Monthly Archives: February 2013

ABC of Polio Vaccination in Nigeria – Part 1

Polio, Vaccination and I

Two weeks ago, an attack aimed at health workers in Kano State brought my attention to Polio. Opposition for Polio vaccination appears to be the strongest reason for such an attack, or perhaps the strongest cover. Until two weeks ago, I knew Polio to be a disease but honestly could not tell what polio looks like. It was embarrassing to find that most of the disabled beggars I have met throughout my life on the street are victims of Polio. I had not personalized it, or even given it much thought.

Small Pox had been eradicated and attention is now on Polio. There is rise in spread of Polio recently in many countries and the strain of the viruses discovered originates from Nigeria. Then I learnt that some Nigerians have had strong opposition against the vaccination, like in a few countries, but it appears the Nigerian opposition has been successful at the detriment of those who are not vaccinated. The main opposition is from a Muslim group even though the President, of International Fiqh Council Yusuf Al-Qaradawi at the time, and other Muslims within Nigeria denounced the opposition as making unfounded allegations that are contrary to established findings.

Polio Victim

I have since explored further the issue of Polio Vaccination in Nigeria with interest. Some materials explored where quite technical for Doctors or Statisticians. The aim of this post is to explain Polio Vaccination Opposition in Nigeria to a lay man, by a lay man. As a result, precise dates, technical terms and referencing of ideas have been omitted. Also, names of people involved have been omitted for tidiness and to avoid the reader’s bias to some who are public figures. The point is for the reader to get the overall story and idea around Polio Vaccination Opposition in Nigeria, not to take a test. I am grateful to those whose observations granted insight into this Polio business. This post has been divided into two: the first part gives a background of Polio in Nigeria and issues raised by opposition; the second part explores responses to the issues raised, and attempts refutations of some claims made in the first part.

Fairness and Setbacks

Faced with many challenges daily, we make decisions without having to justify our choices. We are often living contradictions of ourselves and we become uncomfortable when someone points that out. Although we rest on rational grounds, we don’t always take a rational path to reach it; for example the dogmatic scientist believes strongly in science and prioritizes quality of scientific discoveries based on “credibility” of some journals over others. This approach must be accepted unless we don’t want anything to be done. However, when we are challenged, we must be fair to the challenger in tracing back and justifying our positions, and in understanding the position of the challenger.

“O ye who believe! stand out firmly for God, as witnesses to fair dealings, and let not the hatred of others make you swerve to wrong and depart from justice. Be Just: that is next to Piety, and fear God, for God is well acquainted with all that ye do” Quran 5:08

In most of the debate around Polio vaccine in Nigeria, neither sides are sufficiently justifying their positions, nor do they seem to understand the argument by the other side. It is hardly to do with lacking the capacity to understand, but it seems ego, like in most arguments, is doing its job of distorting what one hears or reads in order to make the opponent ridiculous. There is a difference between an argument and the game of “how can I make you look ridiculous”, and this accounts for why arguments rarely end in one side adjusting their opinions even if slightly. Because this writer supports Polio Vaccination, it is fair to contextualize the arguments from the opposers of Polio Vaccination so that it may not be seen as ridiculous as it is portrayed to be.

Another popular strategy adopted by both sides of the argument is of character assassination. Supporters of polio openly accuse the opposers as simply seeking political power which the Polio issue offers an opportunity for, and for which they don’t care if children get infected in the process. On the other end, the supporters of vaccination are accused of deliberately partaking in the “genocide” of unborn babies (by inducing infertility) just because they want to maintain their salaries (or have been offered bribes). This nonsense degrades the quality of the debate.

Trust in a doctor is as important as trust in the medicine offered by the doctor. Most doctors are trusted because it is assumed they have qualified and are well intentioned, but when a doctor is working as an agent of an untrusted government which is seen as a product of a resented colonial power, it becomes much easier to refuse a medicine even if free. This is the situation public health workers face in Nigeria, especially in the North.

Oral Polio Vaccination

Background

First, it is important to appreciate that anti-colonialism has been mixed up with anti-modernism. This is especially true for Muslim majority regions where colonialism is not seen as a necessary trouble to success, but an interruption of an evolution towards a successful Islamic society. Here is an excerpt from Daniel Pipes’ book “The Hidden Hand: Middle East Fears of Conspiracy” which exemplifies anti colonial sentiments in the Middle East. Coming from Daniel Pipes, one has to be cautious because of his views on Muslims, but it doesn’t seem too far from what one hears being discussed in some circles in Nigeria:

Western colonialism stands accused of causing all “diseases rampant in the Arab lands.” Specifically, the British imported cholera and malaria to Egypt after World War II. A British midwife who trained in the Kabylia province of Algeria got accused by his angry Algerian supervisor of working in league with the “white-coated saboteurs passing their hands from vagina to vagina, infecting my heroic people with syphilis!” An unnamed enemy—presumably American—infiltrated deadly diseases into Iraq via maggot-ridden cigarettes. Israel transmitted cancer to Palestinians by getting them to take dangerous factory jobs or subjecting them to phosphorous searches. It also smuggled irradiated fruit into Egypt to cause cancer.

AIDS, combining sex and disease, prompts recurring nightmares. Jerusalem hires young Jewish women infected with AIDS to spread the affliction in Egypt. One article in the Egyptian press focuses on an Israeli named Sarah who cavorted in luxurious apartments and infected the young and the prominent, while other versions count between 20 and 327 infected Israeli agents. The most imaginative account conjures up a “special formula” of the AIDS virus that infected sexual partners without in any way affecting the Israeli female carriers.

1979, the Iranian revolution took place, the Shah dynasty of Iran was overthrown and Imam Khomeini became the leader of the country. It was a victory that resounded with many Muslims around the world. It was a revolution where good overcame evil. The Shah, who is considered the evil one, was also known as the American Puppet. In short America is evil and out to destroy Muslims. A few years later in 1980s, Nigerian government embarked on two programs simultaneously: Implementation of “National Population Policies”, and the “Expanded Programme on Immunisation”. The Immunisation program was being pressured from outside Nigeria. At the same time, pamphlets were circulated in mosques stating that America and Britain, owing to their defeat in Iran, are out to destroy Muslims by controlling Muslim population. The pamphlet referred to a declassified document which showed that America’s population was declining whereas the Muslim population is increasing. So America feels the need to eliminate Muslims through population control and disease ridden vaccines. Subsequently, vaccination programs were not to be trusted.

In 1996, the pharmaceutical company Pfizer learnt about the insufficient Meningitis vaccine in an ongoing vaccination program by the Nigerian Government. Pfizer took advantage and conducted a drug test for a drug which had been banned in the US and Europe for adults and unapproved for children. The result was that 11 out of about 200 children died from the unauthorized study. It took about four years before the story received international recognition. The unethical study was carried out in Kano State, which is a majority Muslim state. Some opposers of Polio today believe that the unauthorized trial was actually planned with the Federal Ministry of Health and “relevant UN agencies”. Subsequently, vaccines have been mistrusted by an influential Muslim group, even when scientific reports were carried out disputing raised claims, because the reports could be associated t the government and “relevant UN agencies”.

2004, concerns were raised about a Polio vaccination campaign that was to ensue. A group of researchers traveled to India representing the opposing Muslim group, and tested a particular batch of polio vaccines that was being administered in Nigeria at the time. In an interview with one of the researchers from the group, the following issues were raised: The vaccine is contaminated with Estrogen; Estrogen (generally) is known to inhibit fertility; The Polio Vaccine is a fake drug; Polio Vaccination should not only be opposed, it should be prosecuted; There is a secret (evil) agenda by the US on third world countries, which was yet unproven; Powerful countries disdain the intellectual capacity of third world countries;

2004, National Programme on Immunization sent its representatives to South Africa to investigate the claims made about the Polio Vaccine (containing HIV and causing infertility). Their result was that the Vaccine was safe, and they commented that people were not looking towards the proper authorities on the subject but at “archaic information” on the internet.

2004, Kano State, a predominantly Muslim state sent its representatives to Indonesia, an Islamic Country to test the vaccine for contaminants. Their test came back claiming that it was not contaminated with HIV, as previously claimed. An alliance of trust was established between an Indonesian Pharmaceutical company and Kano State, to supply the state with trusted Polio Vaccine hence forth. [Presently I think all of Nigeria’s Polio Vaccines come from Indonesia]

2012, in an article, the following issues were raised: Since the introduction of Polio Vaccine a decade ago, paralysis that are not cause by polio have increased by 1200% in India; The more doses administered, the more cases of paralysis that are not caused by Polio Virus; The Polio Vaccine contains actual living Polio Virus, which has been shown to cause paralysis rather than vaccinating; In a period of twenty years, about 150 people were paralyzed due use of live Polio virus in vaccines in the US, which led the US to stop using it (Yet US NGOs are using it disdainfully in other countries).

On Certainty

Don’t trust experts, experts are overrated. Opinions by experts are accepted less critically on the assumption that an expert is well, an expert. For more reasons on why you should not trust a single expert’s opinion, pay attention to people like Noreena Hertz on experts. But we have to give experts the credit of knowing more than a lay man in their trades. Experts are human, and so they are susceptible to altering results of a study in order to serve certain personal interests. This is where science comes in to save the day. For a scientific discovery to be trusted it must be peer reviewed. This scientific method applies many to subjects, not just core sciences. This is why peer reviewed journals are the standard for accepting any academic conclusion because in peer review, we harness the intellect of many experts in a particular field who serve to keep each other honest. One only needs to understand the ego of academicians to appreciate what an effective method this is.

How do we know anything is true? That is a philosophical question. How do we decide what information to take as reliable? We consult a peer reviewed journal. What about books and interviews and articles? If they claim certain findings that need evidence to be true, we refer to the sources they reference. If the sources are magazines, newspapers, or (non peer reviewed) journals, we keep our suspicion and not make important decisions on those information. If however the source is a peer reviewed journal, one can be comfortable in using those findings to make important decisions; provided one understand what the findings actually mean.

Drug approval test is one of the most thorough that there is. At the same time Pharmaceutical companies are known to be some of the most cunning when it comes to manipulating test results which are presented to government bodies for approval. The best person to monitor these corporations is one whose career is guaranteed, one who cares more about their integrity or reputation than money; it will help if this Monitor is egotistic as well. Who better fits these criteria than an Academician. This is why you find countries, that are serious about drug regulations, entrust the Academic Community with the task of investigating findings claimed by drug companies.

This is all to set the stage for the next part of this post. When presented with two conflicting “findings”, one from an expert and the other from a peer reviewed paper, it should now be easy to know which to consider especially in making important decisions. Findings from peer reviewed journals set the tone for the “common knowledge” of an expert community. Therefore, established knowledge cannot be overturned merely by the findings of an expert, unless other experts review and support the new findings. Then knowledge is updated, and this new knowledge becomes the common knowledge. At best, opinions or claims to findings by an expert should provoke a review of that experts findings, and if found with integrity and true, then a review of previous conflicting findings so that knowledge can be updated.

Stay tuned for the second part of this post.

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The Accidental Public Servant: Sceptical Then, Sceptical Now

Today, I was at the presentation of the long awaited book titled The Accidental Public Servant by Malam Nasir El-Rufai. I went in a sceptic and came out hopeful, but a sceptic. What was I sceptical about before the launch and why was I sceptical after the launch?

Over a year ago, a book by Olusegun Adeniyi Power, Politics and Death was released to an eager Nigerian public. Nigerians were just coming out of a troubling time, when hearsays and rumours were the most reliable information about the state of the Country. The end of the time was marked by the assumption to office of the President, by the former Vice President, after the death of the Former President. However, there were too many unanswered questions, situations that needed explanation, gaps in stories that needed to be filled, gossip mongers that needed to be vindicated, politicians that wanted the truth to remain hidden, and politicians that wanted the truth to come out. Who better to clear the air than the late President’s Spokesman; who authored the mentioned book. I didn’t read the book.

I had two reasons for not reading the book, or bothering to do so. The first was that I know there will be so much juicy news and gossips that keeping an eye on my social media would give me most of the gist. Second reason was that I considered it to be only slightly more credible than the usual hearsays, which may well be true, but cannot hold as evidence in a legal court. To me, it was a political drama literature… and I had already watched The West Wing on TV.

My worries were sedated when I took a peek at the 90-page appendix, of The Accidental Public Servant, that seemed like large pages of international passports decorated with stamps, and signatures. These were no immigration stamps because the stamps read “RESTRICTED”, and the signatures were of former top government officials. I understood that the appendix was loaded with documents adorned with RESTRICTED stamps, perhaps to serve as evidence to some of the author’s claims. There was some other document that looked like minutes of a meeting. This book might be interesting and relevant after all.

There was still a stone in my shoe. It is amusing, at best, to hear about political dramas and scandals, but it is careless to accept unproven claims as true, especially when the information originates from a partisan in politics. The author, Malam Nasir El-Rufai, probably has the most ears of Nigerian youth, especially those on Twitter and Facebook. Now that is a dangerous man! Any person in such a position is indeed a force to reckon with. It doesn’t matter that some of his “followers” don’t like him, what matters is that he can decided what issues are being debated about on and off social media. As for those who look up to him, they are lucky to be guided… or misguided. In a country where evidence is a strange word, where narratives of a war from forty years ago still decide public attitudes and government policy, my fear of a monopoly of a narrative is forgiven; even if this book’s narrative is not along tribal and religious variables. So regardless of what a nice person I think the author is, this recognition scares the hell out of the Leftist in me. Thankfully, this fear was calmed at the Presentation; in what follows.

Disclaimers and clarifications were given early. There were many top current (& former) government officials, and Civil Society Members at the Book Presentation. Even though many of them consider themselves friends with the author, they were not spared in the book, their bad nor their goods. Some, who had already read the book, gave accounts of their sides of the story, where they disagreed with the book. This is remarkable. It calms my fear of a person, or group, having hegemony of narratives to story. This distributed opportunity of narrative is a key feature of (proper) Academia; which is the source of credible knowledge used in all sorts of applications. The fittest theory survives based on evidence and validity. In the political realm, the fittest narrative may henceforth be based on evidence; or be open to alternative narratives that must counter the opposing evidence with at least an equivalent quality of evidence. Instead of a peer-reviewed journal, we could have a peer-reviewed Narrative.

Many speakers at the Presentation called for public servants to write books. I thought it was a joke because frankly I have never thought of public servants as intelligent. Even after some recent personal dealings, I came to see them more as cunning than intelligent. I must have forgotten the ritual of how money can summon Ghost Writers. However, many of those present could easily write books I would like to read. If not for the sake of writing, it seems this is a book that could ignite responses of narratives especially by those featured in the book.

On a different note, the book may well be what I have been waiting for, to justify taking a stand on political matters. For long, I have taken the high road when it comes to taking a stand on government policies (except Subsidy removal) because I fear the tendency of being carried away by orchestrated misinformation. Unfortunately, many others take a strong stand on public policy issues, when interactions with them shows that they don’t quite understand the issues enough. One of the speakers at the launch mentioned that the book contains information about how the economy is planned, how projects are run, why projects have succeeded or failed etc. These are gold for citizens that want to (really) engage the government. Knowing that the author has a way of simplifying the complicated, as in the case of his frequent articles analysing government budget, then this book could serve as an introduction into the workings of public service. A reader of the book then will be more justified in taking a stand in policy matters and government dealings.

It was also pointed out that the book is a rich source of the history of Abuja, and that should interest residents of Abuja.

The book launch was very interesting and there is a lot more to be reported from the funny and captivating contributions by speakers at the launch, but I definitely recommend reading the book review by Prof. Chidi Odinkalu. I went to the book launch a sceptic, I became hopeful from the available evidence pool to back claims, I became hopeful from the promise of an academic-type responses and future books, I became hopeful of enriched citizen awareness into the engines of public service. But I left as a sceptic… which I picked up sitting among fellow audience. I left sceptical of whether those who respond will respond with quality arguments and evidences on the relevant issues, not the distractions they have so perfected. I left a sceptic of whether Nigerians will use this book as a resource to enrich engagement with the government, not a tabloid for juicy gossips.

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