A few years ago, northern Nigeria was a global epicenter of polio transmission, but a program that mobilized local Muslim clerics, who were once opposed to immunization and are now advocates for vaccination, has helped radically reduce infections, according to researchers.
Gambo G. Aliyu, a research fellow in vaccine evaluation at the University of Manitoba in Canada, and his colleagues launched a pilot program in 2008 in Gezawa, an area near Kano, northern Nigeria’s largest city, where there was strong opposition to polio vaccination.
Working with a government health agency, they used mobile roadside film shows to educate the community about the risks of polio and show testimonies from caretakers of polio sufferers and those affected by the disease. And they directly involved local Muslim leaders called imams, who had been distrustful of the vaccination programs, to mobilize the communities.
“This is the society I belong to, and I know how seriously they take the message from the Friday prayers. I believe they will take the advice of the imam most seriously,” said Aliyu, lead author of the report published Tuesday in PLOS Medicine.
In six months of the pilot program, the number of immunized children younger than 5 went from 2,755 to 11,364.
Aliyu said that when he was growing up in Jigawa state in northern Nigeria, he saw many children affected by polio, a crippling and potentially fatal disease. He believed, like many, that it was caused by a bad spirit.
“The local community believed the disease was spread by a demon spirit and if you were unlucky you might come across it and it would strike you, and your limb would be paralyzed,” he said in a telephone interview. “We didn’t know this is something infectious, something you can get from the environment.”
At medical school in Zaria, another northern state, he learned about polio and realized the bad curse was in fact a disease that could be protected against.
In 1988, polio was endemic in 125 countries, according to UNICEF. Since then, through aggressive vaccination programs, the virus has been almost eradicated in most countries, with the notable exceptions of Pakistan, Afghanistan and Nigeria.
Until two or three years ago, Nigeria, and particularly Kano in the predominantly Muslim north of Africa’s most populous country, was the epicenter of global polio infections, according to UNICEF.
Opposition to the vaccine by some local scientists and rumors that the vaccines caused sterility and were a covert attempt to reduce the Muslim population in the north added to resistance. Incidents such as when a small number of vaccine-induced infections in 2006 led to outbreaks bolstered these fears.
A milestone for the program was when it gained the support of the Sultan of Sokoto, a spiritual leader in Nigeria, who helped launch the Northern Traditional Leaders Committee for Primary Health Care and Polio Eradication in 2009.
In 2010, a team of experts consisting mainly of Nigerian Muslim scientists was formed to assist the committee, which included four of the authors of the new report. The team mapped the high-risk areas in the north within the 12 polio-prevalent states and set up the Northern Religious Leaders Contact Group, assisted by the sharia boards and ministries for religious affairs.
The program has since provided training for about 18,000 Muslim imams, through 10 weekly sessions, educating them on the facts about polio, providing a platform for discussion, answering questions and concerns, and arming them with advice they can share with their communities.
Imams were given template sermons about polio and the importance of vaccination that they could use during Friday prayers and daily discussions.
“The missing link with campaigns in the past was that we didn’t figure out how to connect with the society,” Aliyu said. “From now on, we will maximize the use of traditional and religious leaders as part of the campaign.”
When the committee of imams was launched in 2009, there were 384 new wild poliovirus cases reported in Nigeria, most in the northern states. By 2010, the number of reported cases had plummeted to 21.
In 2011, however, there were 62 cases in the northern states, and 118 in 2012. Last year the number of cases dropped to 49.
According to UNICEF, there have been five cases so far in 2014, three of which were in Kano state.
“We’re seeing exciting news in Nigeria,” said Sarah Crowe, chief of crisis communications at UNICEF. “It’s the next big hope.”