Vaccination against poliomyelitis: violence and resistance

Published on Humanitarian Policy and Conflict Research (HPCR)

On January 8th, nine Nigerians, all working on the poliomyelitis vaccination campaign, were murdered in Kano, in the north of the country. A few weeks before, several Pakistani (nine in December, seven in January), again members of poliomyelitis vaccination teams, were also killed.

These barbaric acts attracted widespread media interest, particularly international, often portraying them as a violent extension of the resistance to poliomyelitis vaccination campaigns - a rejection fuelled by public ignorance and manipulation by local authorities. Yet it is precisely because these murders are inadmissible, and no attenuating circumstances can reduce their gravity, that they must be differentiated from another movement, that of the resistance to poliomyelitis vaccination campaigns, which is in part justified by rational arguments delivered by the representatives of the countries concerned. There is indeed room for public health debate here, given that the World Health Organisation and its partners, led by Bill Gates, state their increasingly inflexible intention to wipe the polio virus out blow by blow.

In Pakistan, Taliban representatives from North Waziristan announced in June that poliomyelitis campaigns were to be boycotted henceforth. They distributed a leaflet that suggested the boycott could be lifted if America stopped using drones, while denouncing the excessive means being deployed: "What is the need for such a polio campaign over which the 'well-wishers' are spending millions of money, as hardly a child among thousands of children becomes victim of polio virus. While at the same time, the well-wishers with the help of their 'slave' Pakistan are busy targeting us with the drones. Hundreds of our innocent children, women and old men have become prey to such attacks(...) The hovering of drone aircrafts in the area has made almost all the tribesmen psychologically sick." This call for a boycott was introduced in a context in which vaccination in Pakistan suffers from particularly bad press since the running of a false hepatitis B campaign in the CIA hunt for Ben Laden was denounced .

Were the vaccinators killed because they violated this embargo? Whatever the Talibans' responsibility in these murders, or the political agenda they follow, their call echoes the concerns of some traditional authorities. Joining the boycott, they are stating their demands for electricity in their region: "Our children die of scorching heat and mosquito bites, what difference does it make if they die of polio? We will continue our boycott until the government fulfills our demand ".

This is not the first time that efforts to vaccinate against poliomyelitis are found excessive by those very people they aim to assist, a particularly illustrative example being the boycott against polio campaigns in Nigeria in 2003, which merits our review.

At the time, when the virus' eradication was already being presented as "within our reach", the WHO decided to redouble its efforts in Nigeria - harbouring half the world's remaining recorded cases. But the vaccination teams battled with growing resistance from the population, including at times physical violence. Rumours that the vaccines were contaminated with sterilising agents ran increasingly rife, leading the Supreme Council of Sharia in Nigeria to call for the vaccination's suspension in July 2003. Several states announced that they would not participate in the following campaign until an independent investigation proved that the vaccination was harmless.

This episode led to a great deal of ink being spilt, both in the media and in scientific publications. As for Pakistan, the boycott was presented as a reflection of the general public's ignorance (its belief in a global conspiracy against Muslims), anchored in a context marked by the war in Iraq and Afghanistan and the religious hardening in the north, where sharia was adopted in 2000. Meanwhile the authorities held the leaders responsible, accusing them of unscrupulous abuse of Nigerian's credibility and the jeopardising of "15 years of work, and 3 million dollars ". But careful examination of the arguments against the campaign given by certain representatives of political and religious powers at the time gives rise to a different interpretation. The extract below is from a discussion between the Emir of Kazaure, in Jigawa state, and a WHO representative in Nigeria in 2003 .

Dr Gloria (WHO): Your Royal Highness, we like to thank you very much for this audience. I am from Zimbabwe and I have been sent to cover WHO activities in Nigeria and especially polio eradication. In my country we have eradicated polio. (...)So far in the whole of Nigeria, there are 109 cases, and 45 of these cases are in Kano State. (...) We are also aware of the fears of people as expressed by your Highness on the polio vaccine. I remember even in my country Zimbabwe people initially hide their children from immunisation fearing that those immunised will become pigs. This is because the exercise was not explained to them properly, and when this happens it creates doubts and suspicion.(...). We need your blessing, your support and cooperation to succeed in this exercise. Thank you your Highness.

The Emir de Kazaure: Thank you very much for your visit. I must say that you have read the WHO Advocacy manual very well by the way you spoke persuasively about your mission here. I have been going through the manual myself, and, I have seen how sophisticated and aggressive it is.

In 2000 and 2001, when we informed the WHO of our fears and concerns [regarding the possibility that the vaccine contains substances that could render the population sterile], we received the response that the medicines had been certified by the WHO and manufactured in the best possible conditions, and that the vaccine contained no other ingredient. We wanted to have evidence but what we are given is only assurances. To address the fears of our people, we had to carry out our own investigations, look at books and conduct Internet research. All the books and documents you see here are on polio. So you can see for yourself, Madame, that the fears of my people are not those of the people of Zimbabwe, where people thought that the vaccine would transform them into pigs. Our fears are more centred on medical issues.

When you have vaccinated a population, you tell us that you have reached 60, 70 or 100,000 people, that all the children of the State have been vaccinated. Then you return the next day saying there is a new case, and you need to revaccinate the entire State. What does that say about the vaccine's effectiveness? But we are beginning to see why some of these questions are not being answered. In the United States for example, they have the vaccine Adverse Reaction System, but we don't have such a system here. No one knows what's going on, you come, you vaccinate, you raise funds and the following year, you re-vaccinate the same children. But what are you after, what is the WHO after? What is UNICEF after? Why all this desperation? How much money has been spent in Nigeria to wipe out 109 cases? How many children die of measles, malaria, diarrhoea? [...] ».

During the discussion, the Emir of Kazaure evoked the discrepancies between the population's health priorities and those imposed by Global Health actors, discrepancies that the WHO and its partners have since made partial efforts to reduce by including the distribution of bed nets and vaccination against measles into the polio campaigns. He also questioned the relentless efforts made by proponents of eradication: The latter justify their relentless determination on a range of arguments - symbolic (the eradication of poliomyelitis is a "generation defining achievement"), financial (the perspective of eradication stimulates donor interest, and would be cheaper than a containment strategy) and security ("polio anywhere is a threat everywhere"). These arguments, far removed from the day to day public health concerns of many Pakistani or Nigerian families, could render the "last miles" of the road towards the eradication of polio an impossible distance to cover.

Whatever the case may be, for action against polio to be effective, the motives of the vaccinators' murderers - real or supposed - must not be assimilated with the populations' resistance to vaccination. And perhaps it must be accepted that negotiations are needed with these latter to ensure acceptance of reasonable public health measures, in terms of the constraints they entail and the benefits they provide.

HPCR