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Nigeria dispute endangers global polio drive
(Africa Recovery)

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By Michael Fleshman
Local Nigerian suspicions fuelled by the war on terrorism and disputed safety tests of UN-supplied vaccines have halted a vital immunization campaign in the northern part of that West African country. The controversy is jeopardizing what the World Health Organization (WHO) describes as the world's "best and perhaps last" chance to eliminate polio entirely. Since the immunization campaign was suspended in October, the polio strains unique to the area have spread to southern Nigeria and seven other West African countries -- Ghana, Togo, Benin, Burkina Faso, Chad, the Central African Republic and Cameroon. The outbreak has required costly new immunization campaigns in these otherwise polio-free areas and is endangering a 15-year, $3 bn international effort to completely eradicate the crippling illness.

A World Health Organization poster urging immunization against polio. The campaign for its eradication may now be in jeopardy.

The dispute began last July when Mr. Datti Ahmed, the head of the Kano state Sharia Supreme Council, which administers Islamic law, claimed that polio vaccines supplied by the UN children's agency UNICEF contained sterilization chemicals and the HIV virus that causes AIDS. Mr. Ahmed, an influential leader in the largely Islamic region, charged that the vaccines had been deliberately contaminated by the US government to reduce the size of the Muslim population as part of its war on terrorism. The allegations led the governments of Kano and two other states with Sharia law, Kaduna and Zamfara, to halt immunization activities until their concerns about the safety of the vaccine are resolved.

Laboratory tests by the Nigerian government and independent analysts overseas announced they had found no contaminants in the vaccine. However, tests by the Kano state government were said to confirm the presence of oestrogen and other foreign substances. A 15 January statement by Nigerian Health Minister Eyitayo Lambo pledging to resume the immunization drive was promptly contradicted by state health authorities, who said the vaccines would not be distributed until safety concerns are met.

Polio 'not under control' in Kano

At stake in the dispute, WHO polio campaign director Dr. David Heymann told Africa Recovery in New York, is the health of 15 million children in West Africa and the success of the global eradication campaign. At present, he noted in a mid-January interview, polio "is not under control in northern Nigeria. They've had low quality immunization and campaign services. Therefore, they have been unable to build a 'wall of immunity' to prevent polio from continuing to spread."

The area around Kano is one of only six remaining "reservoirs" of polio in the world after a global eradication drive launched in 1988 (see table below). That effort has brought the disease to the brink of extinction. WHO intends to provide multiple inoculations to over 250 million children in the affected areas by the end of 2004, thereby eradicating the disease entirely.

"The first and most important issue is to make sure that everybody is confident that the vaccine is safe and the programme can continue," Dr. Heymann emphasized. "And the vaccines are safe. We know they are. The vaccines are purchased from industries that meet WHO standards for purity. UNICEF purchases these vaccines and distributes them all over the world, so the same vaccines in Nigeria have been used everywhere else, and there have been no problems." WHO officials speculate that Kano state researchers are mistaking minor impurities in the water used to manufacture the vaccine with contaminants added to the vaccine itself.

Politics and history fuel doubts

Dr. Heymann noted that while concerns about the safety of the polio vaccine is misplaced, world events and the highly publicized deaths of 11 Nigerian children in 1996 during tests of an experimental meningitis drug by the US pharmaceutical company Pfizer are contributing to public unease. Ironically, international alarm over the polio dispute may only be fuelling popular scepticism. "What arouses my suspicion about this immunisation thing is the desperation of the so-called developed countries on it," one Kano resident told the Nigerian newspaper Thisday. "These people are the ones we can hold responsible for our woes, but who are now trying to help our children from dying. I think that something must be wrong somewhere."

To change those perceptions, Dr. Heymann said, WHO has enlisted the support of the Organisation of the Islamic Conference (OIC), the African Union and the Arab League to urge a resumption of the Nigerian immunization drive. The OIC, he noted, adopted a resolution in November urging Islamic countries with polio to make extra efforts to eradicate it. Countries with endemic polio, he observed, owe it to their citizens and their neighbours to join the eradication campaign. "Everywhere in the world this vaccine is available at no cost. Countries that haven't delivered it are denying their people health equity. At the same time they're not being responsible neighbours, because infectious diseases know no borders. This virus can hop on an airplane and go to wherever it wants to go."

For that reason, Dr. Heymann said, a solution to the problem in northern Nigeria must be found quickly. "We have no choice but to make it work. And we have to find the way that includes the activities of UNICEF on the ground, Islamic leaders who are convinced the vaccine is safe and all kinds of people working together. It's not an easy solution, but it's the one we have to find."

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