What Led to the Nigerian Boycott of the Polio Vaccination Campaign?

"Public trust...plays an important role in the public's compliance with public health interventions, especially compliance with vaccination programs, which target mainly healthy people. Where public trust is eroded, rumours can spread and this can lead to rejection of health interventions."

This article looks at the controversy surrounding the polio immunisation programme in 3 states in northern Nigeria in 2003. (Political and religious leaders of Kano, Zamfara, and Kaduna states brought the immunisation campaign to a halt by calling on parents to not allow their children to be immunised. These leaders argued that the vaccine could be contaminated with anti-fertility agents (estradiol hormone), HIV, and cancerous agents). The article discusses the problems caused by the boycott, its implications, and how it was resolved. Finally, it makes recommendations for the future to prevent a similar situation from arising.

To start, the boycott itself and background, including historical and political context, are described. In brief, in an article reported by a South African online news site, Sule Ya'u Sule, speaking for the governor of Kano, is quoted as saying: "Since September 11 [2001, the date of the terrorist attacks on the United States (US)], the Muslim world is beginning to be suspicious of any move from the Western world...Our people have become really concerned about polio vaccine." In the same article, 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." In addition to such media reports, one of the factors fueling the boycott, as described here, was the general distrust of aggressive, mass immunisation programmes in a country where access to basic health care is not easily available. In his report for the Baltimore Sun, John Murphy wrote: "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." Also, suspicions about Western health interventions were already circulating in northern Nigeria, ahead of the polio vaccination boycott, in the wake of Pfizer's 1996 "Trovan trial": In 2001, 30 Nigerian families sued Pfizer in a federal court in New York, NY (US) which alleged: "Pfizer chose to select children to participate in a medical experiment of a new, untested and unproven drug without first obtaining their informed consent."

As reported here, in response to public outcry about the polio vaccine, the Nigerian federal government set up a technical committee on October 29 2003 to assess the safety of the polio vaccine, sending samples of the vaccine for laboratory tests abroad. The committee's report, however, was rejected by the SCSN, which alleged that the Muslim community was not properly represented on the committee. "Although the truth of the rumour that the polio vaccine contained HIV and cancerous and anti-fertility agents was never established, the lack of trust among the general population in northern Nigeria about the efficacy of Western medicine remained....This impasse was eventually resolved in July 2004 through dialogue, with religious leaders playing a significant role in the process. The federal government had invited political and religious leaders to a series of meetings in order to find a solution to the impasse. The WHO [World Health Organization] and UNICEF [the United Nations Children's Fund] also played a role in breaking the deadlock. These meetings led to a consensus in February 2004 to accept the SCSN's demand to test the vaccine independently in a Muslim country."

Two months after Kano state resumed its polio immunisation programme, about 150 Muslim clerics and traditional chiefs from Chad, Cameroon, Niger, Togo, Benin, and Burkina Faso met in Kano on September 22 2004 to discuss the way forward with respect to the polio immunisation campaign. The meeting was hosted by WHO and UNICEF, and its aim was to "inform religious and traditional leaders about issues that affect children, with emphasis on polio." The meeting also shared knowledge and experiences and generated an advocacy agenda to ensure that the right messages were delivered to the people.

How can the health community prevent further boycotts? The article recommends that:

• Research should be undertaken to investigate why people have concerns and fears about vaccination.
• Governments should be sensitive to local politics, especially as they affect healthcare delivery. For example, in northern Nigeria, there are 3 types of community leaders; as stated here, it is the traditional rulers - who have acquired their status through succession, and their authority is rooted in traditions and customs - who are best placed to represent the interests of children.
• Public awareness campaigns stress the value of immunisation and involve the media. "Reaching the community requires radio, television, and folk media (such as local music, theatre, and festivals). Immunization messages can be packaged into songs by local musicians and can be communicated through drama in the language that local people understand."
• Research ethics committees should be established in each local government. "Members of these community-based ethics committees should include volunteers who are ready to undergo basic ethics training relevant to their duties....They should choose their own chairperson and determine their own agenda in line with the national ethics code."