Although the storm generated by the rejection of the oral polio vaccine by some Northern states seems to have subsided after tests have certified the vaccine as being safe, it may yet take sometime before the controversy is finally laid to rest, Mike Ebonugwo and Okey Ndiribe report.

IF the report of the All Inclusive Final Verification Committee on Oral Polio Vaccine (OPV) Safety is anything to go by, it is expected that the controversy arising from the rejection of the vaccine by some states in the North would soon be laid to rest. The committee which had visited such countries as South Africa, Indonesia and India in its final report stated thus: "Based on all the evidence before us, including interactions held with professionals and scientists in various countries, it is the considered opinion of the Committee that the Oral Polio Vaccine, when used as recommended in the Polio Eradication Programme in Nigeria is safe".

However, responding to a question during last Sunday's Presidential Media Chat, President Olusegun Obasanjo had given indication that the last may not have been heard of the issue as he alleged that the entire polio vaccine controversy was a vindictive attempt to blackmail him. "I have heard that one of the people pushing this issue said that I have offended him. And I asked:

How have I offended him? What I was told was that he gave quotations for supplying vaccines... and it was turned down. That is the offence and that's why he's raising the issue. And if it's true, you can see how selfish, callous and irresponsible people can be.

"But since we're not manufacturing this (vaccine) and we're not the only ones using it, well, we can see the danger that people out of selfishness can do to humanity," he said.

Storm in tea cup

Though initially dismissed as a storm in a tea cup, the controversy arising from the allegation by influential Islamic leaders in Northern Nigeria that the vaccine supplied for the polio immunisation programme contained contaminants that could cause infertility and even HIV/AIDS soon developed into a full-blown storm. The Jama'atu Nasril Islam, backed by the Supreme Council for Sharia had pointedly accused Western powers of deliberately contaminating the vaccines with anti-fertility hormones in line with a grand plot to depopulate Nigeria, indeed the entire African continent. Convinced that the vaccines were indeed not safe, some states in the North, led by Kano, had immediately announced that they were no longer participating in a national immunisation programme which was part of a World Health Organisation (WHO) and United Nations International Children Education Fund (UNICEF) effort to protect 63 million African children from polio infection.

Besides Kano State whose government totally rejected the polio immunisation for its people, other states like Zamfara, Bauchi and Niger also registered their opposition to the polio vaccine by suspending participation in the National Immunisation Days (NIDs) exercise which kicked off on Monday, February 23, 2004. The abstaining states had cited fears of the polio vaccine being contaminated and therefore unsafe as reason for their decision. For instance the governor of Kano Sate, Alhaji Ibrahim Shekarau was quoted as saying on state television that: "Our committee told us that there was an anti-fertility element in the vaccine and that is why we are not using it".

And even after Niger and Bauchi States had dropped their opposition and said they were re-joining the immunisation programme, Kano had stuck to its gun, with the State's chief executive insisting that tests carried out on the vaccine by scientists in the state proved conclusively that it contained traces of anti-fertility hormones.

Shearau's suspicion

"It is a lesser of two evils to sacrifice two, three, four, five and even 10 children (to polio) than allow hundreds or thousands or possibly millions of girl-children likely to be rendered infertile," Governor Shekarau said during an interview to justify his continuing opposition to the vaccine.

Alhaji Shekarau was forced to make this statement in defense of claims by UNICEF spokesman, Gerit Beger that Kano's opposition is threatening to "reverse the tremendous gains that have been made by UNICEF and its partners in reducing global cases of polio from 350,000 in 1998 to less than 1,000 in 2003'. Kano is said to presently account for 89 cases, which represents 25 percent of the national virus cases.

Last year, Nigeria, according to findings from the WHO-led Global Polio Eradication Initiative had overtaken India as the country with the most reported wild polio virus cases in the world. The country accounted for 217 cases last October, representing nearly half of all cases in the world.

This development was traced to the low immunisation coverage of the North, particularly the refusal of Kano to participate in the programme. Kano together with Jigawa, Kaduna and Katsina is said to account for 62 percent of new cases in Nigeria presently. Nigeria is one of six countries where the polio virus is said to be endemic. The other countries are India, Pakistan, Egypt, Afghanistan and Niger.

The WHO has set a 2005 target date for the universal elimination of polio. But the organisation is presently worried that the target date may not be achieved if the polio immunisation campaign is being disrupted by opposition in the Northern part of Nigeria. Polio virus from the North, according to WHO's claim, is presently re-infecting previously polio-free areas within Nigeria and nearby West African countries.

For instance, a recent outbreak of the disease in Cote D'Ivoire and 45 new cases recorded in Benin, Burkina Faso, Cameroun, the Central African Republic, Chad, Ghana and Togo were traced to developments in Nigeria which has been identified as a major transmission centre of the disease.

Nigeria's Health Minister, Professor Eyitayo Lambo admitted this much when cornered by newsmen after a Federal Executive Council meeting in January. "What I can tell you for sure is that given what is happening in Nigeria, evidence has shown that some countries around us that were hitherto polio-free for two years have been re-infected by the strains of polio virus from Nigeria," he stated.

In her reaction to the development, the Executive Director of UNICEF, Carol Bellamy enjoined authorities in Northern Nigeria to halt their opposition and help to stop the virus from spreading any further. "It is unforgivable to allow still more children to be paralysed because of further delay and baseless rumours. We call on these authorities to immediately re-join the polio eradication effort," she appealed.

But the Supreme Council for Sharia in Nigeria had responded through its secretary general, Nafi'u Baba-Ahmed, who dismissed as a propaganda the claim that Northern Nigeria was responsible for recent outbreak and spread of polio virus. "We are very happy with the low level of participation by the population in the latest polio campaign, despite government propaganda. The donor agencies are trying to intimidate us by saying we are spreading the virus to other countries. We will not be intimdated," he stated emphatically.

But responding to concerns expressed over the oral polio vaccine, the Federal Government had set up a committee to ascertain its safety and to reassure Nigerians that the vaccines being used in the nation-wide immunisation were safe.

This committee and another verification committee set up by the Jama'atu Nasril Islam have submitted reports which gave the vaccines a clean bill of health. However it would appear that the Kano State government was yet to be convinced that the vaccines are really safe, reports of the respective verification committees notwithstanding.

This has led some individuals and groups to allege that the position of the Kano State government was politically motivated. One of the proponents of this is radical lecturer, Professor Bala Usman who dismissed the whole polio vaccine controversy as part pf the crude politics being played by President Obasanjo's political opponents.

Religious manipulation

"They are using religion to convince the people in this part of the country that the government does not like them and is all out to eliminate them," he alleged.

This is also the conclusion of Dr. Adelaja Adenuga, the Managing Director and Chief Executive of Doctoroncall, a health safety consultancy organisation. According to him, the decision of the Northern leaders to refuse the polio vaccination for their people smacks of the penchant of opinion leaders in Nigeria to mislead their subjects. "The country is replete with several examples of such deceptions. They exploit a loophole in the people's passion and massage it to their class favour," he stated.

For former Nigerian Medical Association Vice President, Dr. Beko Ransome-Kuti, it was very unfortunate and in fact dangerous that some governors in the Northern part of the country could prevent their children from receiving the OPV. "This is unfortunate, especially when you consider the fact that it is in the Northern part of the country that you have majority of the polio cases in this country. This is dangerous for the rest of the nation because the nest of polio in the North can spread to other parts of the country and beyond, thereby frustrating attempts to eradicate polio in the world," he said.

On the possibility of the vaccines being contaminated as alleged, Dr. Ransome-Kuti said there was no merit in such a suspicion. "There is no reason why agencies of the United Nations would like to deplete the population of the North. I don't see what they will gain from it.

"One cannot contemplate that this rumour could be true for the simple reason that if the anti-fertility agents were found in the Northern part of the country, it means a separate batch of the vaccine was manufactured specifically for that part of the country. I don't see how this could be done in practical terms. If that happens, I think it would bring the credibibility of the relevant UN agencies into focus, "he said.

A Lagos-based medical practitioner, Dr. Adewale Balogun also spoke in the same vein. According to him, if the vaccine contained anti-fertility agents, then it couldn't have been restricted to the North, since the same was supplied to other parts of the country. He did not stop there.

"Their fears are unjustified considering the fact that the polio vaccine is usually given to children. I am not aware of any sterility vaccine that can last and remain effective in a child's body until he/she becomes an adult," he stressed.

In also passing a vote of confidence on the vaccines, Dr. Adenuga had this to say: "The vaccines used in Nigeria are very safe indeed. At least the batch I allowed my 17 month old daughter to receive severally, I received same 40 years ago; same as five other siblings born after me. All of us are currently well and have full use of our locomotry organs".

Since the OPV controversy began, the view in some quarters has been that if those opposed to the vaccine are able to prove their claim that it contained anti-fertility contaminants this may rubbish the credibility of the National Programme on Immunisation (NPI) as most Nigerians will no longer trust in the safety of the immunisation it conducts and supervises. However, former NMA president, Dr. George Okpagu was very cautious in his response on whether the NPI could be a willing tool in the hands of any group trying to use the OPV to depopulate Northen Nigeria.

NPI is reliable

"The coordinator of the National Programme on Immunisation, Dr. Awosika is somebody I can tell you is credible. She's somebody I can vouch for her integrity. But that does not mean that a genuine person cannot make mistake, cannot be deceived. I am saying that ab initio that Mrs Awosika will never connive to deceive Nigerians in relation with immunisation," he said, adding that the best way to determine the safety of the vaccine was for a standard test to be carried out on it.

The Lagos State chairman of the Pharmaceutical Society of Nigeria (PSN) Mr. Olumide Akintayo also passed a vote of confidence on the NPI, saying the body has been doing a good job. He however described as needless, the controversy over the safety of the OPV and how this has been hampering the efforts of NPI officials to carry out immunisation exercises in the North. He had then gone ahead to offer a scientific explanation on the safety profile of the vaccine.

"What a lot of concerned people may not have known is that there was a verification exercise recently and I have taken time to analyse the technical report. From what I saw samples of OPV were taken from the Kano OPV committee which started this controversy, from the current batch in NPI stores and NAFDAC quarantine. These samples were taken through a pool of experts to three different counties. South Africa, India, and Indonesia. You must be informed that WHO, which is the apex medical body globally does not have a standard analytical protocol, because this is the very first time there has been a controversy on OPV.

"In terms of scientific evaluation, when you are thinking of analytical methods, the most sophisticated methods are gas chromatography mass spectrometry. And this is in order of preference ; high performance steel layer chromatography and radioimmumo assay. These samples were subjected to gas chromatography mass spectrometry analysis in South Africa. The crux of that allegation was that the vaccines contained anti-fertility hormones; basically that they contained progesterone and estrogen. But you must understand that the gas chromatography mass spectrometry is probably the most sensitive equipment in the whole world, that can detect any chemical. It can detect as little as one part in a 100 million parts of chemical.

"After that analysis, it was discovered that there were trace amounts of extro-diol-which is a form of estrogen. No progesterone was detected at all. But the conclusion of the report was that the quantity of extro diol that was found in that sample was so inconsequential because the quantity of extro-diel that is found in re-cycled water that they drink in developed countries is even much more than what was found in the sample. This implies that the quantity of estrogen found in the sample could not exert any therapeutic action.

It is the same sample that is used all over the world. UNICEF has been supplying the vaccine.

"The current OPV controversy si a local problem. We must avoid a situation where we are confusing members of the public. What I see on ground is not a scientific or technical problem but more of a political problem," he said at length.

However, the man at the centre of the controversy, Governor Shekarau of Kano State has dismissed any notion that his opposition to the OPV was politically motivated. "What political benefit are we going to get by kicking against the administration of polio vaccine on innocent children if it's for their own good? We only relied on the reports we got from the Independent Medical Verification Committee which we gave the mandate to verify the content of the vaccines, and they gave us their professional report that the vaccines contain some substances that can cause infertility, cancer, and HIV virus," he informed. And so, the controversy goes on.

The clean bill of health which has been given the OPV vaccine notwithstanding, there is a raging international debate on the safety of OPV and other vaccines. For instance, a group known as the Polio Connection of America has expressed reservations about the use of oral polio vaccines in the United States. The association stated that it's investigations into 13,641 vaccine associated events, revealed that 6,364 cases required emergency room visits; while 540 cases resulted in death and 133 children became permanently disabled. This development had compelled the United States Congress to pass the National Children Vaccine Injury Act in 1986.