A must-read article in The New Yorker: The Political Fight Against Polio. Excerpt:
In recent years, a bright spot of polio-eradication efforts has been Nigeria—a country that also raises some of the most challenging questions about sustaining progress in the absence of peace.
The mass abduction of schoolgirls in April made the threat of violence tied to Boko Haram more visible to the rest of the world. It has taken creative tactics by health workers to grow immunization efforts amid the resulting unrest, including efforts by insurgents to thwart them. In February of last year, gunmen on motorbikes reportedly shot dead at least nine female polio-vaccination workers in two Kano-area clinics.
The public blame quickly fell on Boko Haram, as well as on certain Muslim leaders who had declared the vaccine a Western conspiracy aimed at causing infertility.
The shootings in Nigeria echoed mass assassinations in Pakistan, where more than sixty polio workers and security personnel have been killed since 2012. Although such attacks have a long history, they were stoked, in part, by reports that the C.I.A. used a phony vaccination campaign in the hope of collecting DNA from Osama bin Laden’s compound in Abbottabad. (After objections from prominent public-health figures, a top White House official announced last month that the C.I.A. had agreed to cease using vaccine programs in spy operations.)
Pakistan is now living with the results of anti-vaccine attacks, public distrust, and authorities’ fumbling: at least sixty-six cases have emerged so far this year.
Nigeria, thus far, has largely avoided such a fate. “The insurgents make it very difficult to immunize the children as planned, but that has not deterred us completely,” Pascal Mkanda, who leads the W.H.O.’s efforts on polio in the country, told me recently. He added, “We’ve tried to go around the problem and create innovative solutions.”
One example is “firewalling,” whereby vaccinations are given to children entering and exiting the so-called no-go areas that health workers can’t reach. Another involves training local elderly women to create “permanent health teams,” which administer vaccines and other small health interventions quietly, without fuss.
There’s also an approach, known as hit and run, whereby immunization teams move quickly into dangerous locations and complete campaigns in a day or two; often, Mkanda says, this means working closely with government security and intelligence forces, getting reconnaissance about “areas where we can go and where we can’t go.”
But such collaborations carry risks, too. Last week, I spoke with the Elisha Renne, of the University of Michigan, an anthropologist who wrote about the relationship between polio transmission and political violence in northern Nigeria for a forthcoming issue of the journal Africa. (She is also the author of “The Politics of Polio in Northern Nigeria,” from 2010.)
Renne worries that the government’s perceived rights abuses in their pursuit of Boko Haram—including questionable home raids and the arrests of journalists who air anti-vaccine sentiments—may tarnish the hard-won credibility of health workers who rely on coöperation with police to operate in dangerous areas.
“People are afraid of the government; they are afraid of the police,” she said. “Polio workers are seen as part of the government now, in the northeast.” That, too, has its dangers.
The problem of parents refusing vaccines for their kids, it turns out, is far smaller than the problem of children never having the chance to be immunized, owing to political violence thwarting health-worker access. But it’s alarming how quickly that can change. An eruption of anti-vaccine sentiment in Nigeria a decade ago, followed by a wave of infections, made that clear.
Oyewale Tomori, who chairs the Expert Review Committee on Polio Eradication in Nigeria, reminded me by phone last week that just two or three cases of polio can quickly escalate to thousands.
“In 2010, Kano was dancing … they had overcome the polio problem,” he told me. “Almost immediately, the following year, they almost doubled the number of cases they have, and followed the same pattern in 2012.”