The Politics of Polio in Northern Nigeria

In 2008, Northern Nigeria had the greatest number of confirmed cases of polio in the world and was the source of outbreaks in several West African countries. Elisha P. Renne explores the politics and social dynamics of the Northern Nigerian response to the Global Polio Eradication Initiative, which has been met with extreme skepticism, subversion, and the refusal of some parents to immunize their children. Renne explains this resistance by situating the eradication effort within the social, political, cultural, and historical context of the experience of polio in Northern Nigeria. Questions of vaccine safety, the ability of the government to provide basic health care, and the role of the international community are factored into this sensitive and complex treatment of the ethics of global polio eradication efforts.

Anthropologist Renne (Univ. of Michigan) provides an insightful analysis and a detailed historical background of the controversial campaign to eradicate polio in northern Nigeria. Her important study reveals how Western public health experts misunderstood the epidemiology of polio in Nigeria and shows how this contributed to the way local people negatively perceived the campaign to eradicate polio from 1988 to 2009, ultimately undermining its effectiveness. As Renne argues, because their children faced even greater threats from malaria and measles, Nigerians saw the Western obsession with polio as misguided. She shows how international efforts to prioritize northern Nigeria as part of a global polio eradication program impinged on more pressing needs for a broad-based public health campaign. In the context of tensions between Nigerians and the West, many people were suspicious of intrusive public health initiatives and opposed them as part of broader political expressions. Renne also situates the campaign in the wider framework of new trends in public health that emphasize specific disease eradication and technology. This well-written work complements similar studies, such as Randall Packard's White Plague and Black Labor (1989) and Luise White's Speaking with Vampires (2000). Summing Up: Recommended. Upper-division undergraduates and above. -- ChoiceA. S. MacKinnon, University of West Georgia, May 2011

"An awesome, thoughtful piece of work exploring in remarkable detail the subject of eradication, the ethics of eradication, and the motivations of all parties concerned." --Donald Henderson, Center for Biosecurity Indiana University Press

"Renne understands the stakes and has done some important research. The issue of vaccination resistance and protest in Northern Nigeria has gained a great deal of attention in the media." --Julie Livingston, Rutgers University

"[P]rovides an insightful analysis and a detailed historical background of the controversial campaign to eradicate polio in northern Nigeria.... Recommended." --Choice Indiana University Press

"[T]his book provides a strong, comprehensive analysis of opposition to polio vaccination in northern Nigeria and provides fodder for the continuing debates about vertical, directed programs, eradication, and 'broad-based health projects'... worldwide." --Medical Anthropology Quarterly Indiana University Press

"A remarkable exploration of ordinary Muslims' often skeptical response to polio and other vaccinations promoted by their government and WHO. Renne may not persuade you that Muslims' fears were justified, but she ensures you will understand their rationale. An invaluable, provocative text for all those involved in promoting 'global' health." --Murray Last, University College London

The Politics of Polio in Northern Nigeria is a detailed examination of efforts being made to eradicate polio in an area in which polio is endemic and that in 2006 had the largest number of naturally occurring (wild) polio cases in the world. The author painstakingly examines the failure to eradicate the disease after more than a decade of trying. The book traces the influence of the country's social and historical contexts on the politics affecting polio vaccination. The book is interesting and shows insight into the effects of the country's culture on the slow acceptance of polio vaccine.

Chapter 1, 'Introduction: Protesting Polio,' begins with a story about a father, his child with polio, and how a bias against Western medicine (in favor of a traditional healer) affects the child's disease. Although the chapter discusses the epidemiology of polio, it also stresses the importance of religion in determining attitudes toward the polio vaccine. The population of Northern Nigeria is divided between Muslim and Christian groups. Among the Muslims, there is distrust of the vaccine, often manifesting as fear of contamination with human immunodeficiency virus or other diseases. I was puzzled by the title of this chapter until the end, when the author explains that the religious affiliations of many Nigerians cause them to 'protest' the polio vaccine by not allowing their children to take it.

In chapter 2, the author compares the course of smallpox eradication in Northern Nigeria with that of polio. The smallpox program succeeded in 3 years, apparently because smallpox was 'widely recognized as a dangerous disease,' while relatively few individuals have had experience with paralytic polio, experiencing it most commonly as a cold or fever. Chapter 3 chronicles the course of the Polio Eradication Initiative. Chapter 4 delves deeper into the philosophy of many Northern Nigerian Muslim parents toward immunization. For some who do not want to expose their healthy infants to the vaccine, prayer is enough. Apparently in this context, Kariya Allah, which translates into 'natural immunity,' can be interpreted as the natural protection provided by Allah, rather than the response of the immune system after being exposed to a virus. It is not surprising that the next logical step is for each political party (Muslim or Christian) to try to sway interpretation of what a vaccine is.

I found chapter 5 to be the most interesting, because it discusses cultural mores and begins to dissect the social roles of persons with polio. It details the perception and treatment of those who have been paralyzed by polio in Northern Nigeria, with attitudes toward physical disability largely affected by ethnic context. According to the author, among the Yoruba society (Christians), disabled persons are kept at home because of fear for the family's reputation. Among those from the Hausa society (Muslims), disability is thought given by God and not socially stigmatizing. In fact, because good fortune is also given by God, people are encouraged to share their good fortune with those unable to work because of disability. Alms giving during Ramadan (zakkat) is one of the 5 primary obligations of Islam. As a result, begging has apparently been considered a vocation, with expectations that paralyzed boys would earn a living through begging, returning home to sleep at night. With improvements in the education system, however, begging is coming to be considered shameful, and educated persons with polio now look for other ways to support themselves. New international initiatives concerned with the rights of disabled persons to receive training and assistance are also affecting change.

Chapter 6 compares the attempts to eradicate polio in Northern Nigeria with that in Northeastern Ghana, where Muslims actively participated in the eradication effort. Chapter 7, 'The Ethics of Eradication,' examines the cases for individual as well as public health viewpoints concerning vaccination choices. This chapter seems self-evident in light of the previous chapters. It would have benefited from some quantitative information regarding polio in Northern Nigeria and some speculation about appropriate future steps.

Overall, The Politics of Polio in Northern Nigeria takes an interesting look at a public health issue from a sociological and cultural aspect. It contains important insight into the Northern Nigerian culture. However, it requires some determination to finish; the prose is dry and reads like a dissertation. The book is peppered throughout with individual cases, which makes it a little more colorful, and the photographs in the middle are visually engaging.

Author Information

1. Author Affiliation: Dr Chang is Contributing Editor, JAMA ([email protected]).Dr Chang, Contributing Editor, JAMA JRNL AMERICAN MEDICAL ASSN, August 3, 2011

Elisha P. Renne is Professor in the Department of Anthropology and the Center for Afroamerican and African Studies at the University of Michigan-Ann Arbor. She is author of Population and Progress in a Yoruba Town and Cloth That Does Not Die and editor (with E. van de Walle) of Regulating Menstruation.

Acknowledgments

1. Introduction: Protesting Polio

2. Smallpox and Polio Histories

3. Politics and Polio in Nigeria

4. Islam and Immunization in Northern Nigeria

5. Polio, Disability, and Begging

6. Polio in Northern Nigeria and Northeastern Ghana

7. The Ethics of Eradication

Epilogue

Notes

Bibliography

Index