# The global poliovirus eradication initiatives in Kano state, Nigeria: a case report on the African regional commission pre-certification visit and lessons learnt

## TL;DR

Kano State in Nigeria successfully eradicated polio through a combination of surveillance, community engagement, and technology, offering lessons for other regions.

## Contribution

This case report provides insights into the strategies and lessons learned from Kano's successful polio eradication efforts.

## Key findings

- Kano achieved AFP surveillance sensitivity above WHO benchmarks and expanded environmental surveillance.
- Integration of technology, advocacy, and community engagement led to polio-free certification in Kano.
- Strong documentation and political commitment were key to successful verification by ARCC.

## Abstract

Polio eradication in Kano State, Nigeria, represents a major milestone in the Global Polio Eradication Initiative (GPEI). Formerly the epicentre of wild poliovirus (WPV) in Africa, Kano experienced multiple outbreaks between 2003 and 2008, threatening national and regional stability. Persistent transmission, vaccine resistance, and surveillance gaps kept Kano in global focus. By 2020, following intensive interventions, Kano was certified polio-free by the African Regional Certification Commission (ARCC).

This narrative report draws from ARCC field verification visits, peer-reviewed literature, unpublished reports from the National Primary Health Care Development Agency (NPHCDA), and records from WHO, UNICEF, and partners. Data (2008–2020) included surveillance indicators, immunisation coverage, cold chain assessments, supplementary immunisation activities (SIAs), and stakeholder interviews. Emphasis was on Acute Flaccid Paralysis (AFP) surveillance, technological innovations such as AVADAR and GIS mapping, and the role of traditional and religious leaders in overcoming resistance.

Kano achieved AFP surveillance sensitivity above the WHO benchmark (2/100,000 children under 15), expanded environmental surveillance, and improved routine immunisation with coverage exceeding 80% in most Local Government Areas by 2019. ARCC verification noted strong documentation, political commitment, advocacy, and correction of case investigation and outbreak records.

Kano’s transformation from a WPV hotspot to polio-free status resulted from integrated strategies combining technology, advocacy, surveillance, and independent verification. These lessons offer a model for sustaining polio-free gains, addressing circulating vaccine-derived polioviruses, and strengthening wider health systems.