Polio's Return: A WHO-Done-It?

This article examines the global campaign to eradicate polio and the recent revival of polio in northern Nigeria. According to the article, the Global Polio Eradication Initiative (GPEI) was created in 1988 to eradicate polio by the year 2000, and by 2003 polio was at its lowest level since the first known polio epidemics of the early 20th century.

In 2003 Emir Adamu, a Nigerian lawyer, along with the president of the Supreme Council for Shari’a in Nigeria, Dr. Datti Ahmed, called for a boycott of the polio vaccine claiming that the vaccine contained anti-fertility drugs. Mistrust of the vaccine spread throughout much of Nigeria, and in October 2003 the GPEI was suspended in Kano, Zamfara and Kaduna states until answers could be obtained about the vaccine. After two months the GPEI resumed in Zamfara and Dakuna, however the government of Kano refused to call off its boycott, setting up its own committee to investigate the vaccine. Headed by Dr. Alhassan Bichi, the committee found trace elements of the female hormone estradiol. Although the hormone was not believed to be harmful to children, it was not listed on the French-made vaccine. As a result, the committee deemed it unethical to recommend the vaccine. Within 18 months polio spread to 16 countries that had been previously free of the disease.

Many people blamed the collapse of the GPEI in Nigeria on the actions of Nigerian religious leaders, however, according to the authors, the collapse of the polio campaign is a result of a combination of many circumstances and lessons “regarding religious tension, the security implications of weak or absent public health infrastructures, the political limitations of UN agencies, the folly of purely bilateral aid efforts, and the volatility of long-term distrust not only of people against their own governments, but against "the West" writ large as well.”

According to the article, the fact that Nigeria lacked a basic health care infrastructure, electricity and potable water, meant that many northern Nigerians lacked faith in the federal government and were suspicious when United Nations (UN) health officials appeared to vaccinate their children. Many people felt that there were more pressing and deadly diseases to fight rather than polio, and thus they distrusted the polio vaccine.

An incident with the American pharmaceutical corporation Pfizer also strengthened Nigerian distrust of immunisation campaigns. In 1996 Pfizer tested its drug, Trovan, during a bacterial meningitis outbreak in Kano. The experimental drug was responsible for the cause of brain damage, loss of motor skills and death to some of the participants of the study, leading to a mistrust of vaccines and a mistrust of the United States.

In March 2004 a review committee was established by the WHO to address the source of the problem in Nigeria. Communication and outreach in support of the polio campaign was carried out and included: public statements by leaders of the G-8 and African Union in support of the campaign; fatwas were released urging Muslim countries to eradicate polio; public tests were conducted on the oral polio vaccine; the highest-ranking Muslim in Nigeria, The Sultan of Sokoto, supported the vaccination campaign; and in Kano state a massive public information and immunisation campaign was initiated and supported by the local, federal and international levels of government.

Despite the above efforts, polio continues to erupt in countries and mistrust against the vaccine persists. However, the World Health Organization (WHO) is confident that the GPEI can overcome these setbacks and eradicate the virus. In the spring of 2005 the World Health Assembly passed International Health Regulations (IHR) that expand the powers and authority of WHO, particularly in cases of outbreaks and pandemics. While current investigations into avian influenza outbreaks have found that the regulations have made governments more transparent and cooperative, the GPEI is still limited in its capacity to act globally, as it still needs the approval of local governments to initiate local polio vaccination campaigns.

According to the article, despite the need for more resources and people power, the GPEI has strengthened national health systems by strengthening disease surveillance and by training surveillance officers for local health crises. However, the article concludes by stating that eradication campaigns may not be the best use of WHO's expertise and limited resources, and that “U.S. global health and development goals, laudable as they are, cannot be met without an international institutional partner that is up to the task. Striving to bring that partner into being should be a part of U.S. policy, too.”