And then it all went wrong.
Although the rumour didn’t surface until after 11 September, in reality it had been born a year earlier. Its birthplace was Nigeria, one of the last ten reservoirs of wild poliovirus on the planet. In 2000, the emir of one of the country’s northern states, Najib Hussein Adamu, had noted a degree of confusion among his rural constituents about vaccination programmes in the country.
Inhabitants of Kazaure wanted to know why the WHO was still vaccinating against polio when there were so few cases of it. Why weren’t they concentrating on measles? Adamu, a lawyer, did a little research on the Internet and discovered the answer: according to his sources, all was not as it seemed with the GPEI.
In the United States and Europe, Adamu learned, children received a different vaccine to the one being handed out in Nigeria. His interest piqued, he read on, to discover that Oral Polio Vaccine (OPV), the form in which it was distributed in the Third World, was made using monkey cells. There was a chance, he read, that these might be contaminated with pathogens, including Simian Immunodeficiency Viruses (SIVs). Worse, according to a theory fashionable at the time, OPV manufactured in the Congo during the 1950s using chimpanzee tissue cultures had led to the transferral of SIVs to human beings, causing the outbreak that would later become the AIDS pandemic. The vaccine wasn’t safe.
Why would the First World feed African children a vaccine that wasn’t safe when it was using a different one at home? Adamu found the answer buried in a secret 1974 US National Security Study Memorandum known as ‘NSSM-200’. Signed by Secretary of State Henry Kissinger and declassified in 1989, the document addressed trends in Third World population levels, warning that explosive growth in the world’s thirteen ‘Least Developed Countries’ was unsustainable and could lead them to become security concerns to the United States.
To this end, NSSM-200 recommended that it should be US policy to encourage these thirteen nations to educate their populations in modern family-planning techniques, including contraception (which it included under the euphemism ‘actions to reduce fertility’). If the nations were unwilling to listen, the United States should consider acting anonymously via private intermediaries, through which financial coercion could be channelled. The document also mooted making US aid to the thirteen nations dependent on their showing sufficient zeal on the family-planning front. One of them was Nigeria.
To Emir Adamu, the relationship between contaminated OPV and secret United States funding of a fertility-reduction programme was as clear as it was explosive: GPEI was not about eradicating polio at all. It was about the struggle for global resources. It was about depopulating the Third World. It was noteworthy that the populations of six of the thirteen nations listed in NSSM-200 as in need of ‘actions to reduce fertility’ were predominantly Islamic. In July 2003, the Emir fired a memorandum to an Islamic umbrella group, Jama’atual Nasirul Islam (JNI), warning of the issue of OPV, depopulation and Islam.
Ironically, while Adamu was busy spreading the news of his findings, the Nigerian polio situation was going quite well. In April 2002, Health Minister Alphonsus Nwosu announced that the country was aiming for complete eradication of the disease by the end of the year. Six months later, GPEI launched what it hoped would be a final drive to immunize children in West and Central Africa. But, just as the organization geared up to vaccinate 15 million children, the story found an outlet in the form of the President of the Supreme Council for Shariah in Nigeria (SCSN), Dr Ibrahim Datti Ahmed.
Ahmed concurred with Adamu’s reasoning: OPV caused AIDS. It contained female hormones designed to make Muslim men sterile and Muslim women barren.
‘Modern-day Hitlers have deliberately adulterated the Oral Polio Vaccine with anti-fertility drugs,’ he told the press, ‘and contaminated it with certain viruses which are known to cause AIDS.’
In October 2003, three of Nigeria’s northern states, predictably those with the highest Islamic populations, stopped vaccinating children against polio.
‘It is the lesser of two evils to sacrifice two, three, four, five, even ten children [to polio],’ reasoned Ibrahim Shakarao, the governor of Kano Province, ‘than to allow hundreds of thousands, or possibly millions, of girl children to be rendered infertile.’
Ignoring protests from the WHO, Nigerian authorities refused to resume vaccination until OPV distributed by the organization had been subjected to scientific testing to prove its purity. In charge of the tests was a Nigerian pharmacologist, Dr Alhassan Bichi, who subjected OPV to photometry and, to the horror of international aid agencies, promptly discovered a low-level contaminant structurally similar to oestradiol, a female hormone. Despite the fact that the quantity of oestradiol was insufficient to cause any significant effects, the compound had not been listed among the vaccine’s contents on the bottle’s label.
In December 2003, Dr Bichi reported the finding, along with his conclusions: ‘Where polio vaccine is seen to contain something that has not been declared, then I find it unethical to recommend that the vaccine be used.’
Further tests were commissioned, but the damage was done. Full vaccination in Nigeria would not recommence for another ten months.
For GPEI officials, the Nigerian ban was more significant than simply a missed deadline for the eradication of polio. At the Senate hearing in 1998, Dr Bill Foege, a former Director of the US Centers for Disease Control and one of the key figures behind the elimination of smallpox in the 1970s, explained why. Smallpox eradication from Ethiopia had taken a month longer than predicted. During that month, the virus had slipped across the border and reinfected Somalia. It took two years to get the disease out of Somalia again. A delay in polio eradication, if it led to further infections, could spell catastrophe for GPEI efforts.
‘That is my fear with polio,’ Foege told the Senate Panel. ‘If it takes one month, six months, one year too long, then we will have reimportations into Brazil or India or Burma.’
The process would have to start all over again.
In a sense, the GPEI had become a victim of its own success. The programme had worked so well, so fast, that the disease was now rare. Villagers in Ethiopia or Yemen – or Nigeria – failed to see why they should continue vaccinating against a disease that appeared already to be gone. The problem was more pronounced in countries that had been cleared of polio altogether: why should precious health care resources be used to support a vaccination programme when the country was not apparently at risk any more? How long would this last?
The answer, of course, was that, for the programme to work, each country had to continue vaccinating until all countries were free of the disease. By the time of the Nigerian ban, nearly 200 countries were vaccinating against a disease that did not exist within their borders. The longer the eradication programme took, the harder it became to sustain.
There was an even greater risk. Like an incomplete course of antibiotics, GPEI had removed the bulk of the pathogen, but any opportunity for it to return could be catastrophic. This had been the case with the malaria eradication programme started by the United States in 1955. Although $2 billion had been spent and significant progress made, in the late 1960s, the programme had been abandoned for financial reasons. Malaria rushed back into the regions that had formerly been cleared. In some areas, since natural immunity to the disease had now been lost, it caused more damage than it would have done had the programme never been started in the first place.
From the outset, experts had warned of the dangers of a failed polio-eradication campaign. In 1980, Donald Henderson, who had coordinated the smallpox operation, specifically spoke out against the idea of a polio programme. Smallpox, he said, had been eradicated only with a vast quantity of luck. Ten years into the campaign, donors had been as bored of ploughing cash into the operation as Third World countries were of vaccinating. When it came to eradication operations, there was a brief window of opportunity; if it was missed, eradication became ever more difficult and expensive. It was for this reason that th
e Senate committee in 1998 had declared that, while the programme was ‘on the threshold of victory’, vigilance was crucial: the last part might be the hardest.
‘The consequences of having time run out,’ according to WHO’s David Heymann, ‘are inconceivable.’
Sure enough, almost immediately after the three northern Nigerian states stopped vaccinating against polio, there was a new outbreak. In 2000, Nigeria had seen twenty-eight cases of the disease. By the end of 2003, the number was up to 355. The next year, the figure more than doubled. A second test of the vaccine revealed that it was indeed safe and full immunization resumed in July 2004, but by now it was too late. The virus started reinfecting neighbours formerly declared clear of it: Niger, Sudan, Togo, Ghana, Guinea, Cameroon, the Central African Republic, Burkina Faso and Côte D’Ivoire all saw new cases. One showed up as far south as Botswana. When the Centers for Disease Control in Atlanta analysed wild virus found in each country, all were traceable back to northern Nigeria.
In February 2005, a case occurred in Indonesia. The country had been free of polio for nearly a decade, lulling health authorities into a sense of false security: vaccination programmes had lapsed. Five million children were immediately immunized, but the virus was already up and running. Within a year, WHO had logged 264 new cases in the country – all direct descendants of the Nigerian strain. Eighteen months later, Somalia, clean of the virus for three years, was reinfected: 228 children were crippled.
In the four years following the cessation of vaccination, twenty-seven countries were reinfected with polio – twenty with the Nigerian strain. The country had become the number-one transmitting point for poliovirus in the world.
The WHO was forced to abandon its goal of eradicating polio worldwide by 2005. By the end of the following year, the cost of mopping up the aftermath of the Nigerian vaccine ban was $450 million, and the number of countries with endemic polio had risen from four to sixteen; 1500 children had been paralysed.
‘The world,’ noted David Heymann, ‘is still paying the price for what happened in Nigeria in 2003.’
Abdul Ghani understood all of these points well. Deputy Medical Superintendent in Nowshera Hospital, he was second-in-charge of vaccination efforts for the region. The way he saw it, Pakistan – until the Nigerian incident one of the last four countries left on earth harbouring reservoirs of wild poliovirus – was going to fight the disease with all it had.
Azmatullah Jan Faiq, who would later organize Ghani’s ‘surprise’ promotion party in 2002, recalls the doctor’s devotion to the issue. On the second day of the Muslim festival of Eid in 2001, Faiq received a telephone call from his boss. Ghani informed him that he planned to visit two villages in the region, Taro and Akbarpura, where clusters of children had been missed during the recent NIDs. He needed assistance. Faiq, District Storekeeper for the region, was not amused.
‘I told him that it was Eid. I had guests at my home. I was busy’
Unusually, Ghani insisted, telling his subordinate that this was the perfect time to vaccinate. ‘This is a great opportunity’ he said. ‘Not only can we spread goodwill on Eid, we can vaccinate the children at the same time.’
The reluctant Faiq was instructed to make apologies to his guests and wait outside his house. Ghani would pick him up.
Faiq and Ghani missed the celebrations and ended up driving home late that night. As they made their way back to Nowshera, Ghani noticed that his companion was tired and unhappy.
‘Don’t be angry,’ he told him. ‘We’ve missed Eid. But look at it this way: we were more successful today than we would have been at any other time. All the parents were at home and in a jolly mood. This is a national cause, and we are responsible for it.’
Faiq grudgingly agreed, but said that the missed holiday still rankled.
‘I understand,’ Ghani commiserated. ‘But remember: Eid will come again next year. If we miss a single child, they won’t have that opportunity’
The Nigerian polio outbreak of 2003 was not simply the result of a vaccine boycott. Many factors were at play. The country’s immunization programmes were weak and poorly run: there was every chance of an outbreak anyway. More importantly, the vaccine ban was partly the result of political issues.
In April 2003, Olusegun Obasanjo, a Baptist, had won a second term of office as president over his opponent Muhammadu Buhari, a Muslim. The election had served to crystallize political rancour between the largely Christian, and comparatively wealthy, south of the country and the poorer, largely Islamic, north. Organizations such as the Supreme Council for Shariah became focal points for dissent against what they saw as their elitist, and possibly racist, southern rulers. Refusing to administer polio vaccine had been a simple yet effective means of expressing resistance.
The movement also unwittingly tapped into a groundswell of rage against the United States. With America at war in Afghanistan and angling for war in Iraq, there was a potent belief that what the First World was really engaged in was a crusade against Islam. If the United States could not be trusted in matters of international politics and was willing to invade foreign countries on false premises, why should it be trusted on other issues?
‘They claim that the polio campaign is conceived out of love for our children,’ explained a leading Nigerian cleric in 2002. ‘If they really love our children, why did they watch Bosnian children killed and 500,000 Iraqi children die?’
Interest from the international community in Nigeria had always been suspicious: little was done about measles, little was done about drinking water. Nobody really cared. Yet every year westerners appeared in Land Cruisers insisting that Nigerian children swallow a vaccine for a disease that appeared to be gone. It didn’t add up.
‘America hates Muslims, and so whatever comes from the United States, no matter how good it is, people will reject it,’ said the chief imam at Kano’s second largest mosque.
In October 2003, the National Security Council suggested that President Bush write a personal letter to President Obasanjo reminding him of the importance of polio vaccination, but the idea was vetoed: such was the level of distrust in Nigeria that a letter from the US president would have looked even more suspicious, and might have made things worse. In the aftermath of America’s reaction to 9/11, the world had lost faith in its last remaining superpower.
‘They have always taken us in the Third World for granted,’ one member of Nigeria’s OPV testing team crowed after oestradiol had been found, ‘thinking we don’t have the capacity, knowledge or equipments to conduct tests that would reveal such contaminants.’ Nigerian technology, Nigerian scientists and Nigerian know-how were proving them wrong.
The problem had been facilitated by technological advances. Globalization – the corrosion of international borders and apparent elimination of distance that had made 9/11 possible and the invasion of Iraq a priority – was dependent on the flow of materials internationally. The United States liked to harp on about the movement of terrorists and weapons, but the most important commodity of all was information. And the driver of the new-found information exchange was, of course, the Internet.
One of the wonders of the World Wide Web was its ability instantaneously to disseminate vast quantities of unfiltered, often complex, technical information. The availability of this information made it extremely alluring: the Internet provided a licence for those with shadier motives to propagate whatever rumours they felt like propagating, covering their tracks with footnotes and other miscellaneous data that seemingly served to make the arguments not less, but more, credible: Israel blew up the World Trade Centers; America deserved 9/11; the Holocaust didn’t happen. All around the world such arguments, peppered with footnotes to prove their authenticity, were disgorged by the Internet, like so much cuttlefish ink. It was this same process that led to Emir Adamu’s conclusions about OPV.
It wasn’t just the Third World that was duped. At the same time as Nigeria’s religious leaders were warning of the dangers of OPV, the
United Kingdom was experiencing a vaccine panic of its own. Convinced by erroneous but credible-sounding medical reports that the measles, mumps and rubella (MMR) vaccine caused autism, a swathe of British parents – like the Nigerians – elected to err on the side of caution. In 1996, MMR had been administered to 92 per cent of British children. By 2004, this figure had dropped to 84 per cent – the lowest since reporting began, and far short of the 95 per cent necessary to achieve national immunity. In London, the figure fell below 75 per cent, with some boroughs struggling to break 60.
In the midst of such confusion, it was for the experts – such as those at the WHO and US Centers for Disease Control (CDC) – to establish what was actually going on. Shortly after Nigeria stopped vaccinating against polio and the virus began to spread, CDC scientists analysed data from genetic fingerprinting of wild poliovirus specimens. By correlating information from these specimens, they were able to piece together exactly how the outbreak had moved.
The virus had travelled first to Nigeria’s immediate neighbour, Chad, before moving to Sudan. From Port Sudan, it had then crossed the Red Sea, presumably by ferry, into Yemen. Initially, it was speculated that the virus had simply followed traditional trade routes, skirting the southern Sahara before moving on. Perhaps it had travelled with migrant workers seeking employment, or exporters of Nigerian products to the Middle East.
As details of the routes taken by virus-carriers out of Nigeria into the rest of the world emerged, however, it became clear that many of the routes shared a common goal: Mecca.
A History of the World Since 9/11 Page 32