Listening to the Rumours: What the Northern Nigeria Polio Vaccine Boycott Can Tell Us Ten Years On

"The response to future crises must build upon the diplomatic success of the 2003 boycott, whilst recognising the importance of community values and the power of individuals."

Between July 2003 and August 2004, five northern Nigerian states boycotted the oral polio vaccine (OPV) due to fears that it was unsafe - in a move that proved a huge setback for polio eradication. Though this set of refusals and the international responses to it have been well documented, this paper argues that the internal, local dynamics of the boycott have not yet received sufficient scrutiny. The authors focus mainly on Kano state, which initiated the boycotts and continued to reject immunisations for the longest period, to provide a focused analysis of the internal dynamics and complex multifaceted causes of the boycott. They argue that the delay in resolving the year-long boycott was largely due to the spread of rumours at a grassroots level that were intensified by the outspoken involvement of high-profile individuals whose views were misunderstood or underestimated. Because refusals still challenge the Global Polio Eradication Initiative (GPEI), the paper aims to shed light on how this problem may be tackled, with the ultimate aim of vaccinating more children and eradicating polio.

Data for this analysis were collected from peer reviewed material and grey literature, which were supplemented by interviews with key informants. Findings are organised according to, first, societal factors:

• Religion and ethnicity: One of the justifications given for the boycott was the belief that OPV spread HIV and caused sterility in Muslim girls. An understanding of the religious elements at play, which, in northern Nigeria, are intrinsically interwoven with ethnic identity, is therefore described here as key to understanding the power this accusation had. To that end, the paper details the significance of the north of Nigeria as being home to a Muslim majority, with corresponding implications such as the fact that "[t]he moral lens of northern Nigerians in 2003 was focused clearly on the neo-imperialist threat to African Muslims posed by OPV."
• Politics: "Domestic political events around this time strengthened perceived cultural divisions between Nigerians." They are described. Also, "[t]he GPEI in Nigeria, which had a large number of well-paid jobs, was especially susceptible to politicisation."
• Society: "Religious and political divisions were exacerbated by social disadvantages in many northern states; poverty is much higher than in other areas of Nigeria....That OPV was offered free amidst more pressing health concerns mystified many and this dichotomy of priorities understandably created resentment....Historical experiences of the pharmaceutical industry in Kano also undermined public trust in Western medical interventions."

While such societal factors provided a fertile ground for rumours to spread, the authors note that the role of local politics - which, in northern Nigeria, is built around individuals - was fundamental to inflaming the disputes around OPV. Here, they analyse four key individuals and groups: Dr Datti Ahmed - president of the Supreme Council for Sharia in Nigeria (SCSN); Ibrahim Shekarau - newly elected Governor of Kano; Professor Haruna Kaita - Dean of the Faculty of Pharmaceutical Sciences at Ahmadu Bello University in Zaria; and several Emirs (traditional and religious leaders) of northern Nigeria. As the authors explain, it was necessary for the GPEI to rapidly establish local ownership to enable immunisations to resume, and it was to these personnel whom they turned. For example, Muhammadu Maccido, the Sultan of Sokoto, the highest ranking traditional and spiritual leader in northern Nigeria, had refused to comment on polio vaccination early in the boycott. After targeted meetings and engagement from GPEI representatives, the Sultan publicly declared OPV safe in March 2004 and personally led vaccination drives.

"Whilst skilful and sensitive negotiations eventually persuaded religious and political leaders to support vaccination, engagement with the Nigerian scientific community was less successful." The authors demonstrate this by detailing a controversy that erupted with Professor Haruna Kaita. In the end, "[t]he research community of northern Nigeria clearly did not feel listened to, and the resulting confusion delayed the prompt resolution of the boycott."

In sum: "The rumours that caused the boycotts in northern Nigeria had traction because of a number of contextual circumstances unique to northern Nigeria; socio-economic marginalisation, dichotomous priorities, historic precedents of bad experiences and contemporary conflicts all played a part in undermining trust in GPEI. The rancorous situation following presidential elections in 2003 converged with other prompters to provide a culture for the rumour to grow and spread at a grass-roots level." While detailed recommendations of how individual and community involvement can be translated into programmatic changes are beyond the scope of this article, the authors point to the Independent Monitoring Board for polio eradication (IMB)'s suggestion that locally based risk assessments should be routinely factored into vaccination programmes. Larson and Heymann (2010) stress the need to prevent vaccination rumours through the long-term building of public trust. The GPEI continues to build upon this, engaging with groups such as the Northern Traditional Leaders' Committee on Health Care Delivery.