ldv There is a scarcity of

There is a scarcity of rigorous and reliable information about the occurrence, operation, and outcomes of immigration detention worldwide. New initiatives are needed to increase transparency and accountability and to build an evidence ldv for detention policy and practice. More comprehensive and robust data, such as those provided by the Global Detention Project, could be used by international bodies such as the UN High Commissioner for Refugees, WHO, and the International Organization for Migration to better monitor the prevalence and potential effects of child detention. Although many of the factors that lead to migration are difficult to change, none of these considerations should stand in the way of ensuring that countries meet the following minimum standards of care. First, children should not be separated from their accompanying families or caregivers. The absence of a caregiver has important implications for child security, health, and development. Second, alternatives to detention, such as community-based supervision, as implemented in Sweden, must be considered. Third, many of these children have experienced violence in their home countries, during their journeys, and not uncommonly in places of refuge. For the cycle of violence to not be perpetuated in the next generation, systems are needed to share good practice and coordinate efforts to eliminate further exposure to harm. The truncated childhoods of individuals who have been forced to migrate, yet placed in detention, are unacceptable. These children, arriving in large numbers and rightfully seeking a brighter future, deserve better protection and the development of safer, more sustainable, humanitarian models of care.
Similar to recent qualitative analyses, Tara Mangal and colleagues showed in their quantitative study (February, p e90) that, despite achievements in top down political engagement at the national and sub-national levels, vaccine refusal and scant information on the importance and availability of oral poliovirus vaccine (OPV) at the community level continue to impede poliomyelitis eradication efforts in northern Nigeria. However, in addition to contextual factors that account for vaccine refusal, they omit from their discussion two important implications of their results for strengthening the poliomyelitis eradication initiative in Nigeria. First, OPV refusal rates were consistently lower for routine immunisation than for supplemental campaigns. Thus, the OPV programme should mimic routine immunisation by delivering the vaccine with other priority interventions—eg, for malaria, diarrhoea, pneumonia, malnutrition, and sanitation—for which demand is greater in view of their prominence as common causes of childhood mortality in Nigeria. This strategy takes the focus away from poliomyelitis and reduces the likelihood of rejection because of suspicions that OPV is for reasons other than poliomyelitis eradication. Second, the results of the study by Mangal and colleagues suggest a rethink of the community engagement strategies that initially increased acceptance of OPV in northern Nigeria. This can be achieved by moving beyond key political and traditional leaders and actively engaging community structures, such as village health committees, that can stimulate demand and distribute information on the importance and availability of OPV, thereby boosting vaccine acceptability from the bottom up. However, communities should be mobilised not only for poliomyelitis vaccination but also for overall maternal and child health services.
We thank Seye Abimbola for highlighting some of the implications arising from our analyses of oral poliovirus vaccine (OPV) use in Nigeria. Community engagement and demand generation are vital to the success of the poliomyelitis eradication programme. Our analyses suggest that efficacy of OPV in Nigeria, even in the northern states, is sufficient to interrupt wild poliovirus transmission if high coverage is achieved consistently. Therefore, Nigeria has the means necessary to finish the job; the major setbacks during 2012 were a result of low campaign quality, rather than low vaccine efficacy.