Vaccines, the CIA, and how the War on Terror helped spread polio in Nigeria

Vaccines, the CIA, and how the War on Terror helped spread polio in Nigeria

http://www.guardian.co.uk/science/the-lay-scientist/2011/jul/15/1

How a polio vaccination in Nigeria collapsed in the face of anti-Western sentiment and conspiracy theories, and why using a vaccine drive to hunt Bin Laden may not have been the smartest idea ever conceived by the CIA's strategists







Residents of Columbus, Georgia awaiting polio vaccination in the early 1960s. Guardian reporter Saeed Shah claimed this week that "the CIA organised a fake vaccination programme in the town where it believed Osama bin Laden was hiding in an elaborate attempt to obtain DNA from the fugitive al-Qaida leader's family."



It sounds a bit like something out of a bad novel, and has aroused the anger of Medicins sans Frontiers and bloggers like Seth Mnookin, who point out that anti-vaccine conspiracy theories abound in the developing world (and here too of course), and suggest a CIA plot involving a vaccine programme is hardly going to help matters.



Two writers at the Guardian, Sarah Boseley and Andrew Chambers, highlighted the problems caused by anti-Western sentiment and conspiracy theories in Nigeria, where attempts to eradicate Polio fell into disarray in the mid-noughties. Neither went into much detail about it, so I thought I'd add a little background here.



In 1988 the World Health Organzation launched an ambitious attempt to mass-vaccinate African children against poliomyelitis. This ramped up in 1996 with a campaign to "Kick Polio out of Africa", launched by Nelson Mandela, and supported by the African Football Confederation. Combining vaccinations with health worker training and door-to-door awareness campaigns, aid workers swept across Africa and drove the disease into full-scale retreat. Fifty million children were to be vaccinated in 1996 alone.



By 2003, much of Africa was polio-free. In a fascinating review published in PLoS Medicine in 2007, bioethicist Ayadele Jegede takes up the story of what happened next:



in mid-October 2003, the GPEI launched what was hoped to be the final onslaught against polio, with a plan to immunize more than 15 million children in west and central Africa. The GPEI had particular concerns about the high prevalence of polio in Nigeria, which accounted for 45% of polio cases worldwide and 80% of cases reported from the African region in 2003 [Renne, 2006].



Things began to go horribly wrong when the officials of three states in the northern, Muslim regions of the Nigeria - Kano, Kaduna, and Zamfara - refused to allow the vaccine to be administered in their territories.



Vaccination campaigns need to reach virtually 100% of a population to prevent pockets of resistance from emerging. For this to happen, healthy people must allow themselves to be treated with preventative medicine, and so public trust is immensely important. If trust is eroded - as we saw in Britain with the media-driven MMR hoax - a mass-vaccination strategy becomes very difficult to manage. You can judge for yourself what Jegede's paper reveals about the state of trust in northern Nigeria:



[The leaders of the three rogue states] argued that the vaccine could be contaminated with anti-fertility agents (estradiol hormone), HIV, and cancerous agents. Datti Ahmed, a Kano-based physician who heads a prominent Muslim group, the Supreme Council for Sharia in Nigeria (SCSN), is quoted as saying that polio vaccines were 'corrupted and tainted by evildoers from America and their Western allies.' Ahmed went on to say: 'We believe that modern-day Hitlers have deliberately adulterated the oral polio vaccines with anti-fertility drugs and viruses which are known to cause HIV and AIDS'.



This story is depressingly familiar for the UN and WHO, particularly in the wake of 9/11 and the subsequent War on Terror. The AfPak region has been a particularly tricky area in which to gain trust, for obvious reasons, and in 2007 the parents of twenty-four thousand children refused to allow health workers to administer polio vaccines. The Guardian reported at the time that this was "mostly due to rumours that the harmless vaccine was an American plot to sterilise innocent Muslim children."



In Nigeria, as in Pakistan, Muslim clerics played a key part in driving these rumours, playing on anti-American sentiment and fears that America's wars were part of a wider war on Islam. Back in 2004 Ali Guda Takai, a WHO doctor working in Kano, told the Baltimore Sun:



What is happening in the Middle East has aggravated the situation. If America is fighting people in the Middle East, the conclusion is that they are fighting Muslims.



Of course it would be simplistic to blame these failures entirely on the War on Terror. Nigeria has a large and growing population, over 154,000,000 according to World Bank as of 2009, having added the equivalent of the entire UK in twenty years. Since at least the 1980s, population control has been a controversial political issue.



In a male-dominated culture with a strong tradition of polygamy (in the Islamic north at least), where children are seen as gifts from God, the power of men is measured by the size of their families, and different political, ethnic and religious groups compete to be the most populous, fertility is an especially sensitive issue. After various government attempts to tackle the problem, and reduce family sizes, many Nigerians have a fear of state health plans that borders on paranoia, as Jegede's review notes:



Some people connected this population control campaign with immunization, believing that vaccination was one way the government might be reducing the population. This belief was not restricted to northern Nigeria—similar opinions were also expressed in some communities in southern Nigeria.



For example, in an anthropological study carried out in Nigeria, an adult male participant stated that 'people do carry rumour that immunization is a secret way of controlling population.' A young female participant said 'some people say that immunization is part of the methods used to check the number of children a woman can bear.'



A third major factor in distrust of is one that probably wouldn't occur to many of us, described in the Baltimore Sun and quoted in Jegede's paper. Would you trust a stranger knocking on your door offering you free medicine?



The aggressive door-to-door mass immunizations that have slashed polio infections around the world also raise suspicions. From a Nigerian's perspective, to be offered free medicine is about as unusual as a stranger's going door to door in America and handing over $100 bills. It does not make any sense in a country where people struggle to obtain the most basic medicines and treatment at local clinics.



The end result of all this was that the attempt at total eradication failed, and polio remains in Nigeria to this day. By 2006, the region accounted for more than 80% of global polio cases, and became an exporter of the virus to other nations as far afield as Yemen, Saudi Arabia, and Indonesia.



It's a reminder that, when it comes to health, no country is an island. To pathogens our species is one big interconnected lump of opportunity, whether we like it or not. Vaccines are one of the greatest weapons against disease ever invented, they turn us from victims into conquerors, and they probably shouldn't be taken in vain.



(Adapted and expanded from an article originally published at layscience.net in 2008)



Twitter: @mjrobbins