IRIN Focus on worsening epidemics in the north

There are signs that Nigeria’s northern region is becoming increasingly vulnerable to annual epidemics of measles and meningitis amid widespread resistance to immunisation by suspicious locals. Taking advantage of strong anti-Western sentiments sweeping across the predominantly Muslim region since a number of states started implementing strict Islamic law over the past year and a half, some radical Muslims have launched a strong campaign against Western medicine. The campaign, waged through anonymous messages recorded on audio cassettes in the local Hausa language, include allegations that Western countries have conspired to limit population growth in Africa by infecting people with HIV and sterilising them under the guise of immunisation. One result of this propaganda has been a significant drop in the level of immunisation among people in the region, particularly in rural areas. Local health officials and international humanitarian agencies involved in immunisation against the polio virus, measles and meningitis have reported being turned away from homes, especially in Kano, Jigawa, Sokoto and Zamfara states. “We have a situation where immunisation levels in this state has dropped by up to a third so far this year,” a senior official of the Kano State Ministry of Health told IRIN. Coinciding with this widespread resistance of immunisation has been a significant rise in the number of people affected by outbreaks of measles and meningitis. Cases of measles rose by 670 percent in Kano, the biggest city in northern Nigeria, in the first 21 weeks of this year compared to the same period in 2000, according to figures provided by the international medical charity, Medecins sans Frontieres (MSF). According to MSF, 16,263 cases were recorded by its personnel at two hospitals in Kano and during a joint surveillance the NGO conducted with Kano’s health ministry as against 2,111 cases for the corresponding period of last year. While the overall death toll was not available, MSF said 84 out of over 424 people who were admitted to hospitals in Kano city between January and early April died. Local newspaper reports quoting health officials from different parts of northern Nigeria indicate that the disease took a higher death toll, particularly among children - its main victims - in line with the dramatic increase in its incidence. While MSF reported only a slight increase in cases of meningitis (compared to measles), media reports indicate a sizable death toll. Local newspapers reported about 200 deaths from meningitis in Sokoto State within one week in March, at the peak of the hot season in northern Nigeria, when the disease is most active. The French news agency, AFP, reported another 80 deaths from meningitis in the north-central state of Niger about the same period, quoting a radio broadcast by the official in charge of health in the state. Some officials of humanitarian agencies believe that just as many deaths in remote communities went unreported. The suspicions against modern medicine among the largely illiterate population in the poor urban neighbourhoods and rural areas in the north have not been helped by a controversy early this year over a meningitis drug trial that the pharmaceutical transnational, Pfizer Inc, conducted in 1996 in Kano. A report by ‘The Washington Post’ alleging that Pfizer did not obtain the required written consent before conducting the drug experiment, during which 11 children died and several others suffered meningitis-related disabilities, was heavily played up in the Nigerian media, apparently reinforcing existing suspicions. While the Nigerian authorities have launched an investigation into Pfizer’s conduct, the families of about 200 people affected by the drug trial have filed a lawsuit against the company claiming $120 million. A hearing on the case is due on 31 May, and the issue continues to generate massive publicity, reinforcing adverse opinions among the people. Andrew Cunningham, MSF’s Nigeria country manager, told IRIN that the northern region has had a history of propaganda alleging that the provision of health care, particularly vaccines, is somehow linked to some other “hidden agenda”. But he said such misinformation has not had a direct impact on the work of MSF, which does not involve immunisation but largely entails working with local authorities to collect and study epidemiological data on infectious diseases. This also makes the group unable to gauge the impact of such propaganda on public health. “We can’t make a judgment, it is hard to quantify the impact of those issues on the measles epidemic,” he said, stressing the need for all partners involved in health care to take a careful look at why some epidemics appear to be resurgent. However, Yakubu Ishaya, a medical practitioner in Sokoto, believes that the epidemics are linked to the intensification of Islamic sentiments in several northern states which have adopted the Sharia and anti-Western feelings born of the widespread perception that the West is opposed to the Islamic legal system. “For a lot of the ordinary people in the mainly Muslim areas, accepting Sharia also means rejecting everything Western, be it education, fashion or medicines. And in the case of medicines the consequences are already being felt in terms of increasing casualties from infectious diseases,” he told IRIN. He added that the local authorities were also reluctant to give information indicating the extent of epidemics as the recent developments leave them in a bind. “Everybody also wants to make the pilgrimage to Mecca. Publicising the full impact of the epidemic will only make the Saudi (Arabia) authorities wary, which may result in people from these parts being excluded from Mecca,” he said.