Health workers move from door to door in the rural Sumaila district of Kano state, northern Nigeria, administering oral polio vaccines to children under five.
It could be any other vaccination drive but the programme has extra importance in Nigeria, where there has not been a case of the virus since July 24 last year.
As the one-year anniversary approaches without a case, health officials are keen to keep it that way. If successful, Nigeria will be taken off the list of polio-endemic countries.
Fauziyya Ahmed scribbles a code with chalk on the door of a house that she and her team have just visited to indicate the children are now immunised.
“So far we have not encountered any resistance from parents in all the homes we have visited,” she told AFP.
“People now accept the polio vaccine as safe for their children, unlike in the past, when parents were hostile to vaccinators and would call them names.”
– Aggressive battle –
They weren’t only called names. In February 2013, eight unknown gunmen opened fire on two polio clinics in Kano, killing nine women vaccinators.
Between 2003 and 2004, Kano state suspended polio immunisation for 13 months, after some Muslim clerics and doctors claimed the vaccine was a US-led Western plot to depopulate Africa.
Similar claims have been made in the world’s two other polio-endemic countries, Pakistan and Afghanistan.
In all three, that and Islamist extremist violence from the likes of Boko Haram and the Taliban have hindered vaccination efforts, allowing the virus to re-emerge.
Laboratory analysis both inside and outside Nigeria has declared the vaccine safe but public health officials and international agencies have faced a battle ever since to convince parents.
Their aggressive fight with the help of organisations such as the Gates Foundation and Rotary International has paid off.
In 2009 there were 338 recorded cases of polio in Nigeria but there were only six last year, according to World Health Organization surveillance data.
– Local leaders –
In Kano state, work to combat polio has included using the latest satellite technology to track teams of vaccinators and determine the areas covered.
Influential religious and community leaders were also brought in to help persuade parents to give their children the jab, said health education officer Ahmed Sule Hungu.
Public information films were shown illustrating the debilitating effects of polio, which includes paralysis, permanent disability and death.
Health workers used the distribution of nutritional supplements to persuade parents to have their children inoculated.
Murtala Yahaya, 47, had his two children vaccinated after watching the film while 52-year-old Umar Sallau said he was convinced because of the involvement of clerics and traditional chiefs.
“I didn’t trust polio vaccines because I was told it was not safe for children,” said Sallau, from Rimi village, 20 kilometres (13 miles) from Sumaila.
“But when I heard clerics advising people to allow their children to be immunised and I saw our traditional chief publicly giving polio drops to his child, my view on polio vaccines changed.
“If polio vaccines were not safe, our clerics would not advise us to use it for our children and our traditional leaders would not have given it to their own children.”
– Bargaining chip –
Vaccinators still face challenges, stemming from the priority the local authorities have placed on polio at the expense of treatment for other prevalent conditions such as malaria.
“This was why some of us rejected it in protest but now that they include other much-needed drugs, we accept it,” said housewife Laraba Maikudi from Gidan Sidi village, as her three-year-old daughter received the polio jab.
Two hundred metres away, two health workers were sitting under a huge baobab tree, examining sick children and dispensing drugs for free.
“This is part of the incentives to make them accept the polio vaccine because they complain the government is always concerned about polio,” said one health worker, without giving his name.
Resistance to the vaccine is also used as a bargaining chip to force the state government to provide much-needed but scarce social services.
People in remote Dagora village in Sumaila district for example demanded an access road in exchange for allowing in the vaccinators.
“Resistance is no longer about ignorance… but is as a result of social frustration created by lack of basic amenities, especially lack of healthcare facilities in public hospitals,” said Danjuma Al-Mustapha, a monitoring and evaluation officer with the UN children’s fund in Kano.
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