Restoring faith in the polio vaccine

Three-year-old Mustapha Kabiru hobbles to keep up with the other village kids after polio withered his right leg. When Mustapha was a baby, his father refused to let him take the polio vaccination on the advice of political and religious leaders in Nigeria’s northern state of Kano.

Across northern Nigeria health workers say that villagers like those in Kwachiri, a poor farming community some 30 km outside of the state capital Kano city, are slowly accepting polio immunisation again but not before the virus crippled many hundreds of children.

“His father didn’t allow immunisation; he didn’t believe in it,” said Mustapha’s mother, 25-year-old Barahatu Kabiru, as she sits in one of the dark women-only rooms of the family’s mud-walled compound. “But he has changed his mind since his child was affected.”

Mustapha uses his hand to press down on the thigh of his bad leg when he takes each step to prevent it from buckling underneath him. Although he is undergoing physiotherapy at one of the main hospitals in Kano, he will never be able to run and will always walk with a pronounced limp.

Controversy led to spike in polio cases

World Health Organisation (WHO) doctors link Nigeria’s rise in polio cases to the interruption in the polio immunisation campaign almost three years ago.

“This rise in polio is mainly due to non-vaccination. Where immunisation is high we don’t find the disease there,” said Dr. Abdullahi Walla, WHO’s surveillance officer for disease control for Nigeria’s North West region, focused on polio.

In September 2003, Ibrahim Shekarau, the governor of Nigeria’s majority Muslim northern state of Kano refused to take part in a global campaign to eradicate the crippling and sometimes fatal disease. The programme to administer two drops of polio vaccine onto the tongues of some four million children in Kano State ground to a halt.

At the height of the controversy, neighbouring Kaduna and Zamfara states also banned the polio vaccine. Any parents who wanted to vaccinate their children had to travel out of these states or pay at a private clinic - few could afford either option.

Since Kano suspended polio immunisation, there has been a resurgence of cases across 10 African countries previously declared polio-free, with strains traced to Nigeria. A WHO target to eradicate polio by end of 2005, has been missed.

Nigeria now accounts for 70 percent of the world’s polio cases recorded in 2006, according to WHO. Furthermore, over 80 percent of those 685 cases are concentrated in five northern Nigerian states: Jigawa, Kaduna, Kano, Katsina and Zamfara.

Polio spreads rapidly through ingestion of contaminated stool and sometimes saliva and can cause permanent paralysis, usually in the legs, within hours. Young children are most vulnerable. There is no cure. But the oral polio vaccination, which was launched in 1964, can provide complete protection.

Six countries - Afghanistan, Egypt, India, Niger, Nigeria and Pakistan - are classified as polio endemic by WHO.

A Western plot

Nigerian state and Muslim religious leaders claimed that their tests proved that the WHO vaccines were laced with the hormone oestrogen, which they said could cause infertility. They said the vaccines were part of a Western plot to reduce the Muslim birth rate. WHO rejected the claims but people like Mustapha’s father listened to the speeches of their leaders broadcast on radio and on television.

The Polio Victims Association of Kano teaches members skills like welding, carpentry and tailoring to ensure that members don't have to beg. This man is making crutches and special wheelchairs.

From his front porch, the man who said he uncovered the “plot” on the internet, Dr. Dahti Ahamad, a trained medical doctor and fervent proponent of Islam, denied any responsibility for Kano’s newest and youngest polio victims.

“Not at all - responsibility lies with [Nigerian President Olusegun] Obasanjo and his government that supplied the vaccine. They are 100 percent and solely to blame,” said Ahamad.

As one of the founding members of the Supreme Council for Shari’a in Nigeria, which successfully lobbied for the adoption of Muslim Shari’a law in Kano state Ahamad is widely respected. Despite attesting to personally vaccinating hundreds, if not thousands, of children during his days as a doctor, 69-year old Ahamad still refuses to support the campaign.

“If they bring a clean vaccine we will support the campaign but we will not support foreign and local rascals in affecting our future generation,” he said.

Kano’s governor, Shekarau, withdrew his ban on polio vaccinations in August 2004 as has the Emir of Kano - the highest Muslim authority in Nigeria. But the reluctance of Ahamad and other influential Muslim leaders to come on side, or to advocate for polio vaccination as strongly as they fought against it, is making resuscitating the programme difficult, say aid workers.

Low education also a barrier

State and religious leaders are taking advantage of low education levels to flex their political muscle, say aid workers. Northern Nigeria has never embraced education like Christian and animist communities in the south of the country. Many northern children got to Islamic schools to study the Koran, but the Nigerian government calculates that less than half of children in the North West Region of Nigeria go to primary school, compared to over 80 percent in the South West.

“People like Ahamad take advantage of that ignorance. It’s all about controlling power and business - it’s politics,” said an officer with the UN children’s agency UNICEF who asked not to be named.

Aminu Ahmed Wada, Chairman of the Kano State Polio Victims Association on his specially adapted motorbike

Uneducated mothers, says UNICEF, are another obstacle to tackling Nigeria’s high infant mortality rate where nearly one in five children don’t survive to their fifth birthday. Girls are less likely to go to school than their brothers in Kano, where many usually Muslim men worry that an educated wife would be an unruly wife.

In Nigeria, where polio is endemic, the crippling disease is also often attributed to evil spirits or “jiins”. The worst of the evil spirits is the “inna,” which literally means “mother”, in the Hausa language. Folklore says this spirit has the power to paralyse children for sins of the parents or wrongdoings in a past life.

At the busy Murtala Mohammed hospital in Kano city, Dr. Binta Jibir Wudil said that this belief in spirits makes many parents feel powerless to tackle polio.

Nonetheless, Wudil says that slowly more mothers are accepting the vaccines again. She attributes the turn-around, in part, to the dramatic success of a recent measles campaign.

“Last year measles vaccinations were given out door-to-door and it made a dramatic impact - this year we have hardly seen any measles cases,” said Wudil.

Polio plus

So this year the government’s National Programme of Immunisation, conducted in conjunction with the WHO and UNICEF, in May launched a door-to-door “Polio Plus” campaign to inoculate children against not only polio, but also diphtheria, whooping cough, tetanus and hepatitis B.

If there are mothers who are reluctant to get their children inoculated, Yusuf Umar and some of the 2,380 registered Kano members of the Polio Victims Association will be on hand with their own hard-hitting brand of encouragement.

Umar, a 37 year-old polio victim whose legs are frail and useless after falling ill with polio as a child, often joins immunisation campaigns “to show our people, as living examples, of what polio can do,” said Umar, “to show them what can happen if children are not immunised.”

As a further incentive, mothers receive soap, Vitamin A and de-worming tablets. Those who complete the inoculation programme can claim a free bed net impregnated with mosquito repellent to help protect their family against malaria.

Mustapha’s mother says that from now on her three children will take part in every immunisation programme that comes to the village.

“When I see Mustapha walk and see other children walking normally,” said Kabiru, “I feel sad about what happened to my child.”

[NIGERIA: Hear Our Voices - “I feel sad about what happened to my child”]
[NIGERIA: Hear Our Voices - Polio must be stopped]

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