. Vaccines that have prevented some 6 million deaths a year, worldwide.

Kulchumi H: 10:49

This is for polio.

Dr Sanjay Gupta: 10:50

This house-to-house?

Kulchumi H: 10:51

Yes, this is house-to-house polio campaign.

Dr Sanjay Gupta: 10:53

But science often loses the zeal argument to ideology, and that was the case in Nigeria.

Dr Sanjay Gupta: 11:00

Remember those check-marks we saw in Kano state? Well, they were always so easy to get.

Dr Sanjay Gupta: 11:06

There’s a lot of reasons for people to be suspicious, right?

Kulchumi H: 11:10

Yes.

Dr Sanjay Gupta: 11:10

Does the vaccine make us sick? Shouldn’t I be focusing on other things, instead of just these vaccines … of just basic health things? Aside from religion, how do you combat those perceptions? Those are real issues.

Kulchumi H: 11:24

We just engage them in conversation. Sometimes, we engage dialogue with them … we talk with them. Sometimes  it works. Sometimes they will need the higher, traditional leader.

Dr Sanjay Gupta: 11:36

Hammanyero says a turning point came when respected traditional leaders, like the Emir of Kano, put their full backing into the vaccine programme.

Dr Sanjay Gupta: 11:45

How helpful has the support of the Emir been with this?

Kulchumi H: 11:49

Oh, fantastic. Actually the Emir has demonstrated to the whole world, that he is fully in support of what we have been doing, and he has taken a bottle of  OPV. The whole of it … he put it in his mouth and swallowed it, and told the people, “Look, this is safe. It’s not going to kill me, so it won’t kill your children, and I’m your leader.”

Dr Sanjay Gupta: 12:11

There’s this picture of you in a public setting, taking the oral polio vaccine. Can you tell me what was happening at that time? What were you trying to achieve.

Lamido Sanusi: 12:21

I intend to achieve a number of things. First of all, show them that was not harmful, which is why I took that OPV in their presence, and told them that my children had taken it.  Then, secondary, reminded them of a law that has not been applied before, but … which we are not applying, which provides for imprisonment for up to seven years for a parent who refuses to have his child vaccinated.

Dr Sanjay Gupta: 12:44

Have you ever had any doubts about the vaccine, yourself? How did you go about educating yourself?

Lamido Sanusi: 12:50

The level of Islamic education, is such, that we do understand that getting treatment or getting prevention, does not in any way contradict, or conflict with Islamic law, but when  you’ve got people who are not educated, and introduced to new things … especially if you now have, either politicians or scholars, who misapply and misinterpret religion, it becomes very easy to convince people that anything foreign is harmful, education is bad … western education is bad, vaccination is bad, and basically un-Islamic.

Lamido Sanusi: 13:23

It takes time to deal with that.

Dr Sanjay Gupta: 13:28

The myths about vaccines aren’t  unique to Nigeria. In the United States, vaccination rates for measles have dropped, leading to outbreaks in New York, California, and 11 other states in 2014.

Dr Sanjay Gupta: 13:41

In Seattle … Headquarters of the Gates Foundation, the city’s polio vaccination rates are actually lower than in Kano State.

Dr Sanjay Gupta: 13:50

You’ve probably heard some of the stories from the United States, where parents are refusing vaccinations for their children. They say there’s concerns about the links to autism,  and things like that … things that have not been ever proven scientifically. What do you think about that? Sitting over here, and implementing the programmes you’re talking about, what do you think about when you hear what’s happening in the United States?

Lamido Sanusi: 14:13

All over the world, you have all sorts of people who hold onto beliefs, and who follow charismatically the charlatans, and people they think know better, and … who don’t know better. I do hope that it will  not used as a model or as a basis for … Because that is one of the arguments we’ve had here. People say, “Well, you know, even America … not everybody accepts these vaccinations, so it’s not about a lack of education”, but it is about lack of education, because they are a number of Americans who are not educated, in that sense.

Lamido Sanusi: 14:46

I think it’s strange that should happen there, but it’s not something that I think should be a model for us.

Dr Sanjay Gupta: 14:58

The model, says the  Emir, should be based on science.

Dr Sanjay Gupta: 15:02

What are the real facts about vaccines. We’ll take on some of the most common myths. Vaccines prevent an estimated 6 million deaths, worldwide, every year. Even still, common myths about vaccines, are stopping some parents in their tracks. It’s time to set the record straight, backed up by science.

Dr Sanjay Gupta: 15:22

First myth: vaccines cause autism. There’s no proven link. In fact, the study that made that claim, was retracted.  The researcher was discredited and lost his medical license.

Dr Sanjay Gupta: 15:34

The second common myth about vaccines: that they contain poison. Vaccines are safe, and that is proven. You’re actually 100 times more likely to be struck by lightening, than to have an allergic reaction to a vaccine. Only one child in a million has a serious, adverse reaction.

Dr Sanjay Gupta: 15:52

The third myth: the diseases are extinct. This is a big one, and the reasons why vaccinations need to continue.  Polio, once all but contained, came roaring back after vaccines were banned in Nigeria in 2003. It’s the same reason why children in the United States … for example, are still vaccinated for polio, even though a naturally occurring case hasn’t been recorded there since 1979.

Dr Sanjay Gupta: 16:24

Back in Nigeria at a health clinic in Sumaila District, mothers patiently wait in line,  babies in their laps, green immunization cards in their hands. The more people that are vaccinated, the less chance a disease has to spread.

Dr Sanjay Gupta: 16:40

You see, vaccinations are just about protecting one person, they are about protecting entire communities. It’s public health in its truest sense.

Dr Sanjay Gupta: 16:51

It seems simple enough, but Northern Nigeria is vast. Kano State is vast. In Sumaila District alone, there are nearly 68,000 children  under 5 years of age. All of them need immunizations.

Dr Sanjay Gupta: 17:05

What is the most challenging part of the job for you?

Kulchumi H: 17:08

For me, it’s insuring that we don’t miss any child. Missing a child means we are not going to get the desired coverage. That is one. Missing a child means that it is a potential case for … a reservoir for wild polio virus.

Dr Sanjay Gupta: 17:26

and  home, is painfully close to that clinic  … just two kilometers away. It’s something  thinks about often, when he thinks about his son Issa.

Dr Sanjay Gupta: 17:37

“I had this thought”,  says, “If he had received, say, five or six doses, he would’ve been immune from this ailment.”

Dr Sanjay Gupta: 17:47

Issa’s parents say he received two of the oral polio vaccinations, painfully close to the four doses recommended for complete immunity.

Dr Sanjay Gupta: 17:56

“Issa’s health challenge began exactly a year ago.  He started with fever”,  says. “A day later, he woke up in the morning with weak limbs. We were told he had contracted polio.”

Dr Sanjay Gupta: 18:11

“He is facing a challenge”, he says. “He’ll also have problems in the future, because his hand. Up until now, when he walks he falls down, just like that.” 

Dr Sanjay Gupta: 18:22

is expecting another child.

Dr Sanjay Gupta: 18:26

“By God’s grace”, she says, “when I give birth,  I’ll take the baby to the clinic. The baby will surely be immunized whether it’s a girl or a boy.”

Dr Sanjay Gupta: 18:36

In a district that now has a coverage rate of around 85%, they hope Issa will be the last case to slip through the cracks … the last case of polio in Nigeria. Since Issa, there hasn’t been a case in just over a year, but that hope comes with a heavy dose of caution.

Dr Sanjay Gupta: 18:55

With polio, is there going to be a finish date?  Is there a point where you’re going to say, “Okay, mission accomplished”?

Kulchumi H: 19:02

When we see that there are no  drive polio viruses, when we see there are no WPVs, all our indicators are showing us that we have covered grounds, then we can now say, “Okay, we have reached a certain point”, but we are not out of the woods.

Dr Sanjay Gupta: 19:19

How big a deal will that be, though? When that day happens, how important will it be?

Kulchumi H: 19:24

I think it’s a celebration for the world. Everyone is going to celebrate. Once you get Nigeria  alleviated from wild polio virus, and you have interrupted transmission, I think the whole of Africa … You have achieved a very great feat for the whole of Africa, and I think, for the whole world.

Dr Sanjay Gupta: 19:41

How optimistic are you?

Kulchumi H: 19:43

In terms of?

Dr Sanjay Gupta: 19:45

Of that celebration coming some time soon?

Kulchumi H: 19:48

At the pace we are going, I think we would reach … The end of the tunnel is not too far away.

Dr Sanjay Gupta: 19:58

It is truly remarkable what has happened  here. More than 3 million children have been vaccinated, by more than 7,000 teams. Many of those teams coming back to these villages on multiple occasions.

Dr Sanjay Gupta: 20:08

I think the real lesson here is what happens when doubt, gives way to ambition … when skepticism gives way to science.

Dr Sanjay Gupta: 20:16

Thanks for watching Vital Signs. I’m Doctor Sanjay Gupta.

END