Photo courtesy of the Global Polio Eradication Initiative.
Burnet Institute Deputy-Director and Head of the Centre for International Health, Professor Mike Toole comments on the impact recent killings of child immunisation health workers in Nigeria will have on global health for The Conversation.
The murder of nine female health workers involved in child immunisation on February 8 in Kano (the largest city in northern Nigeria) is a chilling reminder that saving children’s lives is not a goal shared by everyone. Unless such incidents are effectively prevented in countries where the poliomyelitis (‘polio’) virus still circulates, vaccination campaigns may collapse and the world may fail to eradicate this virus that causes lifelong paralysis or death.
The incident follows the murder in Pakistan of nine volunteer vaccinators (mostly women) late last year, and seven clinic workers on new year’s day. Those murders were well-planned – four of the volunteers were shot within 20 minutes in various parts of Karachi, the country’s largest city. The killings took place during a nationwide campaign to vaccinate 5.2 million children against polio.
It’s not yet clear whether the Nigerian murders were aimed specifically at the polio program given the national vaccination campaign ended on February 5. The murdered women were in the mop-up phase of vaccination, trying to immunise children who had been missed.
Smallpox is the only human disease that we’ve completely eradicated but we stand tantalisingly close to making polio the second. Nigeria, Pakistan, and Afghanistan are the only three countries in the world that have never interrupted polio transmission. In 1988, polio infection paralysed or killed 350,000 people, mainly children. Following a global eradication initiative, that number had fallen to just 222 cases last year in five countries – Nigeria (121 cases), Pakistan (58), Afghanistan (37), Chad (five), and Niger (one).
For every person paralysed or killed by polio, however, another 99 are infected who have only mild or no symptoms but can spread polio to others. This is why it’s important to vaccinate close to 100% of all children to stamp out the virus (and it’s why the campaign had a mop-up phase).
Polio is not a “tropical” disease – cases were still occurring in Australia in the 1960s. In 1952, there were 58,000 cases of paralytic polio in the United States, resulting in more than 3,000 deaths and 22,000 people left with varying degrees of paralysis.
While no-one has claimed responsibility for the killings in Nigeria, the most likely suspect is the radical Islamist group Boko Haram, which has attacked churches, government offices and police stations in the north of the country.
There’s a history of opposition to polio vaccination by certain Muslim clerics. Between 2002 and 2005, religious leaders forced the cessation of the vaccination campaign in northern Nigeria claiming the vaccines were part of a western plot to sterilise young girls and eliminate the Muslim population. As a result of the subsequent epidemic, polio was exported to 17 countries that had been polio-free.
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