Kano, Nigeria—For Ramatu Garba, the polio vaccine is more curse than saviour—part of an evil conspiracy hatched in the West to sterilise Nigerian girls.
“Allah used Muslim scientists to expose the western plot of using polio vaccines to reduce our population,” said the 28-year-old Muslim food vendor in the northern Nigerian town of Kano.
Each time health teams have tried to vaccinate her daughter, Ms Garba has refused.
Besides lack of funding, equipment and personnel, international health teams fighting disease in the world’s poorest countries must also contend with rumours that spread through vulnerable populations and create barriers to urgent health campaigns that have saved millions of lives.
In Kenya, whispers were once rife that polio vaccine is a tool for devil worship. Across Africa, there is widespread belief that vaccines spread HIV.
The rumours in Kano started in 2003, when local politicians claimed polio vaccine contained anti-fertility agents and suspended vaccination for nearly a year. Since then, public-health authorities have been working desperately to convince the government and people like Ms Garba of the vaccine’s safety.
Fears about the polio vaccine have been so prevalent in rural Nigeria that villagers have fled their homes when polio vaccination teams arrive.
The total cost of fighting the polio-vaccine scare in Nigeria and in other countries where the sterility rumours spread has cost $200 million and caused the World Health Organisation and its partners to miss their 2005 polio-eradication deadline by at least two years, said Dr David Heymann, WHO’s top official in the fight against the disease.
Part of the problem, experts say, is rooted in health workers’ own failure to inform people in poor countries about real vaccine-related risks.
In the developed world, it is virtually a legal requirement to inform people of any potential vaccine-associated risks. But in the developing world, standards of informed consent are often abandoned as a logistical stumbling block.
Claire Hajaj, who has worked on polio eradication at UNICEF, said communicating medical risk to illiterate and remote populations was not always possible. “Usually, you have to settle for something that’s not quite as perfect,” Ms Hajaj said.
“We go repeatedly to families who have no electricity or sanitation,” said Michael Galway, head of UNICEF’s polio communications in India. “They see their kids dying from things like malaria and diarrhoea. And then we bring the polio vaccine—which is not what they want.”
And public-health officials have kept quiet about one obvious adverse effect the polio vaccine can cause: polio itself. For approximately every three million doses of the oral polio vaccine administered, one child is paralysed by the live virus in the vaccine itself.
Some medical ethicists say this failure to educate is wrong—regardless of the difficulties.
“Failing to divulge adverse effects is non-transparent, and it’s essentially a lie,” said Dr Ross Upshur, a specialist in medical ethics at the University of Toronto. “There’s no point in controlling infectious diseases if you’ve violated communities’ dignities and rights in the process.”
Whatever the root cause, experts agree on the dangers of rumours in public-health efforts.
In Nigeria, some mothers try to fool health workers into believing their children have been vaccinated by painting their children’s fingers with nail polish, an attempt to imitate the ink marks used in vaccine campaigns to record that a child has been immunised.