Date Published: March 20, 2007
Publisher: Public Library of Science
Author(s): Ayodele Samuel Jegede
Abstract: Jegede discusses the recent controversy surrounding polio immunization in Nigeria, in which three northern states boycotted the immunization campaign.
Partial Text: Vaccination is a crucial tool for preventing and controlling disease, but its use has been plagued by controversies worldwide [1–6]. In this article, I look at the controversy surrounding the immunization program against polio in Nigeria, in which three states in northern Nigeria in 2003 boycotted the polio immunization campaign. I discuss the problems caused by the boycott, its implications, and how it was resolved. Finally, I make recommendations for the future to prevent a similar situation from arising.
For this article, I consulted relevant books, journals (online and print), Internet materials, and newspaper articles. In particular, I also searched for documentary materials on the history of vaccination in northern Nigeria, factors responsible for the boycott, and ethical issues arising from the boycott.
Due to the difficulty faced by some national governments in containing polio outbreaks, the World Health Organization (WHO) in 1988 launched the Global Polio Eradication Initiative (GPEI) with the goal of eradicating the disease by the year 2000 (see  and http://www.polioeradication.org). In 1989, the World Health Assembly approved a global plan of action for eradicating polio and the WHO Regional Committee for Africa adopted the resolution .
Public trust is essential in promoting public health . Such 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.
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.
The federal government, having lost the public trust of one state—a loss of trust fuelled by Muslim leaders—became handicapped in providing health services. In many parts of Africa, communication and authority flow downward from community leaders who are the gate keepers and decision makers. In the Hausa community of northern Nigeria, traditional rulers have powers derived from both culture and religion. This gives them the opportunity to perform both political and religious roles. They rule through the traditional and the Islamic councils, under the supervision of the local government, having their received staff of office from the state government.
A fresh outbreak of polio was reported in Kano in October 2003. The BBC reported that, due to this fresh outbreak, a new strain of the polio virus was traced to other parts of the country . Even many years after the boycott, polio outbreaks remain a regular occurrence in Nigeria, and these show some form of resistance to vaccines. While three or four doses of polio vaccine administered to a young infant are enough to provide protection in most parts of the world, in Nigeria, with so much polio virus circulating, children under five years must be immunized up to eight or more times .
The vaccine boycott in Nigeria was influenced by a complex interplay of factors. These factors included lack of trust in modern medicine, political and religious motives, a history of perceived betrayal by the federal government, the medical establishment, and big business, and a conceivably genuine—albeit misplaced and ineffective—attempt by the local leadership to protect its people.