Another health disaster in Africa
Jun 23rd 2004
From The Economist Global Agenda
SourceScare stories spread by religious zealots have led to a resurgence of polio in Africa. The UN’s drive to eradicate the crippling disease by next year now looks in danger
HAVING rid the world of the scourge of smallpox in the 1970s, the United Nations and its World Health Organisation (WHO) were until recently on course for another important victory in their war on the diseases that ravage the poorest people in the poorest nations: the eradication of polio. For the past four years, a “countdown clock” at UN headquarters in New York has been ticking away the seconds remaining until its target date of the end of next year for stamping out the poliomyelitis virus worldwide. But now the clock may have to be set back. On Tuesday June 22nd the WHO said that a resurgence of the crippling disease that began in Nigeria last year has now reached ten other African countries. A child crippled by the disease in Sudan’s conflict-torn province of Darfur was found to be carrying the same strain as seen in Nigeria. Until now, there had been no polio cases in Sudan for three years.
The new outbreak is a triumph of superstition over science. The polio cases have spread from the state of Kano, in the mainly Muslim north of Nigeria. There, clerics have preached nonsense about the polio vaccination, claiming it was a western plot to depopulate Africa by rendering girls infertile, or even giving its recipients AIDS. Kano’s state government, under pressure from the militant clerics, has suspended vaccinations. In January a committee of doctors and Muslim scholars set up by the state government said tests had revealed that the vaccine contained oestrogen, which plays a role in fertility. The WHO insists that other tests have refuted those claims. In May, Kano’s government announced that vaccination would begin again, but this has not yet happened.
Even if vaccination resumes tomorrow, damage will already have been done. The WHO says that five times as many children in west and central Africa have been infected with polio so far in 2004 as in the same period in 2003. Though the disease mainly strikes children aged under five—and leaves them crippled for life—it can also be carried by people without their showing any symptoms of infection. Thus, the movement of people escaping the region’s conflicts is helping to spread the outbreak. Several of the African states where it has now appeared have been destabilised by war, including Sudan, where the Arab-dominated government has been carrying out a campaign of terror against Darfur’s black Africans.
It could get much worse. Africa is now approaching the “high season” for transmission, when the rains make it easier for the virus to spread through inadequate sewage disposal. The WHO-led Global Polio Eradication Initiative maintains that it can still meet its goal of eradicating new cases by the end of 2005. But to ensure this, it is seeking fresh donations of $100m, on top of the $3 billion already invested since 1988. $25m must come by August to begin a massive vaccination effort in the autumn. It is looking for the rich “Group of Eight” countries to lead the way in providing this money.
It is a tragic setback. The number of cases of polio worldwide fell from 350,000 in 1988, when the target date was set, to just 784 last year. The disease was eradicated from all the Americas ten years ago but it took until 2002 to declare Europe polio-free. In that year, there was a temporary resurgence of the disease, mainly in Nigeria and northern India. But it was brought back under control with the help of some intrepid and creative vaccination strategies. In Somalia—a failed state for over a decade—the government barely controls parts of the capital. But even there, teams of vaccinators worked with the militias of local warlords (ie, the same people who have rendered the country ungovernable) to set up roadblocks for forcibly vaccinating travelling children. The effort there was hindered by the same rumours about the vaccine (that it is un-Islamic or gives you AIDS) as in Nigeria, but the WHO successfully recruited locals to help spread the word, sometimes hollering from loudhailers on the back of trucks. Unorthodox perhaps, but Somalia is now polio-free. So is Congo, another state ravaged by a war that has claimed 3m lives. The polio-eradication initiative rightly trumpets its successes in even the most difficult places.
If it can be done in the world’s most dysfunctional places, it should be possible in Nigeria, which is poor and corrupt, but is a democracy with a lively press and some degree of openness. But Nigerian politics and society are increasingly polarised between the Muslim north and the mostly Christian south. Violence periodically flares between the communities, and northern governors are often tempted by flirting with Islamisation, including the imposition in several places of Islamic sharia law. Kano’s former governor was voted out of office after saying that no cleric would tell him what to do. His successor, Ibrahim Shekarau, has proved reluctant to keep his promise to reinstate vaccination. There are parallels with South Africa’s deadly slowness in fighting HIV, because for a long time President Thabo Mbeki bone-headedly resisted orthodox medicine’s views on what causes AIDS and how to treat it.
Polio remains largely contained: 98% of the world’s few hundred remaining cases are in Nigeria, India and Pakistan. Perhaps 5m people are now walking who might have been crippled without the eradication effort begun in 1988. If the WHO gets the backing it needs, it might succeed in wiping out the disease, if not by its target date, soon afterwards. But for now the number of children at risk of being permanently crippled is heading the wrong way, thanks to the scaremongering of a few and the cravenness of the politicians who court them.
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