A crisis of trust: History, politics, religion and the polio controversy in Northern Nigeria

Patterns of Prejudice

Volumn 39, Issue 3, 2005, Pages 265-284

  Obadare, Ebenezer ^a  

^a LONDON SCHOOL OF ECONOMICS   (United Kingdom)

Author keywords

Health; Immunization; Nigeria; Polio; Politics; Religion; Trust; Vaccines; World Health Organization

Indexed keywords

EID: 23944500862     PISSN: 0031322X     EISSN: None     Source Type: Journal    
DOI: 10.1080/00313220500198185     Document Type: Review

References (110)

1. The bulk of the research on which this paper is based was conducted during the autumn of 2004 while I was a visiting scholar at the Transregional Center for Democratic Studies (TCDS), New School University, New York. Special thanks are owed to Elzbieta Matynia and Timo Lyyra for the opportunity to participate in the Center's New Social Science Training Fellowship. I am also indebted to the following for their comments, questions and suggestions: the two anonymous reviewers, Barbara Rosenbaum, David Lewis, Adriana Petryna, Mary Dillard, Wale Adebanwi, Marybeth Mcphee, Akin Adesokan, Norma McCaig, Chijioke Evoh, and the entire 2004 New Social Science Training Program cohort of fellows. Earlier drafts of the paper were presented to faculty and students at Haverford College, Philadelphia, and Sarah Lawrence College, Bronxville, New York. Special thanks are owed Iruka Okeke and Elke Zuern for making this possible, and also for the special interest they showed in the study.
2. This was part of a global polio eradication drive. For more on this, see Anita Hardon and Stuart Blume, 'Shifts in global immunisation goals (1984-2004): unfinished agendas and mixed results', Social Science & Medicine, vol. 60, 2005, 345-56;
3. and Cynthia A. Needham and Richard Canning, Global Disease Eradication: The Race for the Last Child (Washington, D.C.: ASM Press 2003).
4. It is interesting to note that at no point during the crisis were any of these Internet websites specified. The role of rumour in the outbreak of the episode should not be underestimated. For an analysis of the sociological meaning of rumour and gossip, especially in Africa, see, for example, Luise White, Speaking with Vampires: Rumor and History in Colonial Africa (Berkeley: University of California Press 2000).
5. See also Tamotsu Shibutani, Improvised News: A Sociological Study of Rumor (Indianapolis, IN: Bobbs-Merrill 1966)
6. and Max Gluckman, 'Gossip and scandal', Current Anthropology, vol. 4, no. 3, 1963, 307-16.
7. The reference to HIV/AIDS must be seen in its proper context, that of the broader politics of its causation (more light is shed on this below). More specifically, it should also be seen against the background of scientific speculation linking the epidemic (HIV/AIDS) to early testing of a polio vaccine that went spectacularly wrong. For a detailed exploration of this and other scientific hypotheses on HIV/AIDS causation, see Edward Hooper, The River: A Journey to the Source of HIV/AIDS (Boston: Little, Brown and Company 2000).
8. Tests were carried out at both the National Hospital Abuja and the Ahmadu Bello University Teaching Hospital. These were witnessed by state health officials, representatives of the WHO and religious leaders. See 'Nigeria polio vaccine passes test', BBC News, 10 November 2003, available at http://news.bbc.co.Uk/1/hi/world/africa/3223874.stm (viewed 27 April 2005).
9. See also Gbenga Abiodun, 'FG, JNI's final report endorses polio vaccine', Daily Independent Online (www.dailyindependentng.com), 18 March 2004 (this article is no longer available online).
10. Indeed, other northern states, notably Kano, authorized their own independent commissions to determine the safety of the vaccines. When tests discovered minute traces of oestrogen in some vaccines, the authorities promptly announced it as a vindication of their scepticism. See Michael Fleshman, 'UN mediates polio deadlock in Nigeria', Africa Renewal, vol. 18, no. 2, July 2004, 5.
11. This was one of the main points of contention as political leaders and commentators in Northern Nigeria insisted that there was no proof that the variant of polio reported in the country was the same as the one reported in other parts of (West) Africa. In this regard, passions appear to have been inflamed by reports in the foreign media that apparently took the presumed linkage between the outbreak in Northern Nigeria and other reported incidents across the region for granted. See, for example, Rory Carroll, 'Polio strikes in Botswana as virus races across Africa', Guardian (London), 16 April 2004, 15;
12. Michael Dynes, 'Nigerian Muslims block polio injections', The Times (London), 28 October 2003, 15;
13. and 'Polio spreads like wildfire in West Africa', South African Mail and Guardian, 5 March 2004. It is plausible that these reports drew in part on the WHO's claim that 'Genetic characteristics of viruses from other countries indicated direct importations from northern Nigeria, or indirect importations from Nigeria via Chad or Burkina Faso';
14. see 'Polio surveillance report, January-June 2004', Polio Lab Network Quarterly Update, vol. 10, no. 3, September 2004, 4.
15. At the time of writing (December 2004), the controversy was still nowhere near a satisfactory resolution. The central government's vaccination drive has been at best desultory, with the governors of at least five northern states (Niger, Bauchi, Kano, Zamfara and Kaduna) banning the use of the controversial vaccine on children there. One interesting observation about the crisis is the way it clearly highlights the perceptual gulf that exists between the northern and southern parts of the country. Thus, in sharp contrast to the scepticism shown by the Northern Nigerian public, many southern groups and commentators simply could not fathom why anybody would decline a vaccine declared safe by the WHO. In fact, for some groups, such as the National Council of Women's Societies, the rejection of the polio vaccine by some northern states amounted to a denial of the right to life to Nigerian children. See in this regard Jane Ezereonwu, 'Women deplore rejection of polio vaccine by some states', Guardian (Lagos), 18 March 2004.
16. and David Asonye Ihenacho, 'On Islamic fanatics and polio vaccines', Nigeriaworld (a website devoted to news, current affairs and commentaries about social and political events in Nigeria), 29 March 2004, available at http://nigeriaworld.com/columnist/ihenacho/032904.html (viewed 2 May 2005).
17. Belief is of course an important component of trust (about which more presently). Barbara Misztal, for example, conceptualizes trust as 'a social mechanism which can be explained by people's beliefs and motivations'. According to her: 'To trust is to believe that results of somebody's intended action will be appropriate from our point of view.' Indeed, so crucial is belief in relation to trust that she argues that to 'trust is to believe despite uncertainty'. See B. Misztal, Trust in Modern Societies: The Search for the Bases of Social Order (Cambridge: Polity Press 1996), 9-10, 18.
18. For most of its career as an independent political entity, Nigeria has been ruled by a power coalition based in the Muslim-dominated north of the country. Out of the eleven different rulers that the country has had in forty-three years of independence, for example, only three have been Southerners and Christians. This situation has provoked resentment in the South. Since May 1999 the country has been under the civilian headship of the retired general Olusegun Obasanjo. Some observers believe that many of the defining crises of his first term (a good example being the controversial introduction of the sharia penal code by many northern states) should be seen as part of efforts to undermine a Southerner-led dispensation. In recent times this position has apparently been strengthened by northern political leaders who have openly 'regretted' backing the incumbent for the presidency in 1999. For further analysis, see Ebenezer Obadare, 'In search of a public sphere: the fundamentalist challenge to civil society in Nigeria', Patterns of Prejudice, vol. 38, no. 2, 2004, 177-98.
19. For many (Northern) Nigerian Muslims, the George W. Bush regime's war on terror is a euphemism for a war against Islam, while western international agencies and pharmaceutical corporations are seen as agents of American hegemony. This theme is taken up later in the paper. For a historical overview of relations between Islam and the West in general, see Luciano Pellicani, 'Islam and the West', Telos, no. 121, Fall 2001, 86-112.
20. 'Citizenship' is used here in the strictly legalistic sense of ordinary membership, for the point to be made relates exactly to its substantive evisceration. Indeed, across Africa, social tension more often than not turns on protest against the perpetual subjectivization of the common. For a historically embedded analysis of the problem, see Mahmood Mamdani, Citizen and Subject: Contemporary Africa and the Legacy of Late Colonialism (Princeton, NJ: Princeton University Press 1997).
21. The basic, if tragic, truth is that in many parts of the developing world declining state capacity has resulted in the 'outsourcing' of basic state functions (for example, healthcare provision) to increasingly powerful (though largely unaccountable) non-governmental organizations (NGOs).
22. For more on this dialectic, especially the connections between the state, (territorial) security and health, see Gwyn Prins, 'AIDS and global security', International Affairs, Autumn 2004, 1-20.
23. and Contagion and Conflict: Health as a Global Security Challenge. A Report of the Chemical and Biological Arms Control Institute and the CSIS International Security Program (Washington, D.C.: Center for Strategic and International Studies 2000).
24. A variation on the same theme is explored in Paul Farmer, Pathologies of Power: Health, Human Rights, and the New War on the Poor (Berkeley: University of California Press 2003).
25. See Amartya Sen, 'How to judge globalism', The American Prospect, vol. 13, no. 1, 1-14 January 2002.
26. This is not to say that such developments must be seen from the narrow perspective of North versus South alone. On the contrary, as will be seen from the analysis here and similar events elsewhere, these 'set-piece' events must be rightly seen as providing the opportunity for a coincidence of multiple themes, among them religion, politics, citizenship and state-society relations.
27. For an overview of theoretical debates on the meaning, nature and functions of trust, see, among others, Niklas Luhmann, Trust and Power (New York: John Wiley 1979);
28. Benjamin Barber, The Logic and Limits of Trust (New Brunswick, NJ: Rutgers University Press 1983);
29. Shmuel N. Eisenstadt and L. Roniger, Patrons, Clients and Friends (Cambridge: Cambridge University Press 1984);
30. Diego Gambetta, Trust: Making and Breaking Cooperative Relations (Oxford: Basil Blackwell 1988);
31. James C. Coleman, Foundations of Social Theory (Cambridge, MA: Harvard University Press 1990);
32. Ulrich Beck, Anthony Giddens and Scott Lash, Reflexive Modernization (Cambridge: Polity Press 1994);
33. Adam Seligman, The Problem of Trust (Princeton, NJ: Princeton University Press 1997);
34. and Allan Silver, '"Trust" in social and political theory', in Gerald D. Suttles and Mayer N. Zald (eds), The Challenge of Social Control: Citizenship and Institution Building in Modern Society. Essays in Honor of Morris Janowitz (Norwood, NJ: Ablex Publishing Corporation 1985).
35. Misztal, Trust in Modern Societies, 4.
36. John Keane (ed.), Civil Society and the State (London: Verso 1988).
37. Ernest Gellner, 'Trust, cohesion, and the social order', in Michael Hechter and Christine Hörne (eds), Theories of Social Order: A Reader (Stanford, CA: Stanford University Press 2003), 310-16.
38. See also Gellner's The Condition of Liberty: Civil Society and Its Rivals (London: Hamish and Hamilton 1994).
39. Adam Seligman, The Idea of Civil Society (New York: The Free Press 1992).
40. Francis Fukuyama, Trust: The Social Virtues and the Creation of Prosperity (New York: The Free Press 1995), 7.
41. The debate over whether indeed trust is necessarily a 'good' thing or whether it enables and/or produces economic prosperity has flourished. See, for example, the richly diverse collection of essays in Mark E. Warren (ed.), Democracy and Trust (Cambridge: Cambridge University Press 1999).
42. Misztal, Trust in Modern Societies, 8.
43. Murray Hausknecht, 'On politics and trust: a growing problem of modern life', Dissent, Fall 1992, 456-60.
44. See Claus Offe, 'How can we trust our fellow citizens?', in Warren (ed.), Democracy and Trust, 42-87.
45. P. Sztompka, Trust. A Sociological Theory (Cambridge: Cambridge University Press 1999).
46. Ibid., 26.
47. Offe, 'How can we trust our fellow citizens?', 55.
48. By this I mean the distinctly unpalatable history of the Pfizer trials, among others. More on this presently.
49. Offe, 'How can we trust our fellow citizens?', 54.
50. Both material and symbolic, the former in the context of poverty and lack of education, and the latter in the form of political power. I will explain the absence of political power in another section.
51. Fleshman, 'UN mediates polio deadlock in Nigeria'.
52. 'North' and 'South' are here used as direct analogues of the industrially developed world and the developing world, respectively.
53. Megan Vaughan, Curing Their Ills: Colonial Power and African Illness (Stanford, CA: Stanford University Press 1991), 205.
54. Ibid., 205-6.
55. Because of the relative uncertainty about its origins and the continued absence of a globally acknowledged cure, HIV/AIDS has been viewed with particular suspicion by people in the developing world. Instructively, in the early days of the disease in Nigeria, many cynically dismissed it as an American Idea of Discouraging Sex.
56. The reference to Adolf Hitler is part of what might be characterized as a deep-seated 'holocaust fantasy'. This is the fear that somewhere not too far from the surface of routine politics is a longstanding western scheme to eradicate the population (or at least drastically reduce) the population of certain parts of the world. Adolf Hitler snuggles into this mindset as a handy symbol. I am grateful to Mary Dillard (Sarah Lawrence College) for pointing out this connection, and also for observing the occurrence of the same trope of 'genocide' in the writings of the executed writer and environmental activist Ken Saro Wiwa.
57. See Guardian (Lagos), 24 February 2004.
58. For him, 'to regard these diseases as if they were just emerging as political issues or considering them under the new global awareness misses the point that most communicable diseases have been global for a long time'; see Hakan Seckinelgin, 'Time to stop and think: HIV/AIDS, global civil society, and people's politics', in Mary Kaldor, Helmut Anheier and Marlies Glasius (eds), Global Civil Society Yearbook 2003 (Oxford: Oxford University Press 2003), 109.
59. See Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity (New York: W. W. Norton 1999), 462-92.
60. Ibid., 27.
61. For more on this, see Vaughan, Curing Their Ills.
62. Seckinelgin, 'Time to stop and think', 113.
63. In turn, it apparently created a situation whereby local cultures equally considered the colonizers' medical services as not being 'for them'.
64. Seckinelgin, 'Time to stop and think'.
65. Established 1899. For a view of the school as 'an instrument of empire', see Sheldon Watts, Epidemics and History: Disease, Power and Imperialism (New Haven, CT: Yale University Press 1997).
66. Porter, The Greatest Benefit to Mankind, 468.
67. Vaughan, Curing Their Ills, x.
68. For more on this, see the insightful collection of essays in Peter Wright and Andrew Treacher (eds), The Problem of Medical Knowledge: Examining the Social Construction of Medicine (Edinburgh: Edinburgh University Press 1982).
69. For a detailed discussion, see Seckinelgin, Time to stop and think', and Hooper, The River.
70. See also Gwyn Prins, 'The political economies of AIDS', lecture delivered at the Centre for the Study of AIDS, University of Pretoria, 2 February 2004.
71. and David P. Fidler, 'Germs, norms and power: global health's political revolution', Law, Social Justice and Global Development Journal (online journal), no. 7, issue 2004 (1), 4 June 2004, available at http://www2.warwick.ac.uk/fac/soc/law/elj/lgd/2004_1/fidler/ (viewed 2 May 2005).
72. Vaughan, Curing Their Ills, 19.
73. Every epidemic has a social meaning, or indeed many social meanings, and the HIV/AIDS scourge is no exception. For a philosophical exploration of the possible meanings of AIDS, see Susan Sontag, Illness as Metaphor and AIDS and Its Metaphors (London: Penguin 2002).
74. Here we may also recall the bitter controversy over the connection between HIV and AIDS involving South African president Thabo Mbeki (championing the cause of the so-called AIDS dissidents) and the scientific mainstream.
75. Dorothy Nelkin and Sander L. Gilman, 'Placing blame for devastating disease', in Arien Mack (ed.), In Time of Plague: The History and Social Consequences of Lethal Epidemic Disease (New York: New York University Press 1991), 41.
76. I b i d.
77. The capital of Kano state, and one of the biggest urban centres in Northern Nigeria, where the resistance to immunization began before spreading to other Northern Nigerian states.
78. Other specific allegations levelled against Pfizer included: following a trial protocol not approved by a US ethics committee, not explaining the experimental nature of the drug (Trovan) to subjects, and administering a lowered dosage even though it had full knowledge of its potentially harmful consequences. See Adriana Petryna, 'Ethical variability: an ethnography of the human subjects research industry', American Ethnologist, vol. 32, no. 2, May 2005, 183-97.
79. See Daily Independent (Lagos), 18 February 2004.
80. The suit remains active in the United States where families of those affected by these allegedly unapproved trials have instituted legal proceedings. The company denies allegations of professional misconduct, insisting that its intention was to save as many lives as possible following an outbreak of cerebro-spinal meningitis (CSM); see Sam Enefaro, 'Pfizer denies CSM experimental drug in Kano', Vanguard (Lagos), 21 December 2000.
81. See, for example, Fred Okoror and Tunde Alao, 'Why Kano rejected polio vaccine, by Shekarau', Guardian (Lagos), 9 July 2004.
82. See also Ahmed Gana, 'Vaccines and the bioterrorist', published on a website devoted to news and commentary about (northern) Nigeria, at www.gamji.com/NEWS3476.htm (viewed 14 May 2004, no longer available).
83. See Adebisi Obafemi, 'Racism in medicine', Nigeriaworld (a website devoted to news, current affairs and commentaries about social and political events in Nigeria), 25 February 2004, available at http://nigeriaworld.com/articles/2004/feb/251.html (viewed 2 May 2005).
84. Which is not to say that such leaders have never been popular or influential, given Northern Nigeria's relative educational disadvantage (compared with the South), a situation that has historically conferred social influence on a tiny educated minority. The point being made here is that the current political equation and balance of forces in which the North feels itself politically marginalized has given this political elite a rich vein of social disaffection to tap into, thus consolidating its own influence.
85. This was his second coming, having exercised power as military head of state between 1976 and 1979.
86. The context of Obasanjo's ascendancy has also been cited in this connection. In June 1993 the military regime of General Ibrahim Babangida abruptly suspended the release of election results just as it was becoming clear that they would show the winner to be M. K. O. Abiola, a southern Muslim. The eventual annulment of the entire election threw the country into a spiral of violence and political uncertainty, interspersed by an exceptionally rigorous period (1993-8) under the late General Sani Abacha. Obasanjo's election was widely seen as part of an attempt to pacify the South following Abiola's death in jail in suspicious circumstances.
87. See Jide Orintunsin, 'The North's pact with Obasanjo, by Kaita', ThisDay (Lagos), 1 April 2003.
88. Details of the purported pact remain shrouded in mystery. While some commentators claim that it relates to appointing Northerners into specific ministerial portfolios, others insist that it compels the president to support a northern candidate for the 2007 presidential election. See the interview with Sunday Awoniyi (a northern politician) in ThisDay (Lagos), 5 October 2002.
89. Muhammadu Buhari was Nigeria's military ruler between 1983 and 1985.
90. The legal suit filed by General Buhari alleging gross misconduct and manipulation of the result of the presidential election by the incumbent remains in the law courts.
91. Zamfara state under Sani Ahmed Yerima was the first northern state to introduce the sharia code. The initial announcement was made by the government on 22 October 1999, while the actual bill was passed into law in January 2000.
92. Obadare, 'In search of a public sphere', 178. For more on the sharia debate in Nigeria, see Lamin Sanneh, 'Shariah sanctions as secular grace? A Nigerian Islamic debate and an intellectual response', Transformation, vol. 20, no. 4, October 2003, 232-44.
93. See also Jibrin Ibrahim, 'The state and religion in Nigeria: forces and dynamics', Afrika Zamani, no. 5, 1997.
94. and Toyin Falola, Violence in Nigeria: The Crisis of Religious Politics and Secular Ideologies (Rochester, NY: University of Rochester Press 1998).
95. The pageant was relocated to London.
96. Interview with Lateef Adegbite, 'Let's never have Miss World here again', Newswatch (Lagos), vol. 36, no. 23, 9 December 2002.
97. To be sure, it was not only Muslims who publicly opposed hosting the pageant in Nigeria. For one, the federal government's decision to invite the beauty queens to Aso Rock (the seat of political power in the country), where they had tea with the president and a chaplain conducted a prayer meeting, was seen by many as simply over the top. There were others who, in principle, were opposed to the very idea of beauty pageants in general. See Jan H. Boer, 'The anatomy of Miss World', January 2003, now available at http://groups.yahoo.com/group/Naija-news/message/ 2587?viscount=100 (viewed 2 May 2005).
98. Boer, 'The anatomy of Miss World'. It is indeed baffling that the government settled for Abuja at the expense of a probably more receptive Lagos. More evidence, perhaps, of its alienation from the general public mood?
99. Isioma Daniel, 'Miss World. The world at their feet', ThisDay (Lagos), 16 November 2002.
100. The beauty pageant was seen in this respect as testimony to western decadence. This was regardless of the fact that, even in the West, opinion about the phenomenon is far from consensual. See, for example, Libby Purves, 'Third World reveals Miss World ugliness', The Times (London), 26 November 2002.
101. and Rod Liddle, 'The ugly side of Miss World', Guardian (London), 26 November 2002.
102. Further evidence that the phenomenon of the beauty pageant is declining in popularity can be seen in the recent decision of the American Broadcasting Corporation (ABC) to abandon the Miss America pageant, which it had broadcast since 1954. See Anthony Ramirez, 'Where is she? Not on ABC, as network abandons pageant', New York Times, 21 October 2004.
103. Nduka Nwosu, 'Faces of a lost pageant', Guardian (Lagos), 30 November 2002.
104. In addition to the tests, the federal government had also set up a twenty-three-person verification commission' that inspected vaccine manufacturing facilities in South Africa, India and Indonesia. The commission also declared the vaccines safe for use. See Fleshman, 'UN mediates polio deadlock in Nigeria'.
105. See the introduction by the editors in Wright and Treacher (eds), The Problem of Medical Knowledge, 7.
106. See also Jean Comaroff, 'Medicine: symbol and ideology, in Wright and Treacher (eds), The Problem of Medical Knowledge, 49-68.
107. and Randall Packard, 'Visions of postwar health and development and their impact on public health interventions in the developing world', in Frederick Cooper and Randall Packard (eds), International Development and the Social Sciences: Essays on the History and Politics of Knowledge (Berkeley: University of California Press 1997), 93-115.
108. For a discussion of the ethical issues raised by medical intervention, see Petryna, 'Ethical variability'.
109. Petryna, 'Ethical variability'.
110. The regime of the late General Sani Abacha, 1993-8.