As a young girl, Amina Ahmed watched her grandmother, Hauwa’u Musa, guide women through labours that lasted for hours. And, just like her grandmother, she spent years perfecting her own midwifery skills. She did this in homes across Kano, the largest city in northern Nigeria.
“She taught me everything I know,” says Ahmed over the phone from her home. “Now, any woman who is pregnant, they call me.”
But Ahmed’s work doesn’t end there. After a woman gives birth, the 37-year-old then accompanies the family to a local healthcare facility. There, a nurse gives the newborn two droplets of the polio vaccine. It’s a small but life-saving action. Polio is a highly infectious viral disease that can cause paralysis and death, particularly in children under five.
On 25th August, the World Health Organization (WHO) declared the African continent free from wild polio, the crowning victory of the largest internationally coordinated public health effort in history. The success of the campaign, which lasted three decades, was described by the WHO’s Director-General Tedros Adhanom Ghebreyesus as “one of the greatest public health achievements” of our time.
Experts say the eradication of wild polio in Africa indicates just how challenging it can be to curb or eliminate an infectious disease: a lesson they believe has become increasingly apparent as the world works to combat the spread of COVID-19. Already, ten months into the devastating coronavirus pandemic, the virus has infected over 40 million people globally and taken over one million people’s lives. Now, as countries race to produce a safe COVID-19 vaccine, the question remains: How do governments and the wider medical community successfully immunise the entire world?
Harnessing the power of women
The answer might just lie with women, who played an enormous role in eradicating wild polio across Africa. World leaders, scientists and civil society can more effectively respond to COVID-19 by harnessing the power of women in local communities globally, says Sona Bari, a polio expert with the WHO.
Decades ago, wild polio paralysed more than 75,000 children across the African continent every year. In 2012, rates in Nigeria — the continent’s most populated country — accounted for more than half of the cases worldwide. While Europe has been polio-free since 2002, and the United States since 1979, wild polio remained active in parts of Africa until August of this year, as well as in Afghanistan and Pakistan, where spikes continue to this day.
Each year, a version of the virus known as vaccine-derived polio still circulates across Africa. It’s caused by a mutant strain of the oral polio vaccine. It poses a threat but rates are low – this year, 172 cases and zero deaths have been reported in 14 countries – and occurs in areas where there are immunity gaps.
Still, without female health workers, it’s likely wild polio would be responsible for the continued deaths of thousands of children across Africa every year. Women like Ahmed were key: they built trust, helped deliver vaccinations, and ultimately eradicated the disease. Going door-to-door, hundreds of thousands of frontline workers administered, or helped to administer, the vaccine to an estimated 51 million Nigerian children in one month in 2019 alone – the vast majority of whom were women.
Building on trust
“They were able to do that because they were granted access to the home,” explains Bari. “In many communities, men would not be granted access.”
Much of Ahmed’s work involves convincing the new mothers’ husbands of the merits of vaccination – not only from polio but from tuberculosis, hepatitis and meningitis as well.
“I meet them for a dialogue,” says Ahmed, referring to those men who appear wary of vaccinations. “Many times they agree after a chat.”
Their hesitations are understandable. Misinformation about vaccines has long been a major barrier to immunisation efforts in the region. It’s largely responsible for the persistence of the disease in Afghanistan and Pakistan.
There are enormous risks associated with contracting wild polio. Despite that, fears about the vaccine’s safety run rampant prior to its eradication across Africa. That’s according to Professor Rose Leke, Chair of the WHO’s African Regional Certification Commission for Polio Eradication. In 2003, four states in northern Nigeria suspended their immunisation programmes after unsubstantiated claims that the polio vaccine was part of a U.S plot to make Muslim women infertile.
Yet female healthcare workers traipsed between millions of households, group meetings and places of worship to distribute information – and dispel misconceptions – about both polio and the vaccine. The reason why the information was well received, says Alice Awuor-Oyuko, a Save the Children senior health advisor, was simple. The women lived and worked in their own communities, and weren’t seen as outsiders.
Ahmed says she believes a COVID-19 vaccine would be welcomed by her community, despite the misinformation that continues to cast a shadow over immunisation programmes, just as long as women like her are on hand to provide public information and education. “People trust me,” she says, “so I find it easy to convince them.”
Now, to combat misinformation in the Covid-era, this work will need to be replicated. When scientists succeed in developing a COVID-19 vaccine, rolling it out will be equally, if not more, challenging than taking on wild polio, experts say – and its success will likely also depend on women. Globally, women make up 70% of health-care workers and 80% of nurses in most regions, according to U.N. data. As a result, it will be women like Ahmed who will likely need to squash community conspiracy theories, says Awuor-Oyuko.
“If [female healthcare workers] don’t uptake the vaccine that will be a problem,” says Professor Helen Rees, Executive Director of the Wits Reproductive Health and HIV Institute at the University of the Witwatersrand in Johannesburg. “They’re the very people who are going to be the backbone of outreach programmes for other adults.”
They have their work cut out, adds Awuor-Oyuko. The push to produce a COVID-19 vaccine coincides with the rise of the anti-vaxxer movement across Europe and the United States. Meanwhile, on the African continent, centuries of colonialism, medical experimentation, and recent racist comments about the testing of COVID-19 vaccines on the African population have made many in the region particularly wary.
“People are afraid,” says Leke from WHO. “[People on social media] are telling Africans: Don’t take any vaccines; they’re coming to eliminate you.”
When a vaccine will be ready is still anyone’s guess. The UK’s Oxford University is leading one of the most advanced of the major global programmes to find a vaccine, involving participants in the UK, Brazil and South Africa, with a related trial in India. Russia became the first country in the world, in August, to approve a vaccine, and has since developed a second one, though critics warn there has not been enough testing for this to be safe.
Even before one is available, female health workers like Ahmed are playing a central role in keeping their communities safe. In the early months of the pandemic, Ahmed initiated a health campaign aimed at educating families in her hometown on the importance of handwashing, social distancing and mask-wearing.
“I tell them COVID-19 is real and they must adhere to the rules,” she says. “Just like polio, going from house-to-house telling residents [about the current situation] will help immensely.”
Her work is critical: When a vaccine is eventually produced, it’s unlikely to be available to everyone. Medical professionals largely agree that the immediate priority will be vaccinating adults over fifty, as well as healthcare workers, care home employees and other vulnerable groups.
While the world waits, Ahmed will continue her life’s work. That is, educating and protecting her small community in Kano, a skill she learned at her grandmother’s knee. And, when the time does come to help deliver a lifesaving coronavirus vaccine, Ahmed will be first in line.