By Alexandra Linn, History of Vaccines Intern
In 1988, the WHO predicted that polio would be eradicated by 2000. Today, in 2012, we impatiently watch as polio continues to infect and sometimes paralyze children. Why has polio survived even though international aid groups been working so hard to stop it? One major recent development is mirrored in the past: distrust and boycott of the polio vaccine.
In 2003-2004, three Islamic states in northern Nigeria – the most populous African country — boycotted polio vaccination efforts, with religious and political leaders claiming that the campaigns were a U.S. plot to cause infertility and spread AIDs. At this time Nigeria accounted for almost half of the remaining polio cases in the world and was an important target of polio eradication. Moreover, the Islamic states in the North were at the epicenter of polio disease in Nigeria. When traditional and political leaders boycotted vaccination, the disease spread to not only other Nigerian states, but to seven African countries where polio had been previously eliminated.
Currently a sense of déjà vu looms as the Taliban has launched an effort to block mass polio immunization efforts in North Waziristan, Pakistan. The Taliban have voiced that this blockade aims to prevent what they call a covert U.S. agenda and will remain in place until the United States has stopped its drone strikes in the area. Pakistan is one of the three countries where polio remains endemic (along with Nigeria) and has the largest number of cases of the three. Boycott of the campaign in this area could prevent several hundred thousand children from receiving the vaccine drops. As history appears to be repeating itself, public health workers fear that this boycott will reverse the gains they have made in recent years.
The Taliban decision originated in reaction to U.S. government use of a Pakistani hepatitis B vaccine initiative as a form of espionage to discover if and where Osama Bin Laden was hiding. Dr. Shakil Afridi, the Pakistani physician associated with the plot, is in prison in Peshawar, having been sentenced to 33-year term.
Is eradication even possible?
Ever since Jonas Salk and Albert Sabin developed the inactivated and attenuated vaccines for polio, eradication has been an international goal. Countries such as Pakistan and Nigeria use the oral polio vaccine because it’s simpler to administer – it can be given orally in drop form rather than as an injection – and promotes a stronger immune response to and better prevention against the disease. Smallpox vaccinators were able to overcome the disruptions of war and natural disasters and the challenges of bringing vaccine to remote locations so that smallpox was declared eradicated in 1980. But similar persistent problems, combined with the nature of polio infection itself (a large percentage of cases are subclinical and thus “invisible” to health authorities and communities), mean that polio eradication will necessarily be more challenging to achieve.
The Future: What We Can Learn from History?
Taking a look at how the WHO, UNICEF, and Rotary International overcame the opinions and propaganda in the Nigeria boycott provides hope for a similar success in Pakistan.
Vaccinators during the 2004 Nigeria boycott decided that their most pressing task was to revamp trust in the vaccine. First they persuaded local religious sects to let them teach the local workers to give vaccines – making vaccination more community based. For example, in the village of Ungogo,a community in Kano, vaccinators teamed up with a local healer and went door-to-door educating families on the safety and benefits of vaccines. Moreover, vaccinators satisfied many of the demands of the religious groups such as building a new water system – all in an effort to show their respect for the community and to get back in their good graces.
Currently, health officials in Pakistan are employing a similar approach but face a much larger hurdle. Nigeria’s boycott stemmed largely from rumor, whereas the use of a sham vaccination campaign as a front for espionage in Pakistan presents problems that are more difficult to address. Thus those promoting polio vaccination efforts in Pakistan will have to prove their trust and purpose in new ways if the goal of eradication is to be achieved.
Pakistan Taliban say “No” to polio drops. http://www.dw.de/dw/article/0,,16100760,00.html
Jegede AS. What led to the Nigerian boycott of the polio vaccination campaign? PLoS Med 4(3): e73. doi:10.1371/journal.pmed.0040073 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040073
McNeil DG, Jr. CIA vaccine ruse may have harmed war on polio. New York Times 7/9/2012. http://www.nytimes.com/2012/07/10/health/cia-vaccine-ruse-in-pakistan-may-have-harmed-polio-fight.html?_r=1&pagewanted=all
Linn V. Polio’s final chapter. The Pittsburgh Post Gazette. Photographs by Martha Rial. April 2005.
Fleshman M. Nigeria dispute endangers global polio drive. Africa Recovery, United Nations. February 2004. http://www.un.org/en/africarenewal/newrels/polio.htm