On July 24, Nigeria found a reason to celebrate. It was a welcome break from the usual stream of negative reports over which the country has been portrayed as incapable of achieving a globally commendable cause. It was a triumph over the forces of superstitious, cultural and communal resistance to the foreign medical interventions designed to eradicate polio in Nigeria. The immunization campaigns, which have received overwhelming international support being part of the Global Polio Eradication Initiatives, marked that date as our dear country’s 365th day without a reported polio case.
The man at the centre of this achievement is the Executive Director and CEO of National Primary Health Care Development Agency (NPHCDA), Dr. Ado JG Muhammad, whose office has become the ammunition against the medical challenges of the common man. His office is one of the few that the Jonathan administration held out correctly as successes, in an otherwise failed Presidency.
Writing in Leadership newspaper to mark the first year anniversary of a polio-free Nigeria, the NPHCDA boss took us down memory lane. “Global efforts to eradicate the paralytic polio virus dates back to 1988, when the World Health Assembly passed a resolution to eradicate the polio virus worldwide by year 2000 and launched the Global Polio Eradication Initiative (GPEI).” He added, “At this time, over 1000 children were paralyzed daily worldwide, with 350,000 children affected in 1988 alone.”
Although the campaign to eradicate polio in Nigeria began in 1979, it was the military government of General Ibrahim Badamasi Babangida that established Primary Healthcare Centres nationwide in 1986 to make access to polio vaccines easy in rural areas. In his op-ed, Dr. Muhammad recognised the 1996 “Kick Polio Out of Africa Campaign” as the formal launch of Nigeria’s polio eradication campaign.
The first obstacle to fighting polio was the perception of it particularly in the states of northern Nigeria, where spiritual accidents are seen as its cause. In Hausa, Polio is called “Shan Inna”, attributing the cause of the disease to “Inna”, a female jinn in the region’s ethno-religious cosmology. “Sha” means “absorbs” or “paralyses”, and thus polio means paralysis caused by Inna—a principal spirit in the Bori cult system. How to convince our medically illiterate and superstitious people, that polio is indeed a clinically preventable disease, was an uphill task some of us have witnessed first-hand.
In the year the World Health Assembly passed its resolution, northern Nigeria, of which geo-polity Dr. Muhammad is a conscious member, was the hub of myth and ignorance fashioned against any foreign medical intervention—especially this one designed to disprove the existence of the dreaded Inna. Also, the presumably atheist West wasn’t expected to believe in the spiritual realm, reinforcing the aversion to even self-interest and logic. Immunization campaigns were thus avoided as being the West’s conspiracy to transmit new diseases to unsuspecting Muslims. Added to this, from “indigenous laboratories” with no known location, came reports that the vaccines carried sterilising agents and HIV virus. Needless to say, these “scientific reports” were cheerily quoted by religious and community leaders in order to institutionalise a massive paranoia on the subject of vaccines.
This fear of “the West” in northern Nigeria further reinforced by the medical effort to stem the outbreak of Cerebrospinal Meningitis (CSM), in 1996, in Kano. This clinical trial was conducted by Pfizer, a pharmaceutical company that would become a defendant in a litigation initiated by parents of the victims of that disastrous drug test. Eleven children, to whom the drugs were administered, died, and about two hundred others were left physically disabled. That experiment of Trovan (Trovafloxacin Mesylate), which couldn’t have happened if those in charge of our health system were not corrupt, became a reference and further evidence of the West’s sinister obsession with the population of the North.
A year earlier, in Zaria, the Rotary International’s vaccination project was discontinued. Parents of the children to be vaccinated refused to bring out their children because, in the previous exercise, boils developed on the injection site, that their children experienced hearing loss. In a March 6, 2004, interview with Weekly Trust, Dr. Haruna Kaita, then the Dean of Faculty of Pharmaceutical Sciences at the Ahmadu Bello University, recalled an incident that occurred at Mayo Belwa in the former Gongola State during the CSM outbreak. He claimed that immunization resulted into “a massive outbreak unprecedented in the history of the country there, and it was mostly those who were given the vaccines that were affected in that outbreak.”
Dr. Kaita granted this interview while serving as a scientist against immunization for Jama’atu Nasril Islam [JNI], the umbrella group of the Muslim community. He stood to be advocating the interests of Muslims. In June 2003, JNI had declared that polio vaccines contained contaminants, and these, according to Dr. Kaita, “have direct effect on human reproductive system.” The President of the Supreme Council for Shariah in Nigeria, Dr. Datti Ahmed, would go on to ask the Federal Government to suspend the immunization exercise. This period was remembered by the NPHCDA boss as one in which Nigeria “suffered a near fatal setback… This resulted in upsurge of polio cases. This upsurge continued to year 2006 with 1122 children paralyzed before the cases started to decline in 2007 with 285 cases. However, 2008 witnessed another upsurge in cases to 798, before it started a steep decline in 2009 to 388 cases, 21 cases in 2010 and 62 cases in 2011.”
Sadly, even the educated and enlightened, who ought to mitigate apprehensions over claims that the vaccines truly contained antifertility agents, joined the band of conspiracy theorists in manufacturing stories of the West’s commitment to halting humanity’s growth. A friend of mine once employed Malthusian theory to highlight what he considered to be “the general perception of exponential population by western institutions” and submitted that the vaccines must indeed cause sterility and engineered diseases that would raise our mortality rate.
Heading an agency established to guide preventive immunization into the heart of a people both scarred by, and scared of, Western medical intervention is to exist in the matrices of these communal and cultural sentiments, of the fear and ignorance promoted by the conspiracy theorists. The anti-immunization sentiments weren’t just expressed through boycotts and neighbour-to-neighbour anti-sensitization and sermons of compliant religious and community leaders, it met a fatal resistance in one of the unsolved cases of gun attacks in the Kano State—the killing of nine polio workers in February, 2013. According to the Global Polio Eradication Initiative, more healthcare workers and volunteers have actually been killed trying to prevent the spread of polio than the number of people who have died from the disease itself. The disease merely cripples, ignorance about it can kill and has.
Dr. Muhammad assumed duties at NPHCDA in 2011, appointed by President Goodluck Jonathan, and it’s commendable that in four years, Nigeria has left the league of Polio-endemic countries. But we still have two more years to be certified polio free, so that we are no longer ranked alongside Afghanistan and Pakistan. With President Buhari’s declaration to have the country certified polio-free by 2017, while noting the remnant distrust and security challenges that frustrate such an accomplishment in terrorism-afflicted regions, the world is already eager to record this new epoch in Nigerian public health history.
This essay is a garland to Dr. Ado JG Muhammad and the development partners who made this happen.
By Gimba Kakanda
@gimbakakanda on Twitter