LONDON – We know how to eradicate polio. Since the 1980s, an international vaccination effort led by the World Health Organization has driven the virus to the cusp of extinction. A disease that killed or paralyzed a half-million people annually now infects only a few hundred.
What is standing in the way of the virus’s eradication is not medical or technical constraints, but political resistance to the vaccination effort. Indeed, the few areas where the virus continues to hold out share worrying similarities. Since 2012, 95% of polio cases have occurred in five countries – Afghanistan, Pakistan, Nigeria, Somalia, and Syria – all of which are affected by Islamist insurgencies. In order to eradicate polio, we must understand this linkage.
Islamist opposition to vaccination programs is often attributed to the belief that vaccines are a Western conspiracy to harm Muslims, and that the vaccines sterilize children, are infected with HIV, or contain pork. But it is important to note that jihadists in Syria and Afghanistan have been largely supportive of polio vaccination campaigns. If the virus is to be defeated, we will have to move beyond caricatures of Islamists as violent zealots opposed to Western science and look closely at the specific political contexts in which the eradication effort has so far been unsuccessful.
In Nigeria, for example, the extremist group Boko Haram’s animosity toward vaccination campaigns stems from an intra-Muslim conflict rooted in the colonial era, when the United Kingdom ruled northern Nigeria indirectly through a pro-British indigenous elite. The descendants of the colonial elite continue to dominate the region’s state governments, which are responsible for implementing the vaccination programs. Boko Haram’s opposition to the effort reflects its broader antipathy to what it regards as a corrupt and Westernized political class.
Similarly, in southern Somalia, attempts by outsiders to impose a stable centralized government have generated resentment toward polio vaccination programs. Since the early 1990s, interventions by the United Nations and the African Union in Somalia have included troops from the United States and from the country’s predominantly Christian neighbors, Kenya and Ethiopia. This has resulted in widespread discontent and has fueled support for Islamist militants, whom many Somalis view as the main bulwark against foreign interference. In recent years, al-Shabaab militants have attacked aid workers, making it very difficult to undertake public-health programs in insurgent-controlled areas. Médecins Sans Frontières, for example, had to close its Somali programs in 2013.
In Pakistan, opposition to the vaccination effort has its roots in Pashtun communities’ resistance to the national government. Broadly speaking, the Pakistani Taliban is a Pashtun movement, concentrated in the semi-autonomous Federally Administered Tribal Areas in the northwest of the country. This mountainous region was never ruled directly by the British, and the Pashtun have fiercely resisted attempts by the Pakistani state to expand its power. Thus, external interventions like the vaccination program are viewed as a stalking horse for deeper government encroachment into Pashtun areas.
The Pakistani Taliban’s hostility has been further hardened by US interventions in the country, including the use of a fake hepatitis vaccination campaign to gather DNA from Osama bin Laden’s relatives prior to his assassination. For Islamist militants, this confirmed that polio immunization efforts are a cover for gathering intelligence to identify targets for drone attacks.
The importance of local politics – rather than religious ideology – can be seen in the response to polio vaccination programs on the other side of the Durand Line. In Afghanistan, the Taliban is also a largely Pashtun movement, but its attitude toward the polio eradication effort could not be more different. When the Taliban ruled Afghanistan, from 1996 to 2001, it supported the vaccination effort, and indeed it continues to do so; a recent Taliban statement urged its Mujahedeen to provide polio workers with “all necessary support.”
This difference reflects the political position of Pashtuns in the two countries. In Afghanistan, Pashtun are the majority; as a result, they have a much stronger influence in national politics than their counterparts in Pakistan – and thus view the state with less suspicion.
In Syria, the biggest obstacle to the vaccination effort has been the central government. The refusal of President Bashar al-Assad’s regime to allow WHO to carry out vaccination programs in insurgent-controlled areas directly resulted in a polio outbreak in 2013. Moderate opposition groups like the Free Syrian Army, with the help of the Turkish authorities and local non-governmental organizations, have organized their own vaccination program in areas outside Syrian government control. Islamist militants, including the Islamic State and the al-Nusra Front, have allowed these immunization programs to operate in areas under their control as well, as they are not associated with the Assad regime.
The stance Islamist insurgents take toward polio vaccination campaigns has less to do with anti-Western zealotry than with the specific dynamics of the conflict in which they are involved. This has important implications for public-health policy. Only by understanding the political context in which vaccination programs operate will those committed to eradicating polio succeed.