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Polio is back in Nigeria, and the next vaccination campaign may have a surprising consequence

A health official administers a polio vaccine to a child in Kawo Kano, Nigeria, in 2014. (Sunday Alamba/Associated Press)
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In early August, Nigeria announced new cases of wild poliovirus, two years after the country’s last reported case. This was a setback for the Nigerian government as well as the global health community, which has invested $14 billion over the past three decades to wipe out polio.

Both of Nigeria’s new cases occurred in Borno state, previously a Boko Haram stronghold, where vaccinators have had limited access. The government is intensifying its vaccination campaign, pledging six rounds of vaccination over the coming months to help meet its high-profile public commitment to polio eradication.

Polio vaccination efforts create opportunities for accountability

While the cases of polio are unfortunate, the experiences of communities in other parts of northern Nigeria suggest that intense efforts to eradicate polio could be an unprecedented opportunity for Borno residents to gain a political voice.

We detail this process in our research paper. We found that polio vaccination campaigns elsewhere in Nigeria empowered communities to get the government to pave roads, electrify villages and fix dilapidated schools.

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Here’s what happens: Entire communities selectively resist vaccination, in what is locally called “block rejection.” Crucially, vaccine noncompliance does not happen because of ignorance, fear or religion — campaign monitoring data show that less than 1 percent of Nigerians hold these objections. Instead, noncompliance is a strategic move by citizens to gain the government’s attention.

Local officials, who must meet strict vaccination coverage targets, then come under intense pressure from state and national polio campaign coordinators to resolve the community’s resistance. Often, local officials make concessions to address community demands.

These instances of block rejection represent nascent bargaining processes between the state and citizens. Accordingly, we term the process opportunistic accountability. And it plays out frequently in Nigeria.

In Giwa local government in Kaduna state, over a four-month period, we documented 30 instances of block rejection. One youth leader organized his community’s noncompliance activities with the goal of getting the local health clinic roof repaired. He told us: “It might be possible we won’t be protected from polio due to block rejection. We admit and concur with the polio campaign but [we are] also concerned with the issues affecting our community.” He added that, “in this whole context of health services [our priority has to be] availability of health service facilities. But it doesn’t mean that we don’t want the polio vaccine.”

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Citizens recognize the opportunity for bargaining

This youth leader and other village leaders recognize the opportunity polio vaccinations afford them to speak to and bargain with local politicians. Vaccination campaigns are intense efforts — vaccinators often visit remote villages more than four times each year. In a country with extremely limited public services, this frequency alerts citizens to the value the state places on vaccine coverage. “Seeing the opportunity of the vaccination campaign, we decided to take advantage of it,” one village leader said. His village collectively refused vaccination for six months, relenting only when they got electricity.

The government takes note of these block rejection cases. Elected officials, even powerful governors, negotiate personally with these communities. Today, polio vaccination is often accompanied by services citizens urgently demand, such as malaria medication. While news coverage generally frames these services as a moral obligation, many were introduced primarily to encourage vaccination uptake, preempting the bargaining process. This pattern is striking evidence of a nascent social contract between the state and its citizens, in the same way that providing public services encourages tax compliance.

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Implications for the re-intensification of the vaccination campaign

In Borno, where some analysts suggest government neglect was one of the underlying causes of the Boko Haram crisis, this new opportunity to keep the government engaged in communities could make a huge difference in citizens’ lives. Some villages may get electricity. Local roads may be improved. But, most crucially, by empowering communities to hold the attention of government, the vacuum of authority that incubated Boko Haram may be overcome.

Eradicating polio in Nigeria may prove both more challenging and more costly because of citizens’ opportunistic use of political agency. But this process may also support real improvements in government accountability in the least accountable places.

Shelby Grossman and Jonathan Phillips are PhD candidates in government at Harvard University. Leah Rosenzweig is a PhD candidate in political science at MIT.