Polio vaccination campaign meets hostility in northern Nigeria

Despite their effectiveness at reducing child mortality, global immunisation campaigns often encounter local opposition. In 2003, Muslim leaders in northern Nigeria ordered the boycott of the Oral Polio Vaccine (OPV), claiming that it had been contaminated with anti-fertility substances as part of a plot by Western governments to reduce Muslim populations worldwide.

Researchers fromthe Institute of Development Studies, UK, found that the 16-month controversyover the polio vaccine in Nigeria was mainly driven by resentment among Muslimleaders over US foreign policy towards the Islamic world. The rumours aboutcontaminated vaccines acquired strength because the wild poliovirus is endemicin northern Nigeria, a predominantly Muslim area.

Local peoplequestioned why the government was focusing on the polio campaign when it wasunable to run a reliable and affordable primary health care system. Many didnot regard polio as a priority disease, giving more importance to otherdiseases such as malaria. The researchers also uncovered widespread mistrust ofthe Nigerian government following allegations that it had collaborated with thedrug company Pfizer in carrying out illegal meningitis drug tests in 1996.

Following the OPVboycott, there was a steady increase in polio cases, with new outbreaks ofinfection. Local members of the Global Polio Eradication Initiative ledprincipally by the World Health Organization and UNICEF launched a vigorousnational campaign. The Kano State Commissioner of Health eventually arranged thepurchase of vaccines from Indonesia to discover they were one of many sourcesof oral polio vaccines for the global initiative. After much pressure from thefederal government and international community through advocacy, the Kano stategovernment resumed polio immunisation. The Supreme Council for Sharia (Muslimlaw) continued to disapprove of the polio vaccine. The controversy has leftlasting fear among Muslim communities in northern Nigeria. The study showedthat:

• Vaccinators continued to be treatedharshly as they carried out the door-to-door Polio Eradication Initiative(PEI) campaign.
• Some respondents in rural areastrusted vaccines used in antenatal clinics as part of routine immunisationsessions but would not accept vaccines from roaming vaccinators, who theysaid were often children as young as nine years.
• A number of Western-educatedprofessionals expressed similar fears about polio vaccines.
• Many people, both Muslims andChristians, were still visiting traditional healers who promotealternative cures for polio, which they believe has a spiritual cause.
• Nigeria’s immunisation services arestill unable to reach many rural areas, where 80 percent of the populationlives.
• There is widespread confusion aboutimmunisation, including among those with higher levels of education.
• The polio vaccine controversy revealeddeeper cracks in the national primary health care system that contributedto the failure of the campaign.

While the poliovaccine boycott was expensive in economic and human terms, it opened upcommunication at both global and national levels. Partnership with localcommunities is vital for the success of immunisation campaigns. Recentcommitments to a more people-centred approach are encouraging. The researchersconclude that:

• there is a need for strong andsustained awareness building about immunisation among all Nigeriancommunities
• religious and traditional leaders haveplayed important roles as advocates within their communities, particularlyduring the OPV boycott – it is equally vital to engage the support of civilsociety groups and opinion leaders.
• The success of polio eradication inNigeria and routine immunisation in general rests on a well functioninghealth system. The problems facing Nigeria’s primary health care system needto be addressed.
• The international community (WHO andUNICEF) need to make greater efforts to work hand-in-hand with thegovernment to develop and implement people-centered programmes.
• There is a need for greater politicalwill and action within the Nigerian government to effectively supportglobal polio eradication and improve the country's health care system.