The Digital Journalist
Polio Rebounds in Nigeria

by Chris Hondros

It all seemed so possible in 1988.

That was when the World Health Organization and other international health groups set the year 2000 as its target to totally eliminate polio from the face of the Earth, later amending the date to 2005. Polio eradication back then seemed ambitious but doable. Health groups were still awash in the glow of eradicating smallpox a decade earlier, and a new, cheap polio vaccine that could be widely distributed over rural areas enabled easier-than-ever mass inoculations. Hope was in the air.

But 2005—the 50th anniversary of the approval of Jonas Salk's famous vaccine—has arrived with polio far from eradicated. In fact it's on the march again, with hundreds of new cases in northern Nigeria alone last year; infections from Nigeria have spread, reaching as far as Indonesia. But the reason polio has endured is not because of the tenacity of the virus. It's politics—post 9/11 politics.

I saw this for myself during a visit to Nigeria's regional capital of Kano last month. Kano is a dusty and historic crossroads that once marked the beginning of trade and civilization for trans-Saharan travelers. During the harmattan season, the brown earthen buildings are sandblasted with a fine yellow dust that obscures the sun. Dominated by Muslim leaders, Kano is home to a virulent mistrust of the West and, at times, of the Nigerian central government in Abuja because of its emerging ties to the United States and Europe.

Two drops is all it takes.

Photo by Chris Hondros/Getty Images
"Polio, in Nigeria, is politics," says a doctor in Kano's main public hospital complex, who asked not to be named for fear of his job. The hospital was built by the British during colonial times in the 20s, and its long breezeways and white stone construction look like a set out of The English Patient or Lawrence of Arabia. "There's no getting around it. Everyone talks about [polio] eradication, but what we need is rehabilitation. Who talks about that? They'll never wipe out polio here; there's too many problems: political, cultural, bureaucratic. What can we do for the people who get the disease? No one is discussing this."

As we talk in the doorway to his office (he was too nervous talking to me to let me in to sit down), one toddler rocketed in from the hallway on his hands and knees, interrupting the doctor's comments; the child looked old enough to walk, except that his legs were noticeably thin and curled up behind him unnaturally, dragging uselessly on the floor. His harried mother soon dashed in and scooped him up to take him out of the office with apologies. The doctor locked eyes with me, his eyebrows raised, with an implied 'see, this is what I'm saying' look.

What brought us to this pass is this: Nigeria, long a polio hot spot, ended its polio vaccination program in 2003 in a colossally misguided protest of everything Western after the invasions of Afghanistan and, especially, Iraq. Religious leaders in Nigeria's predominantly Muslim north, twisting news reports about inadvertent contamination in some vaccinations, began preaching in mosques and market squares that polio vaccines were a Western plot to sterilize Muslim women, a plot by the same devious West that had just declared war on the Islamic world with its invasions of sovereign Muslim states.

And so, for 11 months in 2003 and 2004, polio vaccinations in northern Nigeria were suspended. Eleven months was all it took for the virus to not only gain a renewed foothold in Nigeria, but to spread to 10 other African nations that had previously wiped out the disease. WHO leaders feared a renewed global outbreak due to the suspensions, and undertook a lobbying campaign to restart the critical inoculations. They have now resumed, but in Kano it's too little, too late for far too many people.

Father and son at home.

Photo by Chris Hondros/Getty Images
Like Umar Ahmed, two years old. His father is an energetic and gregarious man named Aminu Ahmed, mostly healthy but with withered, useless legs after being struck with polio as a boy. But Aminu lives a full life; he's the informal head of the polio association in Kano and he is married and has seven kids, from age 20 to two. His oldest six children were immunized and are healthy, but his two-year old, born during the immunization hiatus, has polio.

"This is Umar, my youngest boy," Aminu says, crawling over to his son, who can only crawl himself. "He's got the polio too. Poor son, poor son." But he laughs as he speaks and props up Umar with joy, coo-cooing him and trying to get a response. But Umar is remarkably quiet and dour for a two-year-old and merely totters in his father's grip.

The tragedy of such scenes is made worse by considering how simple the actual administration of polio vaccine is. Two drops in the mouth from a small vial are all it takes to inoculate a child. Two simple drops in Umar's mouth 18 months ago would have spared him a lifetime of pain and difficulty.

Coolers of polio vaccine carried to the field.

Photo by Chris Hondros/Getty
Trying to make up for lost time, the World Health Organization conducted a massive countrywide inoculation campaign in Nigeria while I was there in April-an incredible 40 million inoculations in four hectic days nationwide, of every child in the country under five. I accompanied a vaccination team to a rural province to watch them work. Managing the group was Jibril Abdullahi, an official with the Nigerian National Programme for Immunization. He has spent years trudging through isolated outposts in northern Nigeria, figuring out ways to convince suspicious rural farmers that the vaccine is safe and does not affect fertility, which is the most common anti-vaccine rumor to echo out from Friday sermons at mosques.

Jibril Abdullahi encourages rural inoculations.

Photo by Chris Hondros/Getty Images
"It is difficult to convince the rural people, sometimes," he says, making his way down a brown dirt path in the baking sun, his immaculate white robes flowing in a gentle breeze. "We do everything to convince the people that the vaccine is safe. We even take it ourselves"—he mimicked holding the dropper over his mouth—"and say, 'look, yes, it is safe.' Usually that helps, but you know what some women say? They say 'you are old, you already have children, you can take it and it will not affect you.' And I say, oh my god."

He laughs sadly.

© Chris Hondros

Chris Hondros is a New York-based staff photographer for Getty Images News Service.

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