Polio: The Infertility Conspiracy by Ashraf Usman
Polio is an acute viral infectious disease, transmitted from person to person. It’s complications are widespread depending on the severity of the infection. 90% of the infections actually cause no symptoms at all, and in around 1% of cases, the infection affects the central nervous system. This leads to an array of complications. In children under five years of age, paralysis of one leg is most common; in adults, extensive paralysis of the chest and abdomen also affecting all four limbs (quadriplegia) is more likely.
The disease has attracted widespread public attention and headlines for the past few years. But with such a low mortality rate, why does polio continue to generate heat? Well the answer is simple. The number of people dying or even infected may be negligible when compared to a more widespread and deadly disease like malaria for example, but this is a disease where a vaccine is readily available. It is almost 100% preventable. Get a vaccine and you are safe from polio. You don’t even need to pay for it. Get two if you really want to.
But Nigeria is not that simple. The Polio Eradication Programme (to get every Nigerian child a polio vaccination and eliminate new cases of polio) was started in 1996. It made headway until 2003 when it hit a brick wall. Well, it was more like a bouncy wall because polio came back hard. The bouncy wall was the viral rumour and conspiracy in northern Nigeria that the programme and vaccination was the brainchild of the West to make the population sterile/infertile. The rumour then caught like wildfire when it hit a nerve with some clerics, who subsequently called for the boycott of the programme. Several state governments gave in due to the sheer popularity of the conspiracy. By the time the programme resumed around one year later in some states, the damage had been done. The cases had rebounded and even spread to other border countries that had prior to the bouncy wall, achieved 100% eradication. Many years on, and we are still in the same place. Isolated in the perturbing company of Pakistan and Afghanistan, we are the only three countries to have recorded new cases of polio in 2013. And in the month of February, the disastrous killings of polio workers were carried out in rural Kano, bringing the topic to the front pages again for all the wrong reasons.
Primarily, this write up is just me trying to promote discourse and understanding of the topic in order to get some minds thinking and more importantly instigate people to propose possible solutions. Not an understanding of the physiology of the disease; or its transmission; or its prevalence. We have Wikipedia for that. I want to try and understand what I am going to term, The Infertility Conspiracy and how such an outlandish theory managed to gain so much ground.
The infertility conspiracy has been around for a decade now, but can we honestly say we have made progress in defeating it? I don’t think so. And the reasons are manifold. I think it’s easy to read a headline about the conspiracy and just kiss your teeth at ‘those villagers’, or ‘those northerners’, because you don’t understand the context of the problem. Northern Nigeria is the perfect place for a conspiracy theory like this to find a perfect home. Firstly, the low literacy levels, especially in the communities that neglected the programme make for a desensitized community. Secondly, there already exists a lack of trust between the communities and whatever they see as a symbol of the state.
Here I think it is important to note that this level of suspicion exists for a reason. Most rural communities would have heard stories about the Pfizer meningitis trial. Bare in mind too how stories get exaggerated, chopped and screwed in Nigeria, in a Chinese-whisper like fashion. However the facts are, in 1996, 11 children died and dozens were left disabled after Pfizer gave them the experimental anti-meningitis drug, Trovan. This took place in rural Kano. The victims were left to their own means with no help from Pfizer. In fact, Pfizer even denied responsibility saying that the deaths could have been as a result of the meningitis. That was in court of course. A whole 15 years later they did accept responsibility by settling out of court with the Kano State Government. If you were a rural villager in northern Nigeria, would stories like this not make you more susceptible to believe conspiracies like the infertility conspiracy? The average villager does not know the difference between a drug trial and an eradication programme. They do not know the difference between the World Health Organisation, The Bill and Melinda Gates Foundation or Pfizer. To them it is just ‘the white man and his medicine.’
There are of course other theories of drug trials gone bad, whose stories could have contributed to such a pessimistic process of thought. I am sure you have heard of the Nodding Disease in Uganda. (Here is a Huffington Post link and here is a short YouTube clip). It is a dreadful disease that you wouldn’t wish upon your worst enemy. It isn’t uncommon in endemic areas in northern Uganda to see children tied up to a tree. This is done by their own parents as a form of protection against severe seizure attacks and to stop them wandering off. Imagine hearing such stories, in a place where you don’t particularly have a significant amount of trust for the authorities anyway. Would you not rather let your kid live with whatever disease he or she has than have them suddenly become an agama? An agama with a diminished mental capacity without the ability to talk.
However, the facts are, that the cause of the nodding disease is actually a mystery. Pharmaceutical companies have steered well clear of claiming responsibility, but the local population, are adamant that it was as a result of ‘the white man and his medicine’. The Ugandan governments willingness to open itself up to these drug trials for a dash of cash too does little to help the fight against the conspirators. The link here offers a deeper insight into the nodding disease conspiracy.
But back to Nigeria, conspiracy or no conspiracy, drug trial or no drug trial, the matter remains that the people have heard these stories and it influences their decision making. So now we have this problem. How do we solve it? Well what first comes to mind is to identify a team of trusted persons who the rural communities will listen to, and have them carry out tests on the medicine and report back to them with the results. Science is not exclusive to anyone and these would be basic tests. However of course, this has already been tried by the former governor of Kano state, Ibrahim Shekarau, who suspended the vaccination to do exactly what I just described. However, his effort failed epically after an onslaught of politicisation by local and foreign media.
Finding the right solution is a case of finding the right policy and strategy, strong political will and adequate funding. What I can put forward though, as a raw proposal, is the integration of locals into the sensitization efforts. Let us call it LIPS (The Local Integration Policy of Sensitisation). I think the best way to persuade somebody is to communicate to them in their own language (not just tongue). We have to try and remove the veil that it is a programme from the west. The programme would be given a short life span, so as to reinforce the intensity of the programme.
A sensitisation team needs to be put in place that can travel with the vaccine administrators or prior to their arrival. The team could be made up of health workers, local clerics and polio victims. Already in places like inner Kano, there are voluntary polio victims going around trying to get parents to let their children receive the vaccination. I think this is the best form of moral persuasion you can give. A parent seeing what polio has done to a person first hand would really hit home. You are basically saying to them let us give your child this vaccination or he/she can end up like me! As you will see in Nusaibah Kofar-Naisa’s (@NusaibahNaisa on twitter) mini-documentary titled, ‘A Gateway Into Kano’ there are polio sufferers willing to play a more significant role. It just needs to be formally incorporated into an intensified effort from the higher tier of government to the lower. Meanwhile, in the other ear you have local clerics debunking the conspiracy theories they may have heard of.
With this advanced team too, you could also use the opportunity to assess the acceptance or stubbornness of the area to the vaccination, and allocate resources, time and effort accordingly. Such an assessment can then be used to identify potential hot spots and discreetly increase the presence of security personnel in the area when the health workers are due to avoid the kind of killings that occurred in February.
Other options that could possibly make a difference are incentive driven immunisation programmes. This was one of the techniques adopted in India and was successful. Upon research I came across this study also conducted in India. Full immunisation was significantly increased in areas where incentives were offered. The down side to this however is of course that an increased cost is involved. But surely the economy takes a bigger hit in constantly being spoken of in the same breadth as war ravaged Afghanistan.
Part of the polio stubbornness, experts believe, is the nomadic Fulani travellers, who generally don’t stay in the same place and can carry polio from place to place. It is a potential polio reservoir.
“Until we solve the problem of these unvaccinated nomads, we’re not going to fix polio,” says Frank Mahoney, a veteran field epidemiologist.
But with the right policy and strategy, they too can be reached. A combination of the proposals above would be where I would begin. Couple this then with tracking the Fulani nomads. It is possible and isn’t rocket science with the availability of satellite imagery and identification of their settlements and where the fertile land is, to predict their likely movement.
I hope this article serves its purpose of helping to create a public dialogue on how to solve this persistent problem, and understanding the infertility conspiracy rather than tribalise it as we love to do. If our government has ran out of ideas, we haven’t. What did we go to school for? A wide discussion on the topic could compel the authorities to at least re-intensify its efforts, and try something different.
Believe it or not I really tried to keep this as short as possible. What do you think of my raw ideas? Do you have any ideas of your own? Do you have any feedback, criticisms or suggestions? Drop them in the comments section.
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