Conspiracy Theories Keep Polio Alive

In my 1997 book , The Hidden Hand: Middle East Fears of Conspiracy (New York: St. Martin's Press, 1996) I wrote about Arab and Iranian phobias concerning the West seeking to infect them with diseases:

Western colonialism stands accused of causing all "diseases rampant in the Arab lands." Specifically, the British imported cholera and malaria to Egypt after World War II. A British midwife who trained in the Kabylia province of Algeria got accused by his angry Algerian supervisor of working in league with the "white-coated saboteurs passing their hands from vagina to vagina, infecting my heroic people with syphilis!" An unnamed enemy—presumably American—infiltrated deadly diseases into Iraq via maggot-ridden cigarettes. Israel transmitted cancer to Palestinians by getting them to take dangerous factory jobs or subjecting them to phosphorous searches. It also smuggled irradiated fruit into Egypt to cause cancer.

AIDS, combining sex and disease, prompts recurring nightmares. Jerusalem hires young Jewish women infected with AIDS to spread the affliction in Egypt. One article in the Egyptian press focuses on an Israeli named Sarah who cavorted in luxurious apartments and infected the young and the prominent, while other versions count between 20 and 327 infected Israeli agents. The most imaginative account conjures up a "special formula" of the AIDS virus that infected sexual partners without in any way affecting the Israeli female carriers.

With this background it comes as less than a total shock to learn from an important article in today's Baltimore Sun by John Murphy that the Muslims of northern Nigeria suspect that the polio vaccines being offered them gratis are in fact "contaminated with an anti-fertility agent that would sterilize their children or perhaps infect them with the AIDS virus, all part of an American plot to depopulate the developing world." Murphy tells this shocking anecdote from the village of Fanisau, Nigeria:

In January last year, Nigerian health workers knocked on [Halima] Umar's door, offering her newborn daughter a free dose of polio vaccine. Two drops of the oral polio vaccine taken at least three times as a child, the health workers told her, would protect her daughter, Zaliha, from the crippling virus for life. But Umar turned the vaccinators away. Most of her neighbors did the same, some hiding children under their beds.

They had heard a rumor circulating through the hot, dusty villages of northern Nigeria that the vaccine had been contaminated with an anti-fertility agent that would sterilize their children or perhaps infect them with the AIDS virus, all part of an American plot to depopulate the developing world. The villagers believed it. It didn't matter that the World Health Organization, the Nigerian government and dozens of doctors and scientists dismissed the allegations as baseless, assuring the public that the vaccine taken by 1 billion children worldwide is safe. "We just didn't like the vaccine," says Umar.

During the following three months, vaccinators returned to Umar's neighborhood two more times to immunize the children. On both occasions, the shy 22-year-old mother politely but firmly declined their offer. Then in June, 10-month-old Zaliha developed a fever and diarrhea. Zaliha, who had recently learned to crawl, suddenly could no longer sit up. A few days later, paralysis, polio's damning trademark, arrived, leaving her legs limp and lifeless. …

Standing in her doorway on a recent morning, holding her crippled daughter, she expresses no regret. Asked if she would accept the vaccine if she could wind the clock back to that day health workers first knocked on her door, she does not hesitate with her answer. "No," says Umar, shaking her head. "I would do the same."

On other occasions, villagers have "chased, threatened and assaulted vaccinators. Frustrated, some vaccination teams dumped thousands of doses of the vaccine rather than face angry villagers" and three northern Nigerian states canceled immunization campaigns last year.

Ali Guda Takai, a WHO doctor, explains the logic: "What is happening in the Middle East has aggravated the situation. If America is fighting people in the Middle East, the conclusion is that they are fighting Muslims." Indeed, the number of polio cases has increased sharply with the wars in Afghanistan and Iraq: 9 in 2001, 54 in 2002 and 74 in the first 11 months of 2003.

The source of the problem lies with the doctors, imams, political leaders and professors who endorse the conspiracy theory. They are led by Ibrahim Datti Ahmed, a physician and president of Nigeria's Supreme Council for Sharia Law. Ahmed, 68, says of Americans, "They are the worst criminals on Earth to sterilize children for life. Even Hitler was not as evil as that."

Not only does this conspiracy theory harm Nigerian children like Zaliha, but it has worldwide consequences, obstructing a $2 billion-effort to eradicate polio. So long as it lives on in northern Nigeria, it lives on everywhere: "All it takes is for someone to hop on an airplane ... to start reinfecting another part of the world," notes the epidemiologist David Heymann. Chalk up one more tragedy to the baneful influence of conspiracy theories. (January 4, 2004)

Feb. 26, 2004 update: Ibrahim Shekarau, governor of Kano, one of the three Nigerian states refusing the polio vaccine, justified this decision on the following brilliant grounds: "it is a lesser of two evils to sacrifice two, three, four, five, even ten children [to polio] than allow hundreds of thousands or possibly millions of girl-children likely to be rendered infertile."

March 1, 2004 update: "Laboratory tests have confirmed that Nigeria was the source of the virus that caused a case of polio in Ivory Coast. … Ivory Coast is the eighth previously polio-free country in Africa where the crippling disease has reappeared in recent months. Its last polio case was reported in July 2000. Nigeria is believed to have also exported the infections to the seven other previously polio-free African countries: Benin, Burkina Faso, Cameroon, the Central African Republic, Ghana, Togo and Chad. The World Health Organization says the exported cases and continued opposition to polio vaccination by religious and political leaders in the northern states of Nigeria are jeopardizing its efforts to eradicate polio by the end of this year." So reports today's New York Times on the further ravages of conspiracy theories.

March 22, 2004 update: Good news: "Some Nigerian States End Polio Vaccine Ban" reads the Associated Press headline. Nigeria's president himself put the polio vaccine into five babies' mouths, a sign that the six-month polio vaccine boycott had eroded in Nigeria's predominantly Muslim northern region, dubbed the global epicenter of polio. All the more dramatic was it that one of those five children is the son of the state governor of Zamfara, who until recently rejected the vaccine.

Kano now remains the only one of Nigeria's 36 states still rejecting the anti-polio campaign. It is the largest remaining reservoir of the polio virus in Nigeria, which in turn hosts nearly half of the world's polio cases.

April 24, 2004 update: Bad news: "Holdout Threatens Global Polio Eradication Effort." The details:

The northern Nigerian state of Kano, whose 3 million children younger than 5 are one of the world's last reservoirs of the polio virus, will not participate in a nationwide immunization campaign that starts today, according to observers there.

Over the last year, virus originating in northern Nigeria has caused new polio outbreaks in nine African countries where the disease had earlier been eliminated. Kano's decision to continue its 12-month boycott of mass polio immunization threatens further spread of the virus and is jeopardizing the 16-year, $3 billion effort to eradicate the disease from Earth.

June 30, 2004 update: Good news: The mostly Muslim Nigerian state of Kano, which banned polio vaccinations last year, will resume them in the next few days, the World Health Organization has announced. Ibrahim Shekarau, Kano's governor, has accepted that the oral polio vaccine is safe and effective. This is key, as Kano State "is now the only polio-endemic area where immunization is not taking place," according to the WHO.

Nigerian authorities have reported 259 polio cases so far in 2004, compared with 56 in the same period in 2003. Globally, the total number of polio cases has reached 339 in 2004, almost double the number for the same period in 2003.

July 2, 2004 update: Bad news: "Major Polio Outbreak Reported in Nigeria." Officials in the heavily Muslim northern Nigeria state of Kano disclosed today that dozens of suspected polio cases have appeared among children in recent weeks. Each of 15 districts in the city of Rogo has seen an average of two cases, all of which showed the symptoms associated with polio, with some children already paralyzed. In all, Nigeria this year has reported 259 polio cases, or over 60 percent of the 339 cases reported worldwide). Noteworthy too is that fact that all six countries classified as polio-endemic by the WHO—Afghanistan, Egypt, India, Niger, Nigeria and Pakistan—have substantial Muslim populations. This raises the question, whether conspiracy theories similar to those found in Nigeria are found in the other countries too.

July 21, 2004 update: More bad news: "Muslim radicals still oppose polio vaccine." Kano State may have accepted the polio vaccine but Nafiu Baba Ahmed, secretary general of the influential Supreme Council for Sharia in Nigeria, continues to reject the vaccine and warns that "A lot of people will no longer take part in the polio vaccination exercise because of the fear that they have regarding the immunisation and in particular the scientific proof that it can cause infertility in children."

Aug. 24, 2004 update: What the medical authorities feared is now coming to pass, namely its spread to countries near to Nigeria, including Sudan, Guinea, and Mali, according to the World Health Organization and other agencies. Bruce Aylward, coordinator of the WHO's anti-polio initiative, said this means that the major polio epidemic "we've been fearing has now spread beyond the firewall we put in place ... as we tried to contain the virus as close as possible to the epicenter in Nigeria." In all, the disease which was limited to only two at the beginning of 2003, has now appeared in about a dozen countries and the WHO's hope to eradicate polio by Jan. 1, 2005 is defunct – thanks to the conspiracy theories swirling among northern Nigeria's Muslim population.

Aug. 27, 2004 update: A parallel problem is now developing in India, where conspiracy theories rampant among Muslims in eastern Bihar state are again leading to reluctance to take polio immunizations. In this case again, the purpose of the immunization is thought to be to cut down on population; in the slums of Gaya, about 60 miles from the state capital, Patna, "many poor and ignorant women regard the anti-polio drops as a deceptive strategy to control the birth rate. In the long run they feel it will reduce the fertility of future generations," notes Mahjabeen Anjum, a health worker. "The misgivings against the polio drops are more pronounced among poor Muslims," she continues. For example, Sanjeeda Khatoon, a vegetable vendor, explained why she disallowed polio drops for any of her nine children. "The government is more concerned with population control than the health of the people."

Sept. 6, 2004 update: Health workers have taken to the field in Kano State, Nigeria, and have immunized 57 percent of its 3.8 million children. This relatively high number results from a massive public-information effort by the government to urge polio immunizations.

Oct. 11, 2004 update: The worst of the polio resistance seems to be over. The Times of India reports from Lucknow that Maulana Khalid Rashid, a member of All India Muslim Personal Law Board, personally administered two drops of polio vaccine to a child at Aishbagh Eidgah yesterday. "Not only the children of my madarsa [madrassah], I would like to convey the message to children all over India that this [vaccine] do not have any 'side effect,'" he said, referring to impotency. The newspaper notes that this was perhaps the first time UNICEF had ever knocked on the doors of a madrassah in its efforts to eradicate the virus.

Jan. 12, 2005 update: The World Health Organization reports today that the number of new polio cases rose dramatically in 2004 to 1,185, compared with 784 in 2003, due to the boycott in Nigeria led to a resurgence of the disease in parts of Africa. Most of the new cases were in Africa - Benin, Botswana, Burkina Faso, Central African Republic, Chad, Cameroon, Ghana, Guinea, Mali, Togo – but some appeared in Saudi Arabia. This has stymied efforts to eradicate the disease by Dec. 31, 2005.

Feb. 20, 2005 update: The Polio Conspiracy Theory seems to be dying out. "Squeezing drops of vaccine into the mouths of wailing babies," reports the Associated Press,

the presidents of Nigeria and Benin launched a redoubled polio drive Sunday to regain progress lost after a vaccine-boycott led by Muslim clerics set back eradication efforts. Under tight security, with snipers on the roofs of border posts scouring the surrounding vegetation, Presidents Mathieu Kerekou of Benin and Olusegun Obasanjo of Nigeria launched the polio campaign as dance troupes pranced to pounding drums. The presidential doctoring is a prelude to a four-day, 22-nation vaccination blitz in west and central Africa next week.

March 27, 2005 update: Spoke too soon. Statistics for 2005 from the Nigerian Red Cross and the U.N. World Health Organization indicate that Nigeria has recorded 20,859 measles cases, of which 20,606 occurred in the mainly Muslim north and only 253 in the mainly Christian south. All of the 589 victims who died all lived in the north. Further, anti-vaccine conspiracy theories spread by imams could also affect measles, the outbreak of which is also surging in northern Nigeria.

April 22, 2005 update: A. H. Jaffor Ullah notes in Muslim World Today that this sad story of polio resurgence comes fifty years after the introduction of the polio vaccine on April 12, 1955, by a team of scientists led Jonas Salk.

May 2, 2005 update: The polio infection has traveled from Nigeria to Indonesia, probably via Mecca, Donald G. McNeil Jr., reports in the New York Times. Indonesia's last case of polio had been in 1995; now it is the 16^th country to be re-infected by the virus from northern Nigeria. Because the virus is closely related to a strain found in Saudi Arabia in December, the most likely explanation is that it was brought back from there by an Indonesian worker or by a pilgrim who went on hajj in January. Polio, McNeil notes, "is now found almost exclusively in Muslim countries or regions."

May 7, 2005 update: Things are getting interesting: The World Health Organization, whose campaign to eradicate polio has cost nearly US$4 billion since 1985,

• Is making known that member states of the Organization of the Islamic Conference have contributed just $3 million of that amount - to be precise, $1.2 million from the United Arab Emirates, $1 million from Malaysia, $330,000 from Qatar and $100,000 from Oman.
• Notes that recent outbreaks of polio have occurred in sixteen countries, primarily Muslim ones (including Saudi Arabia, Indonesia, Yemen, Sudan, Chad, Burkina Faso, Cameroon, Mali, Benin, Guinea and Ivory Coast). Further, in 2004, 792 of 1,267 cases of polio worldwide were in Nigeria. In 2005, the count comes to 124 new cases, with Nigeria, Sudan, and Yemen the worst-affected countries. Indonesia and Yemen, previously polio-free countries, have both reported new cases since 2003.
• Requests more money from Muslim governments, especially those of Bahrain, Kuwait, and Saudi Arabia – none of which have contributed funds so far. The amounts now needed? $50 million by July 2005 and $200 million for 2006.

The WHO is talking bluntly, in the way United Nations organizations rarely do:

• Linda Muller, its spokeswoman: "The time to act is now, we can't afford to wait."
• David L. Heymann, WHO's director general's representative for polio eradication: "It would be a good sign for Islamic countries to see other Islamic countries giving. But they've come in more slowly than we expected."
• Kul C. Gautam, deputy executive director of UNICEF, which buys vaccine for poor countries: it is unfortunate that donations the Persian Gulf states "still make up such a small proportion of the overall contribution to this global public good."
• Stephen Strickland, chief of polio eradication for the United Nations Foundation, which has contributed $30 million and raised much more, dismissed a recent Saudi pledge of $500,000 "peanuts," and criticized Kuwait for offering nothing while poor Muslim countries struggle to vaccinate their children. "They could certainly do more" and – given that the new outbreak was apparently spread by pilgrims to Mecca, "you would think they'd take the lead in this."

Multiple calls over two days by a New York Times reporter to the Saudi and Kuwaiti embassies in Washington went unreturned.

And who did give to the polio-eradication campaign? Rotary International, over $600 million, the U.S. government over $500 million (plus the use of staff and laboratories), British and Japanese governments over $250 million each, the European Union, World Bank, and the governments of Canada, Germany, the Netherlands more than $100 million each. Other major donors include several European countries, Russia, Australia, the Bill & Melinda Gates Foundation, and the United Nations Foundation.

Comment: (1) It is noteworthy that the World Health Organization, a U.N. body, should focus on the Muslim countries to pay for a mostly Muslim incidence of polio outbreaks. (2) The trivial participation of the wealthy Muslim countries in the polio campaign fits into a larger pattern (remember the non-aid to the tsunami victims in late 2004) best understood by reading David Pryce-Jones' Closed Circle : An Interpretation of the Arabs.

May 11, 2005 update: The World Health Organization announced that Yemen has more than 63 cases of polio since April 21, 2005, a larger outbreak than found in any other country. Nigeria follows with 54 this year. Indonesia has 6. The Yemeni situation has received special attention: "It's a much bigger outbreak than we originally thought, and it's spread throughout the country," noted the doctor in charge of WHO's polio-eradication campaign, David L. Heymann. Testing shows that the Yemeni strain originated in northern Nigeria, traveled east through Chad and Sudan, and jumped the Red Sea early in 2005.

Yemen and Indonesia are the most recent of 16 previously polio-free countries that have reported new cases since the vaccine boycott began in Nigeria in 2003. Polio in Yemen and Indonesia can be contained through immunization, but the WHO worries especially about Somalia, where anarchy would impede a vaccination campaign. "We have already seen polio reintroduced in Ethiopia," noted Oliver Rosenbauer, spokesman for the WHO's polio eradication program. "If it spreads to Somalia, it will be a problem because it is logistically very, very challenging there."

May 17, 2005 update: The WHO has confirmed 83 cases of polio in Yemen, a country until a month ago thought permanently free of the disease. This amounts, it says, to "a major epidemic."

May 24, 2005 update: I summarized the information in this weblog in more polished form in a column today, "A Conspiracy Theory Spreads Polio."

May 29, 2005 update: Fergus Walsh in the Observer finds that the polio immunization program is "back on track" in Nigeria. In part, this is because the reigning conspiracy theory has taken a new turn, one for the better. Sheikh Aminudeen Abubaker, chief imam of the Daawah mosque in Kano, still believes the polio vaccine contains an anti-fertility agent but he supports immunization because he sees the agent as temporary, like a contraceptive pill. When females stop taking it, they can conceive. Also, to win more support for immunization, the vaccine now used in Kano is manufactured in Muslim-majority Indonesia.

June 1, 2005 update: It's slightly off-topic, but a report by Laura M. Kelley and Nicholas Eberstadt, Behind the Veil of a Public Health Crisis: HIV/AIDS in the Muslim World (National Bureau of Asian Research), points to parallel problems resulting from the Muslim unwillingness to deal with HIV/AIDS:

Despite the fact that the Muslim world is home to many of the behaviors—such as premarital sex, adultery, prostitution, homosexuality, and intravenous drug use—which have helped spread the HIV virus in other countries and regions around the world, many governments in the Muslim world have been slow to respond to the rapidly spreading disease.

July 5, 2005 update: The Associated Press reports from Indonesia that 111 children in that country have come down with polio, including one on the island of Sumatra, which until just last week was polio-free. The other cases have since April 2005 appeared in the provinces of Banten, West Java, and Jakarta. Health experts believe the disease was imported from Nigeria and the WHO expects the number of polio cases in Indonesia to continue to climb.

Media coverage of this appalling development is handled seriously and honestly by the print media; for example, this AP report mentions that the problem originated in Nigeria, "where polio vaccinations were suspended for several months in 2003 after radical Islamic preachers warned parents not to vaccinate their children because they believed it was part of a U.S. plot against Muslims." But the National Public Radio coverage of this story at 9 p.m. EDT this evening attributed the problem to "unfounded reports of contaminated vaccines," shamelessly hiding its cause.

Aug. 9, 2005 update: Indonesia has registered 205 cases of polio in five provinces and 14 districts, including two victims in the capital city, Jakarta. At least 700,000 out of 6.5 million eligible children were not immunized in a recent campaign, some of them because their many parents believed the vaccine was dangerous. Rumors in Indonesia are similar to those that spread earlier in Nigeria.

Aug. 20, 2005 update: A hero to the rescue – and it is none other than the Kingdom of Saudi Arabia, which is requiring, effectively immediately, that visitors under 15 years of age from nineteen countries be vaccinated against polio on arrival in the kingdom, whether or not they were previously vaccinated. Those countries are Afghanistan, Angola, Burkina Faso, Cameroon, the Central African Republic, Chad, Egypt, Eritrea, Ethiopia, Guinea, India, Indonesia, Ivory Coast, Mali, Niger, Nigeria, Pakistan, Sudan and Yemen.

Interestingly, the Saudis have engaged in similar health campaigns before, such as the one against meningitis in the 1960s, when they required proof of a meningitis vaccination before granting a hajj visa. Also of note is that two cases of polio were found during the hajj of early 2005; Saudi Arabia being polio-free since 1995, these clearly came from abroad.

This vaccination requirement stems the potential for contagion as millions of Muslims convene for the hajj – and also at other times of the year, when much smaller but still sizeable numbers go on the 'umra. Beyond the practical dimension, this step firmly places the considerably authority of the Saudi state behind polio vaccination, something likely to be important in places like Nigeria and Indonesia.

Aug. 30, 2005 update: With 225 cases of polio in the country since March 2005, coming after ten years without any, the authorities in Indonesia are swinging into action with a US$24 million polio vaccination drive intended to include 24 million young people. In addition to more than 750,000 health workers at 245,000 posts at health clinics, bus depots, rail stations, and airports, political leaders and celebrities are trying to counter rumors that vaccinations are dangerous and violate Islamic law. For example, Kristiani Yudhoyono, wife of the president, administered the drops to several children in a Jakarta suburb. "People should not be afraid," she said. "We are doing this for the sake of the children, for the sake of the next generation."

June 15, 2006 update: Educe Ababa, a Nigerian health official, announced that Nigeria recorded 467 polio infections in the first months of 2006, compared with 224 new cases for the whole of 2005, more than doubling the prior rate of infection. Nearly 90 percent of the new infections were reported in Nigeria's predominantly Muslim north.

Aug. 15, 2006 update: Polio cases in Afghanistan have increased substantially in recent months, but less due to conspiracy theories than anarchy in the south, obstructing vaccinations. At least 25 cases of polio have been identified so far this year, compared with 9 in all of 2005.

Oct. 18, 2006 update: Kenya has just reported its first case of polio in 22 years, a three-year-old girl in the Dadaab Somali refugee camp in the country's north-east. Dadaab houses about 157,000 refugees. Polio re-emerged in Somalia in 2005 after an absence of three years. About 200 cases have been reported since then.

Nov. 4, 2006 update: As the Government of India presses forward with an "Intensive Pulse Polio Immunisation" program in a week, 4-page pamphlets in Arabic and copies of the September 2006 issue of an Urdu-language monthly, Taameer-e-Hayaat, published from Lucknow, are appearing in Muslim sectors of Vadodara (or Godhra) to warn against taking the anti-polio vaccination. They state that the vaccine is imported from Israel and contains chemicals that render impotence or sterility. The Taameer-e-Hayaat article by Shahbaz Hindi reads: "While the Ulemas of Nigeria have issued a fatwa against polio drops, president of Nigeria's Supreme Council of Sharia Laws Ibrahim Datti, himself a well-known physician, has accused the United States of mixing certain elements into the polio vaccines that causes infertility." To counter this article, Chief District Health Officer Dr Prakash Vaghela circulated materials pointing out that the Saudi authorities do not permit children on the hajj unless they have received their polio vaccines.

Nov. 12, 2006 update: Some rare good news from the polio front, this time in India. Having imams explain that polio inoculations are not a plot by the kafirs to render children infertile seems to be working in Uttar Pradesh, India's most populous state. Biswajeet Banerjee of the Associated Press tells the story of Farzaan Siddaqui, who in August 2006 assaulted health workers when they argued with him to allow them to immunize his 3-year-old son and 1-year-old daughter. This time, Wajhat Valdi, his imam, told of what happened earlier, entered Siddqqui's house alone and a mere 15 minutes later, a smiling Siddaqui, agreed to the procedure, which in turn opened up his neighborhood for the inoculations. "I am so happy that they have listened to me," Valdi said. "It was the will of Allah that I should come here."

On a larger scale, the Uttar Pradesh top health official, A. K. Mishra, noted that nearly three-quarters of the state's new polio cases are in Muslim families. The state has seen 438 new polio cases in 2006, of which 25 appeared over the past week.

Feb. 17, 2007 update: A remote-controlled roadside bomb in Salarzai, a village about 50 kilometers northeast of Khar, the main town in Bajur Agency, instantly killed Dr Abdul Ghani Khan, chief surgeon at the main government hospital in Bajur, and injured three others in his car, one critically. He was returning from a jirga (tribal council) where he had been trying to convince tribesmen to immunize their children against polio.

Dr. Amir Khan, medical superintendent (MS) at Khar District Headquarters Hospital, said that residents of Mullah Said Banda in the Salarzai area had earlier refused to get their children vaccinated against polio and added that Dr. Ghani was visiting the area to allay misperceptions about the vaccination. "The locals had also warned polio teams against visiting the area," the MS said.

Paramedic Hazrat Jamal, who is one of the three injured in the explosion, said that the residents of Mullah Said Banda were against the polio campaign. "As soon as we reached there, an armed prayer leader warned us against visiting the area. Some locals said: 'On one hand, our enemy [the United States] is bombing us for no reason while on the other hand you are coming here disguised as polio campaigners to spread vulgarity."

Feb. 23, 2007 update: From Pakistan, Declan Walsh finds a situation comparable to Kano, Nigeria in 2003.

The parents of 24,000 children in northern Pakistan refused to allow health workers to administer polio vaccinations last month, mostly because of rumours that the harmless vaccine was an American plot to sterilise Muslim children. The disinformation - spread by extremist clerics using mosque loudspeakers and illegal radio stations, and by word of mouth - has caused a sharp jump in polio cases in Pakistan and damaged global efforts to eradicate the disease. The World Health Organisation (WHO) recorded 39 cases of polio in Pakistan in 2006, up from 28 the previous year. The disease is concentrated in North-West Frontier Province, where 60% of the refusals were attributed to "religious reasons".

The government made strenuous efforts against the conspiracy theories about an "infidel vaccine," with health workers carrying copies of a fatwa, endorsing the vaccinations signed by leaders of Pakistan's most powerful religious parties. This seemed to work, in that some 9 million children have been or will be shortly vaccinated. Only 24,000 children have been denied the vaccine, but health officials indicate that is enough to provide the virus with the needed toehold. Walsh provides the political context for the conspiracy theories:

The vaccination struggle is entangled with the confrontation between the government and powerful militants in the tribal areas. Refusals were highest in areas where conservative clerics and self-styled "Pakistani Taliban" fighters hold sway, flouting government authority and making their own strict laws. Almost 2,000 children were not vaccinated in Bajaur, a tribal agency on the Afghan border where US warplanes bombed a house last year in the hope of killing al-Qaida's No 2, Ayman al-Zawahiri. The jets missed al-Zawahiri, but inflamed extremist sentiment. Recently militants ordered Bajaur's barbers to stop shaving beards on the grounds that it was "un-Islamic." The barbers complied. In nearby Swat Valley a young firebrand cleric, Maulana Fazlullah, denounced the polio campaign through a local radio station. His brother was killed in a Pakistani army attack on a madrasa (Islamic school) late last year. Almost 4,000 children were not vaccinated in Swat.

It gets even worse.

Some linked the attack to a fatwa issued in Dara Adam Khel, a lawless town famous for its gunsmiths, in December. A cleric named Mufti Khalid Shah declared a fatwa on employees of the UN, the WHO and all other foreign organisations. "Killing their employees is in line with the teachings of jihad in Islam," said a notice. "We are very worried," said Mr Khan. "You have to be very careful about admitting to working for an NGO these days." Aid workers in Bannu, near North Waziristan, had been sent a letter and a 500 rupee ($10) note, he said. "The letter said they had a choice. They could either stop work or buy their own coffin."

July 28, 2007 update: Sudanese Islamists have jumped into the act. Here's an interview (video available) with the leader of the country's Muslim Brethren, Sadeq Abdallah bin Al-Majed, who declaims on this topic after declaring the Darfur problem the result of an American conspiracy:

Interviewer: You issued a fatwa prohibiting the vaccination of children, claiming it is a conspiracy of the Jews and Freemasons. Is this true?
Sheik Sadeq Abdallah bin Al-Majed: This is 100% true.
Interviewer: How come?
Sheik Sadeq Abdallah bin Al-Majed: I followed this issue in several shocking articles, which failed to shock anyone in the government.
Interviewer: But where did you get the information about a conspiracy?
Sheik Sadeq Abdallah bin Al-Majed: I am following this issue, along with two or three brothers. We are following this issue globally through the Internet, through several media outlets, and through the ministry that carries out this procedure, which I consider to be a crime against the children.
Interviewer: But how come? After all, there is medical supervision...
Sheik Sadeq Abdallah bin Al-Majed: No, brother. They only claim that there is medical supervision. I wrote and challenged the Health Ministry to meet with me for a dialogue, in which I would provide the proof, and they would have to prove me wrong. But they refused. Allah be praised, the fact that I followed this issue bore fruit, and thousands of children were saved from the claws of the Jewish movement, which is represented by the watchamacallit...
Interviewer: The Freemasons?
Sheik Sadeq Abdallah bin Al-Majed: ...the Freemason movement, which is behind this. If the Jews could find a way to annihilate the people throughout the world, and ultimately have the rule to themselves – they would do it.

Oct. 11, 2007 update: Just what was needed in Nigeria - an outbreak of polio caused by a mutating polio vaccine, 16 cases recorded by April 2007, perhaps 70 by now. In other words, the vaccine itself is creating new cases of polio to occur. Though unusual, this problem has occurred in various places around the world. One can only imagine the impact of this news on the Islamists so suspicious of the vaccine in the first place.

On the positive side, the New York Times article reporting this news also, in passing, notes that the polio cases spread to many new countries from the initial 2003 outbreak in Nigeria have mostly been "snuffed out."

Mar. 29, 2008 update: And now measles. The northern Nigerian state of Katsina reports a measles epidemic that has killed nearly 165 children and infected 3,000 in the past three months, though the death toll could be much higher due to unreported cases. Katsina's director of disease control, Halliru Idris, says that "over 95 percent of all the children that have measles are those whose parents have not allowed them to receive immunization."

June 8, 2008 update: The Daily Times of Pakistan reports on "5 polio cases reported, more feared": "Five polio cases have been reported in Karachi recently and have been traced to out-of-town carriers. More cases are suspected to have developed."

July 17, 2008 update: Polio surfaced in Ali Gram, a village in the Swat Valley of Pakistan when an eight-month-old girl tested positive with type 1 polio, the most dangerous and contagious strain. This is the first confirmed case of the disease in Swat since 2003. A pro-Taliban religious leader, Maulana Fazlullah, condemned polio vaccinations as a Western conspiracy to render Muslims infertile, prompting Islamists to campaign against the innoculation, going so far as to beat up medical teams.

Sep. 16, 2008 update: The Taliban claimed responisiblity for a suicide bombing in southeastern Afghanistan, killing two Afghan doctors employed by the World Health Organization, leading the WHO to cancel polio jabs for 1.2 million Afghan children.

Mar. 22, 2009 update: The whole polio problem started in Nigeria, and so maybe now will the solution come from there, reports Katy Pownall of the Associated Press.

after another tripling of cases in 2008, a big new anti-polio push is under way in Africa's most populous country, and this time, some Muslim clerics have made themselves part of the solution, joining community leaders, health workers and the victims themselves in waging the war. … At least one Muslim leader took unprecedented action against the boycott-supporters. The Shehu of Borno, the top Islamic authority in his state until his death in February, last September stripped a chief of his traditional title for divorcing his wife after she had their children immunized. "His excellency has zero tolerance for those who hinder the fight against polio," his spokesman, Usman Chiroma, explained at the time.

June 4, 2009 update: In a much ballyhooed speech to Muslims in Cairo, Barack Obama announced: "Today I'm announcing a new global effort with the Organization of the Islamic Conference to eradicate polio," implicitly recognizing that the survival of polio is a problem connected to Islam.

Sep. 8, 2009 update: The Taliban prohibition against polio vaccinations in the Swat Valley of Pakistan held for a year but has been pushed aside.

Authorities in Pakistan's Swat Valley have resumed vaccinating children for polio, a practice the Taliban had banned as un-Islamic before the insurgents were beaten back by an army offensive, an official said Tuesday. … The army says it has killed more than 1,800 suspected militants in Swat since launching its latest offensive there four months ago. The government is now trying to bring the valley back to normal. … In Swat, government official Khurshid Khan, a doctor, said the last inoculations against polio were administered nearly a year ago. Six cases of polio have been discovered since vaccinations resumed Monday. About 215,000 children are a target of the three-day campaign, he said. …

Swat resident Yar Mohammad said the people of the valley welcomed the resumption of the campaign. "The militants have been depriving our children of our basic right. It is our national responsibility to secure our kids against all diseases," said Mohammad, who lives in the valley's main city, Mingora.

Jan. 25, 2010 update: A Pakistani woman's magazine in Urdu, Mahnama Banat-e-'Aisha, contains a lengthy article "Polio: Disease or Dangerous Jewish Conspiracy?" by Mohammad Kamran Talib. For the imaginative details, see MEMRI's summary and excerpts.

May 20, 2010 update: The persistence of polio among Muslims imperils the ambitious goal of elminating the disease entirely, as "donor fatigue" threatens to end the US$750 million a year required to keep the effort going. Maria Cheng reports for the Associated Press:

Since WHO [the World Health Organization], the U.S. Centers for Disease Control and Prevention, UNICEF and Rotary International set out to eradicate polio in 1988, they have come tantalizingly close. By 2003, cases had dropped by more than 99 percent. But progress has stalled since and several deadlines have been missed. Polio has virtually disappeared from the West but is entrenched in a handful of countries, namely Afghanistan, India, Nigeria and Pakistan. …

Dr. Paul Adovohepke, who heads UNICEF's polio team in Nigeria, said rumors about the vaccine's safety — which resulted in a year-long suspension of polio campaigns in 2003 — seem to have subsided. He has seen Nigerians ask vaccinators to go into their homes to give the polio vaccine to their kids. "[That] was not possible in 2003," he said. But recent surprises, like an outbreak in Tajikistan, which had been free of the disease for years, show how unpredictable the effort remains. … Two of the countries where the virus is spreading — Pakistan and Afghanistan — are plagued by conflict which make it nearly impossible to vaccinate enough kids. Experts had also assumed the polio virus in the vaccine could never spark big outbreaks. They were wrong. Since 2005, a vaccine-derived epidemic has been spreading in Nigeria and similar epidemics are certain to erupt in the future. …

Ellie Ehrenfeld, who sits on WHO's Advisory Committee for Polio Eradication, said the current situation is encouraging, but has a tinge of deja vu. "We have been very close before, and then things blew up," she said. If polio is not stopped in the next few years, she said serious questions should be raised about whether the program should be scrapped. "It's theoretically possible to eradicate polio," she said. "Whether or not we can do it is entirely another matter."

June 2, 2010 update: Indiana University Press has announced The Politics of Polio in Northern Nigeria by Elisha P. Renne, an anthropologist at the University of Michigan. Here's the ad copy:

In 2008, Northern Nigeria had the greatest number of confirmed cases of polio in the world and was the source of outbreaks in several West African countries. Elisha P. Renne explores the politics and social dynamics of the Northern Nigerian response to the Global Polio Eradication Initiative, which has been met with extreme skepticism, subversion, and the refusal of some parents to immunize their children. Renne explains this resistance by situating the eradication effort within the social, political, cultural, and historical context of the experience of polio in Northern Nigeria. Questions of vaccine safety, the ability of the government to provide basic health care, and the role of the international community are factored into this sensitive and complex treatment of the ethics of global polio eradication efforts.

More bluntly, as one of the book's blurbers puts it, Renne tries to "persuade you that Muslims' fears were justified."

Comment: Typical of the academy: Choose the opposite of common sense.

July 21, 2011 update: In a failed effort to collect DNA from Osama bin Laden's family, the CIA sponsored an anti-hepatitis vaccination program that is now having repercussions on the anti-polio effort in Pakistan. Public-health organization officials worry it could harm efforts to vaccinate Muslim children. "In a nation swirling with rumors of CIA plots, critics say, this real-life one could cement public suspicions, play to radical clerics' anti-vaccine propaganda and endanger health workers."

Jan. 17, 2012 update: Cases of polio have tripled in Afghanistan and Pakistan over the past year. Rod Nordland reports for the New York Times that the former saw 25 cases in 2010 and 76 in 2011, while in Pakistan the incidence went from 80 in 2010 to 192 in 2011. Polio is now endemic only to those two countries and to northern Nigeria. Interestingly, the Taliban have endorsed the polio vaccine, unlike many other Islamists.

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