By: Zakwan Khan
(Photo Credit: Dawn News)
Well, we rolled straight into the NCBI archives for this one, folks! Welcome to the first article in an inaugural series detailing both the causes and consequences of medical conspiracies plaguing public health. Today, we will discuss the problematic presence of the poliovirus in Pakistan.
The poliovirus is known to cause the onset of polio, a debilitating and life-threatening condition that can cause paralysis in the spinal cord and other parts of the body. However, while much of the world has been successful in containing the spread of this illness, Pakistan, Afghanistan, and Nigeria are the only remaining countries in the world that have failed to see a cessation in polio transmission. Although Pakistan’s healthcare system is not currently ranked amongst the top in the world, its failures to eradicate the poliovirus do not necessarily stem from a systemic issue within its healthcare system, but, rather from the spread of misinformation. This misinformation is said to have originated from a conspiracy involving the World Health Organization’s “Kick Polio Out of Africa” campaign during the late 1980s. The WHO’s poliovirus campaign had aimed to eradicate the virus in Africa by the year 2000, and they actually came very close to achieving this public health milestone. However, their efforts fell short when the regions of Zamfara, Kano, and Kaduna in Nigeria refused to allow administration of the polio vaccine in 2003.
The opposition to the vaccine stemmed from allegations stating that the vaccine contained an “anti-fertility estradiol hormone, human immunodeficiency virus (HIV), and other cancerous agents.” This viewpoint gained legitimacy within Nigeria as it was staunchly defended by the prominent Nigerian physician, Dr. Ibrahim Datti Ahmed. It is thought that Ahmed’s opposition to the vaccine was likely propelled by the fact that the vaccine was a Western therapeutic. Moreover, following the September 11, 2001 attacks, global tensions were coming to a boil, and Ahmed claimed that the vaccines were “corrupted and tainted by evildoers from America and their Western allies.”As Ahmed also headed the Nigerian Supreme Council for Shariah at the time, it is not difficult to see how he was able to amass such legitimacy and also command such a large following, as his association with a high-ranking religious council readily conferred upon him a significant degree of public credibility.
This conspiracy theory that originated in Nigeria eventually made its way to Pakistan. There are a multitude of reasons as to why vaccines are distrusted by a significant proportion of the population. Furthermore, this suspicion has been widely attributed to ethical problems in Edward Jenner’s original vaccine experiment, population control theories inspired by the works of Robert Malthus, Andrew Wakefield’s problematic and debunked study claiming that vaccines caused autism, as well as a general wariness of corporate entities such as “Big Pharma.” However, in Pakistan’s case, the potential psychological causations of the poliovirus vaccine conspiracies are truly quite intriguing.
Pakistan is a country that has been fraught by periods of significant turmoil and anxiety. The young nation itself was borne out of the widespread belief that Muslims would be persecuted in India, which led to many advocating for the establishment of a Muslim-majority country in the Indian subcontinent called Pakistan. If you also throw in the fact that Pakistan has experienced multiple military coups in the years of 1953, 1958, 1977, and 1999, we can see that its citizens have been forced to reckon with decades of political in-fighting, as well as the subsequent deterioration of Pakistan’s political alliances with the West following the 2001 tragedy. Thus, it is understandable why the Pakistani populace exhibits such wariness toward both local bureaucracies and international agencies as they may view such entities as having encroached upon their personal rights.
Perhaps the most jarring evidence for why the poliovirus vaccine conspiracy has garnered so much traction in Pakistan is that there were widespread reports of Western spies posed as polio vaccine administrators. These agents were believed to be gathering intelligence on nefarious characters in the area while using the guise of medical aid as a potential cover. Thus, the facade facilitated by these "polio vaccinators" has catalyzed the onset of public health damage so severe that it may take decades to rebuild the foundations of trust lost between health officials and the general populace. So while it may seem obvious that these vaccines do not cause infertility, one must also consider the notion of a Western entity violating the very sovereignty of a country that already exhibits wariness towards such political actors and their medical experiments. Thus, it is not difficult to see how such a significant violation of trust allows many in the Pakistani populace to champion the perspective of skepticism and to believe that such malintentions are implicit in Western-based practices and innovations.
This article serves as a brief summary of the current literature published on the topic by the National Center for Biotechnology Information (NCBI), and so I encourage you to also check out these references for yourself. NCBI's resources provide further background information to allow for deeper contextualization, as well as some potential solutions aimed at eradicating polio in Pakistan. You can read more about the topic here.
Andrade, G. E., & Hussain, A. (2018). Polio in Pakistan: Political, Sociological, and Epidemiological Factors. Cureus, 10(10), e3502. https://doi.org/10.7759/cureus.3502
Douglas, K. M., Sutton, R. M., & Cichocka, A. (2017). The psychology of conspiracy theories.Current directions in Psychological Science, 26(6), 538-542. https://pubmed.ncbi.nlm.nih.gov/29276345/
Davies, H. (2007). Ethical reflections on Edward Jenner’s experimental treatment. Journal of Medical Ethics, 33(3), 174-176. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598263/
Gostin, L. O. (2014). Global polio eradication: espionage, disinformation, and the politics of vaccination.The Milbank Quarterly,92(3), 413. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221744/
Junaidi, Ikram (2014). Poliovirus is detected in sewage for 10 cities. Dawn News. https://www.dawn.com/news/1464267
Letore D. (1998). Campaign to kick polio out of Africa. Afr Recovery, 12:18–19. https://pubmed.ncbi.nlm.nih.gov/12348886/
Murakami, H., Kobayashi, M., Hachiya, M., Khan, Z. S., Hassan, S. Q., & Sakurada, S. (2014). Refusal of oral polio vaccine in northwestern Pakistan: a qualitative and quantitative study.Vaccine,32(12), 1382-1387. https://pubmed.ncbi.nlm.nih.gov/24492016/
World Health Organization (2020). Does Polio Still Exist? Is It Incurable? WHO Newsroom. https://www.who.int/news-room/q-a-detail/does-polio-still-exist-is-it-curable