What is state failure? See my conceptualisation of state failure on the right flank below.

Monday, October 15, 2007

The fight against polio in Nigeria and in Pakistan

"Facing leaders and led" (illustration)
The "war" on polio (poliomyelitis), the aim to completely eradicate the disease, was declared in 1988. At that time some 350,000 cases occured annually worldwide. By 2003, with only less than 2,000 cases throughout 2002, it became possible for the WHO to shortlist a few countries where cases still occured, as well as those that were more at risk than others. This came one and a half decade and $2 billion into the polio eradication effort which was originally expected to achieve its total objectives by 2000. Seven countries were included on that list as remaining source countries, and three of the seven accounted for 99% of all cases at the time: these were India, Pakistan and Nigeria (BBC, May 13, 2003).
However, in 2003, in Nigeria, the oral polio vaccination (OPV) campaign that the WHO launched there ran into much resistance in the north of the country, especially in Kano state (with a predominantly Muslim population). In August, 2003, religious leaders in Kano and elsewhere already advised parents not to let their children be vaccinated. And the situation turned even more serious after the Jama'atul Nasril Islam organisation (a northern Nigerian Muslim umbrella organisation) announced that they sent a research team to India which concluded, statedly based on the results of scientific tests there, that the vaccine distributed in WHO's mass immunisation drive wasn't safe, and that so they would boycott the campaign. The governors of Kano, Kaduna and Zamfara endorsed the boycott from October, 2003, and so the WHO was effectively banned from carrying on with its campaign in the area. It was only in 2004, a year later, that that ban was lifted, in the wake of the publication of then freshly produced scientific evidence showing the vaccine to be safe, endorsed by the Nigerian government (Current Drug Safety, 2006; BMJ, February 2004).
Resistance hasn't disappeared altogether of course, but the resumption of immunisation in the north had the result of reducing the number of new cases, reversing bad trends after 2003 somewhat. Now, however, the FP Passport blog has pointed to news a couple of days ago that since 2005 some 69 Nigerian children are found to have been paralysed indirectly as a result of the vaccination itself: because they weren't vaccinated, and other children, who were vaccinated, passed on the weak virus used in the vaccine to them, and upon infection they developed the disease (as a result of the vaccine virus' mutating back to its dangerous form). Note that this happened because these children weren't vaccinated - note it, because it's a safe bet some religious leaders won't do that. Some will rather say it's because of the dangers of the vaccination that these children were paralysed.
Why is this relevant for a blog currently preoccupied with Afghanistan? Well, “in terms of polio eradication, the two countries are one,” declared Pakistan's health minister Nasir Khan about Pakistan and Afghanistan in February, 2007, in Geneva (IRIN, March 22). And in Pakistan, as I've noted in a post discussing an article by Hassan Abbas in the previous days, polio eradication largely failed in Bajaur Agency in the Federally Administered Tribal Areas (FATA) this year. FP Magazine has a list published of what it calls "the world's most stupidest fatwas," and it includes among those the one issued by clerics in the FATA stating that the immunisation drive is an evil plot to sterilise Muslim children (in opposition to the Muttahida Majlis-e-Amal's quite significant backing to the campaign, actually).
And that's a charge (the sterilisation charge) that's been heard before, in Nigeria, already.
It would be impossible (some would say immoral) to argue that a fatwa like the one just mentioned isn't "stupid." So how can it come from supposedly smart leaders of communities then? I mean, to become a leader you have to have some skills, you just can't do without it. Supposing that not every such leader voices charges of the above kind honestly believing in them, as it seems appropriate to assume, the question might be how saying something clearly stupid can be the rational course of action for them? Here's a list of some things to point to, in reply to that question:
1) Already in the case of Nigeria it is claimed by some that one of the sources of these unholy charges was conspiracy propaganda on the internet, see in this article (IRIN).
2) Past incidents of questionable practice by Western pharmaceutical firms - IRIN cites the example of a Pfizer test drug that was used against meningitis on Nigerian patients, with possibly serious side effects. Court proceedings are underway to determine exactly what the company might be responsible for, but even while those are underway some religious leaders will surely already have their own version of a sentence.
3) In the case of Nigeria: I would suspect that one of the reasons why stupid can be smart is exactly that it's smart, in a way, because it's "stupid" (= irrational in a sense). International governmental organisations as well as most humanitarian NGOs legitimise their presence and influence worldwide by claiming an apolitical, neutral status, and by referring to the superior instrumental rationality of their actions, at least within the bounds of thinking that attaches prime value to the individual's biological life. Saying anything that questions the legitimacy of these actors is therefore a rational strategy for such local actors who can thus preserve or expand their influence in the absence of an ability to compete with IGOs and NGOs in the individual biological life-centric provision of public good. Hence the call for tradition-based value-rationality ("Allah will protect his own"). And hence the spreading of rumours about evil plots or the presentation of statedly scientific findings on negligent wrong-doing (in that case turning benevolent IGOs' and NGOs' own logic of self-legitimisation against them).
4) In the case of Pakistan and the FATA: just think of the talk of evil plots, and it's all understandable, given how the Pakistani government is often depicted by Islamist forces as "evil" and as a tool of the "evil West."
Note that this is meant to be value-neutral, rationalising analysis here. I'm not value-neutral at all of course, and I fully support WHO's immunisation efforts. This here has been an analytical look at something I myself define as worrying: when WHO is close to making a disease disappear, as it has happened back in the case of smallpox, it is cause for concern that exactly some of the remaining few centres of the epidemic are where we see religious movements opposing polio eradication efforts. A thought-provoking quote to finish with then, about smallpox eradication in eastern India and in Bangladesh in 1973-1974:
" Police force and military methods were used when necessary, and it was standard practice to post guards on houses and establish tight perimeters in villages where smallpox cases were detected; everyone inside the village was vaccinated, even though some may have been immunized previously [...]. While smallpox eradication has been rightly hailed as a great public health achievement and a blessing on future generations, it was achieved in parts of South Asia at the price of ignoring rights that would have been respected in the North, where conscientious objection guaranteed exemption from immunization for the last century. " (Clements, Greenough and Shull, 2006: 118)
Whatever thoughts this quote provokes, for me the key facts are how infectious polio is (it spreads very rapidly where children/people aren't vaccinated), and how serious its consequences can be. Yes, it can spill over borders, too. See here, for example.

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