PEOPLE & POLITICS BY MOHAMMED HARUNA

So that the National Programme on Immunisation May Succeed

kudugana@yahoo.com

Last Saturday the Arewa Media Forum, which I chair, organised an interactive session at Arewa House, Kaduna, on the way forward from the controversy surrounding the polio immunisation campaign. At the AMF we were concerned that the controversy could have a deleterious effect on future immunisation campaigns, especially those of the more widespread infectious diseases like measles, meningitis and tetanus.

As we all know, the controversy started with the claim by a leading Muslim cleric, himself a medical doctor, Dr. Ibrahim Datti Ahmed, that the polo vaccines for last year’s campaign had been contaminated and adulterated by the manufactures so as to induce infertility among the Muslim population and infect them with HIV and cancer, as part of a Western plot to curb the galloping population of the Third World countries.

Since Dr. Ahmed’s claim, which seems shared by the many among the Ulama’a in the North, the authorities have been battling to reverse the popular rejection of the polio immunisation  programme in the region.

At the AMF we had no illusions that our interactive session will end the controversy, and it didn’t. Our only hope was that the protagonists and antagonists would come out of their trenches so as to allow other immunisation  programmes to succeed .

The obvious question is did we realize our hope? As the chair of those who organised the interactive, it is natural that I should express optimism about its outcome in the context of our somewhat limited objective. Even then I don’t think I am merely expressing the bias of an interested party when I say that both sides in the controversy did come out of their trenches in-spite of the fact that they did re-state some of their earlier positions. I say this for two reasons.

First, participants at the interactive session agreed unanimously that before last year’s campaign there was little or no sustained and systematic campaign to reassure the Ulama’a and their followers alike that the vaccines were safe. Instead it was assumed that the matter was purely scientific and once you got scientific experts, especially those of the World Health Organisation and the UNICEF, to declare a vaccine safe, then that was the end of the matter.

As we all now know, the WHO and UNICEF experts as well as several local experts did declare the polio vaccine safe, but people still rejected the vaccines. Instead of asking why, both the foreign and domestic protagonists of the campaign, including the authorities, resorted to blackmail. They dismissed the antagonists as superstitious and/or mischievous. Soon enough you started hearing rumours of even more outrageous blackmail that taking polio vaccines would soon be made a condition by the Saudi authorities for going on Hajj, as if the vaccines are for adults not infants who wont be qualified to perform Hajj in at least the next 16 years.

By now it should be obvious that such blackmail has not worked and would not work. At the end of the interactive session it was agreed that there simply was no substitute to a sustained and systematic campaign for the enlightenment of the Ulama’a and the grassroots over the safety of, not just the polio vaccines, but all other vaccines.

I say there was a narrowing of the gap between the two sides in the controversy not only because there was an agreement on the need for public enlightenment on the safety of vaccines, but also because the antagonists did emphasise again and again that they have never been against vaccinations in principle. They acknowledged that Islam is pro-science and they could not, therefore, reject the products of science. What they feared, as Dr. Mahdi Abubakar Sadiq from the Kano State Sharia Advisory Committee said, was that the campaign could be the continuation of a history of pharmaceutical companies using the population of Third World countries as guinea-pigs to test their products. This is something which the people of Kano painfully experienced several years ago with a Pfizer drug on meningitis. Part of their grouse was also that the Western world which owned most of the companies put profit before safety and also had the well documented motive and the means to curb the world’s population.

Since all participants at the interactive session were agreed that immunisation is a legitimate tool of disease prevention and since they were also agreed that there was a need for sustained and systematic public enlightenment on the safety of vaccines, to me only two more things need to be done to overcome the popular rejection of the polio vaccines in the North and possibly of other vaccines.

The first is general and the second is particular to those in charge of our National Programme on Immunization. At the general level, the protagonists of the polio vaccines must accept that medicine as science is not value-free and that even if it is, scientists, as human beings, can be and are often compromised. I have, on these pages, had occasion to mention the case of Monsatu, a U.S. based chemical company, which succeeded in suborning American and WHO scientists alike into endorsing one of its leading products which has a highly dubious safety record.

A more recent example is the case of MMR (measles, mumps and rubella) immunisation involving a Dr. Andrew Wakefield. Regular readers of this column will remember that I mentioned his case recently at the height of our polio controversy. Many years ago Wakefield linked MMR with autism as a result of which thousands, if not millions, of parents in the UK, including possibly Prime Minister Tony Blair, rejected the one-doze MMR vaccine for their babies. Late last February, it emerged that Wakefield’s case may have involved conflict of interest. It has now been revealed that when he published his paper in a medical journal linking MMR with autism, the British Legal Aid Board was paying him to discover, on behalf of parents hoping to sue for damage, whether or not the one-shot MMR vaccine was harmful.

Since then Dr. Wakefield has been portrayed in the British media and in medical and scientific circles as a cheat. But as George Monbiot, a columnist with the London Guardian said in the paper’s edition of February 24, “the crime for which the new Dr. Evil is being punished is everywhere ...The scientific establishment is rotten from top to bottom, riddled with conflicts of interest far graver than Dr. Wakefield’s.”

Among the many evidences Monbiot’s sited was a report by the Union of Concerned Scientists showing how American science has been systematically “nobbled” by President George Bush. “Whenever scientific research conflicts with the needs of his corporate sponsors or the religious fanatics who helped him to office, he has sought to suppress it.” Last year, for example, the White House, he said, tried to force the Environmental Protection Agency to alter its findings on climate change by, among other things, ordering it to dump its temperature records and replace them with a discredited study partly funded by the American Petroleum Institute.

Monbiot also said the National Cancer Institute was instructed to claim that there was a link between abortion and breast cancer, which was not true. (American neo-conservatives are instinctively pro-life).  He also said independent scientists have been purged from the government’s expert panels and replaced with “corporate stooges and religious nutters.”

However, Bush, he said, was merely systematizing something which has been taking place in the world of science for years. One study published in 2001, he said, found that only 15% of scientific journals had a policy of conflicts of interest,  and only    0.5% of the papers they published disclosed such conflicts. He also pointed out that a study of the research papers on the side-effect of a class of heart drugs called calcium channel blockers found that 96% of the researchers who said the drugs were safe had financial relationships with the manufacturers, as against 37% of those who expressed concerns.

Monbiot cited worse cases, but even these ones are sufficient to show that scientists are not above being compromised and therefore it was never enough for the authorities here to have argued that people should simply have accepted the word of experts as gospel truth.

The more important consideration here is transparency and accountability. Which      takes us to the second and third steps that will help move the national immunization    programme forward. This absence of transparency and accountability in the programme is the greatest obstacle to the success of immunization: the NPI (the National Programme on immunization) whose National Coordinator is Dr. Dere Awosika, I must say, simply stinks to high heaven. Its reorganization is therefore necessary if it is to succeed.

Last year my good friend and respected columnist of the Vanguard, Pini Jason, wrote in the August 26 edition of the paper to say that “Dr. (Mrs.) Dere Awosika has given the nation service in this area as if her life depends on it.”

Before Awosika came along, said Pini, the immunisation  programme was more hype than substance. There was, he claimed, less than 10% immunisation coverage of the entire country. Then Obasanjo “came in to office and gave Mrs. Awosika the free hand to immunise our children against the deadly polio and other communicable diseases. I make bold to say that she has done a good job.”

With due respect to my good friend, Pini, nothing could be farther from the truth. First, Awosika has been at NPI long before Obasanjo returned in 1999. She got the job because Mrs. Mariam Abacha, the country’s First Lady between 1993 and 1998, insisted against all expert advice, that she must be given the job. Awosika is a pharmacist, whereas the job required a public health doctor, preferably one with management skills and experience. Awosika had neither. Second, before 1998 the immunization programme under the late Dr. Olukoye Kuti,  the country’s longest serving health minister and a well known advocate of primary health care, had achieved at least 70% spread.  Third, from the time Mrs. Abacha insisted on putting a square peg in a round hole, the story of NPI has been of one scandal after another. If it is not of inflated contracts, it is of procuring expired vaccines, etc.

Matters reached a head last year when the part-time chairman of NPI appointed by President Obasanjo, Professor Idris Mohammed, petitioned the president through the Minister of Health, to complain of irregularities, corruption and lack of transparency at the NPI. Contracts worth billions of Naira, he alleged, were being given out without due process. The President never got the petition. Instead he got a letter from his minister of health alleging bad blood between the chairman and the National Coordinator.

Accordingly the president ordered the setting up of a panel to look into the matter in so far as it  affected  the  country’s  immunisation  programme. The panel was set up on      August 29, 2003 by the minister with terms of reference that said nothing about the chairman’s allegations.

Consequently the chairman again petitioned the president. For the second time the petition got missing in transit. As a last resort the chairman wrote through Vice-President Atiku Abubakar who personally delivered the letter to his boss. The president was reportedly shocked that he was kept in the dark about the substance of the chairman’s petition. He then directed the expansion of the panels terms of reference to include the investigation of those allegations.

My information is that the panel has since submitted its report to the minister. However, months after the submission, mum has been the word form both the ministry and the  presidency.

This has led to speculations that the chairman’s allegations has been found to be true and that there are forces more powerful than Mrs. Awosika hell bent on covering up the scandals  at the NPI. The speculations have been fueled by the fact that last year alone the NPI received over 4 billion Naira under the year’s budget, most of which has been spent without the knowledge or the  authorization of its board.

I can claim to know Mrs. Awosika a bit because we were both undergraduates in Ahmadu Bello University, Zaria, in the early seventies at a time when A.B.U. was a fairly tight community. A lot of water has, of course, passed under the bridge between then and now, but the Dere that I knew in the early seventies does not strike me as someone who would act with impunity if she is not sure she has immunity from the powers that be.

I may be wrong on this just as the chairman’s allegations may be false. The only way we will know for sure is if the government publishes the findings of the ministerial panel on the irregularities and large scale fraud at the NPI. Or, better still, if the government sets up a judicial panel to look into those allegations. For, a judicial panel is more likely to get at the truth than an administrative panel. And I am sure the authorities will agree that the failure of the polio vaccination campaign requires such a judicial panel to ensure that there is henceforth the transparency and accountability necessary for the NPI to achieve its broad objective of protecting the health of Nigerians from immunisable diseases.

Certainly such transparency and accountability is necessary if the public enlightenment campaign needed to persuade the public about the safety of its vaccines is to succeed.

Last but by no means the least, there is the need to reexamine our attitudes towards public service. His Royal Highness Dr. Halliru Yahaya Ndanusa, the Emir of Shonga, who chaired the AMF interactive session and who himself is a first class  medial doctor, alluded to this point in his closing remarks. This attitude is clearly responsible for the fact that the country’s center for vaccine manufacture at Yaba, Lagos, has, for all practical purpose, been dead for decades. The center was established in the fifties at about the same time with similar centers in Brazil and Malaysia. Both now export vaccines while we import them.

The difference is clearly one of attitude. While the Brazilians and the Malaysians see aids from foreign donor agencies as opportunities  for capacity building to the extent allowed by the strings attached to the aids, our own officials generally see such donations as opportunities for self-enrichment, especially in the context of the scarcity of foreign exchange in the country. Hence the tendency of such officials to undermine or even sabotage our plants for the local manufacture of goods and services such as we have painfully experienced and are still experiencing in petroleum products.

Combating this terrible attitude will take quite a while, but this government which says transparency and accountability is the centerpiece of its philosophy can make a start by reviving the Yaba center for vaccine manufacture so as to eliminate the suspicions surrounding the imported vaccines, a suspicion which is at the heart of the  failure of  the current polio campaign.