Satisfied by the quality and process of production of the polio vaccine, the Kano state team returned with a seal of approval from Biopharma, an Indonesian company, which they later recommended be the new supplier of polio vaccines for the predominantly Muslim states and perhaps the rest of the country [ 17 ]. Indonesia is a Muslim country trusted by Nigeria's Muslim leaders for testing the polio vaccine. Two months after Kano state resumed its polio immunization program, about Muslim clerics and traditional chiefs from Chad, Cameroon, Niger, Togo, Benin, and Burkina Faso met in Kano on September 22, to discuss the way forward in respect to the polio immunization campaign.
The federal government, having lost the public trust of one state—a loss of trust fuelled by Muslim leaders—became handicapped in providing health services. In many parts of Africa, communication and authority flow downward from community leaders who are the gate keepers and decision makers. In the Hausa community of northern Nigeria, traditional rulers have powers derived from both culture and religion. This gives them the opportunity to perform both political and religious roles. They rule through the traditional and the Islamic councils, under the supervision of the local government, having their received staff of office from the state government.
The modern political system in northern Nigeria relies on this structure to reach out and mobilize people. This is important in the sense that it shows a type of communitarianism where individual autonomy cannot be separated from that of the community [ 34 ]. The Kano state leaders believed that they were acting to protect the interest of their people, though unfortunately, they ended up disrupting national and global health agendas.
Polio vaccination, political authority and the Nigerian state in: The politics of vaccination
A fresh outbreak of polio was reported in Kano in October The BBC reported that, due to this fresh outbreak, a new strain of the polio virus was traced to other parts of the country [ 35 ]. Even many years after the boycott, polio outbreaks remain a regular occurrence in Nigeria, and these show some form of resistance to vaccines. While three or four doses of polio vaccine administered to a young infant are enough to provide protection in most parts of the world, in Nigeria, with so much polio virus circulating, children under five years must be immunized up to eight or more times [ 23 ].
The recent case of an month-old boy in Nasarawa in Kano shows that there is ongoing suspicion about the polio vaccine in Nigeria.
The boy was considered likely to have polio, having lost the use of one of his legs after being diagnosed with acute flaccid paralysis. His mother confirmed that he had never been vaccinated because her husband did not allow it [ 23 ].
It is still a major undertaking to have the population understand that the vaccine is safe [ 36 ]. The number of confirmed polio cases in northern Nigeria more than doubled in the first five months of as compared to the same period in As a result, over 1, children were paralyzed. These new cases are genetically linked to the polio virus endemic in northern Nigeria Figure 3. New cases of polio genetically linked to the wild polio strain from Nigeria have also been recorded in countries as far as the Sudan and Botswana, which were also previously free of polio [ 38 ].
The vaccine boycott in Nigeria was influenced by a complex interplay of factors. These factors included lack of trust in modern medicine, political and religious motives, a history of perceived betrayal by the federal government, the medical establishment, and big business, and a conceivably genuine—albeit misplaced and ineffective—attempt by the local leadership to protect its people.
One lesson from the Kano boycott is that research is needed to investigate why people have concerns and fears about vaccination, and what steps should be taken to avoid boycotts in the future. Other lessons are discussed below. Immunization campaign programs should be a participatory event involving state and local governments, community leaders, and parents. There are three types of community leaders in northern Nigeria—traditional rulers, political leaders, and religious leaders. Traditional rulers acquire their status through succession and their authority is rooted in traditions and customs [ 40—42 ].
Political leaders acquire their status through the political process and religious leaders do so on a religious basis. Among the three, the traditional ruler is best placed to represent the interests of children. Community leaders may contribute to the success or failure of health research and delivery [ 43 , 44 ].
These should stress the value of immunization and involve the media. Reaching the community requires radio, television, and folk media such as local music, theatre, and festivals. Immunization messages can be packaged into songs by local musicians and can be communicated through drama in the language that local people understand. These committees would examine and approve or reject health research in its sphere of influence. Members of these community-based ethics committees should include volunteers who are ready to undergo basic ethics training relevant to their duties.
The committees should be under the supervision of, and funded by, the local government's councils, and the committees should work with local medical associations. They should choose their own chairperson and determine their own agenda in line with the national ethics code. Barriers to the formation of local ethics committees include inadequate capacity, funding, and communication. The staff of the Joint Centre for Bioethics at the University of Toronto reviewed the initial draft of this article.
Methods For this article, I consulted relevant books, journals online and print , Internet materials, and newspaper articles. Download: PPT. Figure 2. The Boycott in Northern Nigeria Public trust is essential in promoting public health [ 13 ]. Background to the Boycott The historical context The polio vaccination boycott should not be considered in isolation, but rather in the context of the history of orthodox health services in northern Nigeria.
Listening to the rumours: What the northern Nigeria polio vaccine boycott can tell us ten years on
The political context In Nigeria, states have administrative control over health affairs at the primary and secondary care levels while the federal government has control at the tertiary care level. Federal Response to the Polio Boycott In response to public outcry about the polio vaccine, the Nigerian federal government set up a technical committee on October 29, to assess the safety of the polio vaccine, sending samples of the vaccine for laboratory tests abroad.
African Communitarianism The federal government, having lost the public trust of one state—a loss of trust fuelled by Muslim leaders—became handicapped in providing health services. Figure 3. Governments should be sensitive to local politics, especially as they affect health-care delivery Immunization campaign programs should be a participatory event involving state and local governments, community leaders, and parents. Public awareness campaigns about vaccination are crucial.
Research ethics committees should be established in each local government. Supporting Information. Alternative Language Text S1. Translation of the article into French by E. Acknowledgments The staff of the Joint Centre for Bioethics at the University of Toronto reviewed the initial draft of this article.
References 1. The district chief Robert Scott, a retired family physician and current chair of Rotary's PolioPlus Committee, says they should organize education programs for vaccine teams, educate parents on the importance of vaccinating children by distributing pamphlets, airing TV spots and using other media to get the message out , and reassure people that the vaccine is safe.
Polio campaigns in Nigeria and other developing countries have been crippled by rumors that the vaccines cause sterility and AIDS. If history provides any guidance, there is no reason to believe northern Nigeria cannot run an effective polio vaccine campaign.
- Progress Toward Poliomyelitis Eradication — Nigeria, January 2014–July 2015;
- Albrecht Durer: A Guide to Research (Artist Resource Manuals);
- The politics of polio in northern Nigeria [electronic resource] / Elisha P. Renne. - Franklin.
- Statistical Case Studies for Industrial Process Improvement!
- UN mediates polio deadlock in Nigeria.
- Inter and Intra Government Arrangements for Productivity: An Agency Approach.
At the end of , the country had only polio cases. Then, in , it fell off the wagon, racking up cases.
Despite the recent setback, worldwide efforts to stamp out polio have been " When the Global Polio Eradication Initiative was launched, polio was endemic thriving and prevalent in countries, paralyzing at least 1, children per day. Now the virus remains active in only four countries—Nigeria, India, Pakistan and Afghanistan—and paralyzes fewer than 2, children worldwide yearly.
You have free article s left. Instead, immunisation workers adapted to the political reality and worked with militants to gain access to areas under their control. The Afghan Taliban have cooperated with polio vaccination programmes since the s. In most cases, local-level leaders have welcomed immunisation workers, seeing vaccination programmes as a form of patronage that reinforces their authority. The few polio cases that have been detected have been either cross-border transmissions from Pakistan or have occurred in areas where intense conflict between the Taliban and the Afghan government has temporarily disrupted polio campaigns.
By contrast, in Somalia, the terrorist group Al Shabaab has historically forbidden polio workers from operating in areas under their control, viewing vaccination campaigns as part of a foreign campaign to impose a centralised government. One million children were unvaccinated between and , when a polio outbreak occurred. Since then, immunisation campaigns have improved their access to rebel-controlled areas by employing locally recruited staff to work within their own clans and negotiate access with local-level militant leaders.
In Syria, after the start of the uprising in , the government prevented the WHO from operating in areas outside its control. Over 3 million children were not vaccinated for polio, leading to an outbreak in rebel-controlled regions in In response, an ad hoc coalition, including moderate opposition groups, Turkish authorities and local NGOs carried out a series of vaccination campaigns and contained the outbreak. The coalition negotiated access with local rebel leaders, allowing them to choose volunteer vaccinators.
Militant groups — even Daesh — permitted immunisation campaigns to operate in areas under their control. Successful immunisation campaigns must secure the support of de facto political leaders — whether of an internationally recognised state or of a vilified militant organisation. As objectionable as working with groups like Daesh might be, it is important to remember that the main objective of efforts like the campaign to eradicate polio is to improve the health of people wherever they may live.
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