What Led to the Nigerian Boycott of the Polio Vaccination Campaign?
Public trust is essential in promoting public health. Such trust plays an important role in the public's compliance with public health interventions, especially compliance with vaccination programs, which target mainly healthy people. Where public trust is eroded, rumours can spread and this can lead to rejection of health interventions.
In northern Nigeria in 2003, the political and religious leaders of Kano, Zamfara, and Kaduna states brought the immunization campaign to a halt by calling on parents not to allow their children to be immunized. These leaders argued that the vaccine could be contaminated with anti-fertility agents (estradiol hormone), HIV, and cancerous agents.
In an article reported by News24.com, a South African online news Web site, Sule Ya'u Sule, speaking for the governor of Kano, is quoted as saying: “Since September 11, the Muslim world is beginning to be suspicious of any move from the Western world…Our people have become really concerned about polio vaccine”. In the same article, Datti Ahmed, a Kano-based physician who heads a prominent Muslim group, the Supreme Council for Sharia in Nigeria (SCSN), is quoted as saying that polio vaccines were “corrupted and tainted by evildoers from America and their Western allies.” Ahmed went on to say: “We believe that modern-day Hitlers have deliberately adulterated the oral polio vaccines with anti-fertility drugs and…viruses which are known to cause HIV and AIDS”.
The New York Sun reported that this fear of polio vaccines in northern Nigeria “caught on because of the war in Iraq”. Ali Guda Takai, a WHO doctor investigating polio cases in Kano, told the Baltimore Sun, “What is happening in the Middle East has aggravated the situation. If America is fighting people in the Middle East, the conclusion is that they are fighting Muslims”.
Embarrassed by the political undertone of the boycott, the prominent Islamic scholar Sheikh Yusuf Al-Qaradawi, President of the International Fiqh Council, said: “In fact, I was completely astonished about the attitude of our fellow scholars of Kano towards polio vaccine. I disapprove of their opinion, for the lawfulness of such vaccine in the point of view of Islam is as clear as sunlight”. Sheikh Qaradawi said that the same polio vaccine has been effective in over 50 Muslim countries, and blamed the SCSN for creating a negative image of Islam: “They distort the image of Islam and make it appear as if it contradicts science and medical progress”.
An important factor that played a role in the polio vaccine boycott was the general distrust of aggressive, mass immunization programs in a country where access to basic health care is not easily available. In his report for the Baltimore Sun, John Murphy wrote: “The aggressive door-to-door mass immunizations that have slashed polio infections around the world also raise suspicions. From a Nigerian's perspective, to be offered free medicine is about as unusual as a stranger's going door to door in America and handing over $100 bills. It does not make any sense in a country where people struggle to obtain the most basic medicines and treatment at local clinics”.
The religious leaders in northern states who boycotted the polio immunization campaign believed that the southern-led federal government was acting in the interests of Western powers. The northern and southern parts of the country had different colonial experiences. While the north was colonized by the Islamic Jihadists, the south was colonized by the British. These colonial experiences are responsible for political differences between north and south and different attitudes to modern medicine.
Suspicions about Western health interventions were already circulating in northern Nigeria, ahead of the polio vaccination boycott, in the wake of Pfizer's 1996 “Trovan trial”. The trial was discussed in detail in a BMJ feature entitled “Pfizer accused of testing new drug without ethical approval”.
In brief, the BMJ reports that in 1996 Pfizer sent a team to Kano during an epidemic of meningococcal meningitis. To test the efficacy of its new antibiotic trovafloxacin (Trovan), the team conducted an open-label trial in 200 children—half were given the gold standard treatment for meningitis, ceftriaxone, and half received trovafloxacin. Five of the children given trovafloxacin died, together with six who were given ceftriaxone. The BMJ reported: “The Washington Post has been investigating the trial and alleges that at least one child was not taken off the experimental drug and given the standard drug when it was clear that her condition was not improving—which is against ethical guidelines.” The BMJ reported that the Nigerian health minister appointed a federal investigative panel to determine whether the trial was conducted legally, and if so, whether it was morally right.