By Dr Cesar Chelala
One of my most persistent memories of my friend Albert Sabin, who developed an oral vaccine against poliomyelitis (polio), was how, when we met after one of my health-related missions overseas, he would question me about the polio situation in the country I visited. I am sure he would be dismayed at the return of polio in many countries, and even more so when this phenomenon is due to the spurious use of public health programmes.
In July 2011, an investigation carried out by The Guardian revealed that the CIA had organised a false vaccination programme where Bin Laden was reportedly hiding, as a way to obtain DNA samples from the Al-Qaeda leader’s family. The CIA had been monitoring the compound were Bin Laden was believed to be living, but the agency wanted confirmation of this fact before mounting a risky operation in another country.
If it could be obtained, DNA from any of Bin Laden’s children could then be compared with a DNA sample from a Bin Laden sister who had died in Boston in 2010, to establish that the family was then at the compound.
A Pakistani doctor, Shakil Afridi, organised a hepatitis B vaccination campaign to be carried out at Abbottabad, the town where Bin Laden was believed to be hiding. Health workers were among the few people who had visited the compound before to administer polio drops to some of the children.
After the deception was revealed by the British newspaper, however, the ruse had an unexpected outcome. Angry villagers in several tribal areas on the Afghan border chased away legitimate health workers. They accused those workers of being spies who wanted to gather information on the people living in that region.
The unfortunate result is that many children were not vaccinated against polio and the disease made a comeback in areas from where it had been practically eliminated. Paradoxically, the cover used by Afridi wasn’t the polio vaccine but the hepatitis B vaccine. “There could hardly have been a more stupid venture, and there was bound to be a backlash, especially for polio,” stated Zulfiqar A. Bhutta, an immunisation expert at Aga Khan University in Karachi, Pakistan. According to many experts’ opinions, this provoked one more setback in the war against polio, which by many assessments could have ended in 2000.
For many years, polio immunisation campaigns have been a source of controversy among Muslims in many countries. Rumours associated with the vaccine: that it carries the HIV, that is unclean under Islamic law, or that it is a Western plot to sterilise Muslim girls, have led to many people in Muslim countries to reject the vaccine. This has resulted in the resurgence of polio in those countries.
This is the case in Nigeria, where in 2003, the governors of three states in Northern Nigeria – Kano, Kaduna and Zamfara – decided to suspend polio immunisation until the vaccines were investigated and proven safe. Although tests conducted at the National Hospital Abuja and at a laboratory in South Africa showed that the vaccines were uncontaminated, the Kano state government declared that its own tests showed the vaccine contained oestrogen in quantities that could lower fertility in women.
As a result, polio, which had been eradicated from almost all of Nigeria, made a comeback not only in Kano, but in other parts of Nigeria, including Lagos, the nation’s commercial capital. Afterwards, Nigerian strains of the polio virus appeared in several west and central African countries, such as Benin, Togo, Ghana, Burkina Faso, Cameroon and Central African Republic.
We thus have a situation where both founded and unfounded beliefs have led people in several countries to reject immunisation against a disease that by many criteria should now be a fact of history. And this is happening at a time when polio’s resurgence has been called a “global emergency” by the World Health Organization (WHO). According to that agency, the first few months of 2014 have seen a significant rise in polio infections across the globe.
As things stand now, a coordinated international response is imperative, as is the commitment of political leaders not to use public health campaigns for spurious political means.
Dr Cesar Chelala is an international public health consultant and a winner of an Overseas Press Club of America award and a national journalism award from Argentina.