23 February 2013

Nigeria: Polio Vaccination and Northern Pseudo-Intellectuals


I cannot claim to be an 'expert' as is common these days. But, I consider myself a student of medicine, public health, infectious diseases and public policy. I studied Medicine in Ahmadu Bello University, Zaria (85-90). I worked in Kaduna and Kano before I proceeded to do clinical research at the Medical Research Council in The Gambia.

I was opportune to specialize in Internal Medicine and sub-specialty of Infectious Diseases from two universities in the United States. After two other academic degrees, I became involved in the global public health arena for eight years with work on public health in more than 10 countries across three continents before returning to Nigeria in 2008, at the invitation of the late President Umaru Musa Yar'adua, to lead the National Primary Healthcare Development Agency (NPHCDA) which drives the polio eradication programme along with other basic health matters. In 2009, Duke University Global Health Institute appointed me an Adjunct Professor in Global Health. So, although I do not yet consider myself fully as an expert, I do consider myself knowledgeable enough to attempt a response to some questions on polio vaccinations.

The central claim in the polio argument appears to be that non-polio acute flaccid paralysis (NPAFP) increased to 1,200 percent in India within a decade. To understand this fully, one should appreciate that polio virus is an "enterovirus" like several other non-polio enteroviruses and viruses that can cause acute flaccid paralysis (AFP, a specific syndrome mostly in children). But polio is the only virus currently being pursued for eradication from this world (recall smallpox was first ever, eradicated in 1979 with mass vaccinations including here in Nigeria) (also, Global Eradication is different from Control). As part of the polio eradication effort, there is intense surveillance for all cases of AFP, which are then investigated by culture and identification in specialized labs to confirm polio or non-polio. One of the easiest ways to get zero polio is to stop surveillance, just as it is to get to a zero AFP report it simply requires stopping surveillance reporting (akin to burying our heads in the sand). When you increase surveillance anywhere, from nothing, you will very likely pick up higher and higher rates of a background situation.

The NPAFP rates are a proxy for good surveillance, because of background non-polio enteroviral and other causes of AFP. Here it is important to note that for two years now, there has not been a single child paralyzed by wild polio virus in India. In one more year, India will be considered to have eradicated polio! Coming closer home, for the last four years in Nigeria we intensified polio eradication drive with multiple rounds of campaigns. The NPAFP rates in Nigeria have not increased despite millions of doses of the oral vaccine. If we see the rates decline, we will immediately check our surveillance system, because of the background entroviral/AFP epidemiology. We thank God that we have made good progress. From thousands of children being paralyzed due to polio, in 2008 we had 788 cases. In 2009 we had less than 400, in 2010 we had 21 only, in 2011 we had 62, 2012 recorded 122 cases and thankfully, not a single Nigerian child has so far been paralyzed by any polio virus in 2013. By the way, almost 99 percent of the children paralyzed in Nigeria recently by the polio viruses have had Muslim names. This is directly linked to the unfortunate refusal of mostly Muslims in select states in Nigeria to get their children vaccinated against a disease that is preventable. In my faith (Islam) I believe in the Day of Judgment. I will never be part of a program that I know will harm humanity.

On the issue of "live" vaccine, this is where a slighter deeper understanding is also required. As you know, there are different kinds of vaccines. Viral diseases such as Measles, Polio, Smallpox, Chickenpox, Influenza can be prevented using "live attenuated" viruses or in the case of polio also "killed" viruses.

The effect is largely the same - to induce immunity. Before any vaccine is licensed, safety are done first, before immunogenicity is confirmed. Smallpox was safely eradicated with live vaccine. Measles is 99 percent preventable with a live attenuated vaccine. Chickenpox vaccine (not available in Nigeria, hence periodic outbreaks) is also live. The oral polio vaccines have proven safe, efficacious, easy to administer (oral drops compared to injection) and have successfully been used to eradicate polio in all African countries except Nigeria (for the twisted reasons we all know), most of South and East Asia and Latin America. As mentioned above, India successfully recently interrupted polio with same oral vaccines. For Nigeria we have efficacy studies published in reputable medical journal showing efficacy of the oral polio vaccine.

On the anti- polio campaign pursued by a group of inadequately informed (some say, pseudo- intellectuals) based in one or two of our universities. They claim polio vaccination contains birth control agents, based on flawed science. Like all professions, credible academia does not present itself in titles. No, academic excellence is attained by rigorous science, peer review and manifested in new knowledge documented in peer reviewed expert publications and scientific conferences, so that men and women of equal standing can critically examine claims of new knowledge before they become popular. On the other hand, our pseudo-intellectuals find comfort in dazzling some of our well-intentioned Ulama's with ill-conceived, unproven and distorted claims, to the utter detriment of our people.

Take Niger, a country that is next to us, it eradicated polio using oral vaccines years ago, yet has higher total fertility rate than Nigeria. If polio vaccine is sterilizer, Niger would have shrunken by now!

Similarly, other Muslim countries eradicated polio, improved the health and education of their people (Iran, Malaysia, Indonesia etc), advanced scientifically, while we painfully remain the poorer, sicker segment of the Nigerian population. What do our pseudo-intellectuals have to offer for our national progress? Not a single solution! Only needless posturing and division. The recent killings of innocent female health workers in Kano, Yobe, Borno is directly linked to the warped ideas concocted by these pseudo-intellectuals allied with a very narrow strand of our respected Ulama. Is this what we are about in the northern part of Nigeria? I need not say much more, but we all know that history tells us the great contributions of Islam and Muslims in the core scientific fields of Mathematics, Physics, Chemistry, Astronomy, Medicine, etc in the past. Sadly, we have closed our minds now to logic and the experts who should light the way are busy fueling conspiracy theories. We use latest technologies (Biological, Chemical, Food, Pharm, IT etc) without questioning the sources, yet the only disease that the entire world has set to eradicate, we turn our eyes away from reason and be object of ridicule. What a shame!

Dr Muhammad Ali Pate is the Minister of State for Health, he wrote this piece in response to arguments for and against polio vaccination in the North.

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