The Politics of Polio in Northern Nigeria

6. Polio in Northern Nigeria and Northeastern Ghana

6. Polio in Northern Nigeria and Northeastern Ghana President Umaru Musa Yar’adua has promised Nigerians and the international community of his administration’s commitment to stem the further transmission of polio virus and make Nigeria a polio-free country. —Daily Trust, 29 March 2009 Barely a year after World Health Organisation (WHO) declared Ghana polio free, a positive polio case has been detected at Yendi Hospital, medical doctors confirmed to GNA on Friday. —Ghana News Agency, “Polio case detected in Yendi” As these news reports from Nigeria and Ghana suggest, the Polio Eradication Initiative has met with variable success in West Africa. In Ghana, with its wellorganized program of routine immunization and high levels of immunization overall, there were no wild poliovirus infections between 2004 and 2007, although eight cases of polio were confirmed in 2008. In Nigeria, there have been no such breaks in polio transmission, although in 2006, with the implementation of Immunization Plus Days, the total number of cases had declined considerably (see chapter 3). Yet by the end of 2008, the number of confirmed cases of wild poliovirus in Nigeria had almost tripled.1 Additionally, several countries in West Africa—Benin, Burkina Faso, Côte d’Ivoire, Mali, Niger, and Togo, as well as Ghana—reported cases which, when analyzed using genomic sequencing, were found to have originated in Northern Nigeria (CDC 2009c, 309). How can these increases be explained, and how have poliovirus strains from Northern Nigeria traveled to Northeastern Ghana? Furthermore, how have migration and identity, which may be matters of ethnicity and religion rather than of allegiance to a particular nation-state, affected the Polio Eradication Initiative’s efforts, which in West Africa are organized by national programs? Taxis and buses carry Hausa traders and businessmen along a network of roads that connect Northern Nigeria with Niger, Chad, Benin, Burkina Faso, Côte d’Ivoire, Ghana, Mali, and Togo. Many of these men have family and work connections with others living both within and outside of Nigeria. These men, who may at times bring their wives and children with them, may carry the wild poliovirus with them as well. Additionally, migratory Fulani families, who travel with their cattle, frequently cross the Nigeria-Niger border. In Northeastern Ghana Polio in Northern Nigeria and Northeastern Ghana 87 and Togo, several ethnic groups straddle national boundaries, with family members traveling back and forth on a regular basis. The children of these mobile populations may or may not have received the oral polio vaccine, depending on where they were at the time that a particular National Immunization Day was held. In 2009, health officials addressed these transnational flows of people and polio by synchronizing National Immunization Days in West Africa, as had been done through 2005 (see table 3.1). However, the effectiveness of state and local programs for routine immunization has also affected the prevalence of polio in Nigeria and Ghana. How does the availability of vaccines and primary health care contribute to and help to explain the distinctive responses of parents living in Northern Nigeria and Northeastern Ghana to the Polio Eradication Initiative? While the variable successes of these programs reflect these governments’ commitment—both in theory and in practice—to the Polio Eradication Initiative, they also reflect the distinctive social, cultural, historical, and political contexts of the areas of Northern Nigeria and Northeastern Ghana where the majority of polio cases have occurred. An examination of these contexts and of parents’ experiences and understandings of gbalibila fiep-fiep (“lame leg”), as it is called by the Dagomba of Yendi District in the Northern Region of Northeastern Ghana, helps to explain why parents respond as they do to government efforts to eradicate polio, and why the responses of some parents in Northern Nigeria differed from those of parents in Northeastern Ghana. It also helps to explain why from 2001 to 2008 Ghana had only sixteen confirmed cases of wild poliovirus while Nigeria had 4,372, and why the 2008 outbreak in Ghana occurred only in the Northern Region. A comparison of polio in the Northern Region of Ghana and in Northern Nigeria is instructive, as they are similar in several ways. Both areas are predominantly Muslim,2 have largely agricultural populations, and retain forms of traditional political organization distinguished by royal families and commoners, whose histories are entangled with British colonial rule (Lentz 2006; Miles 1994). Furthermore , local medical practices continue to be used (and to be preferred by some) alongside various forms of Western...