Friday, November 19, 2010

Hajj and Health: Saudi Religious and Medical Leadership Prevails Over Religious Misinformation About Polio Vaccination


Performing Hajj, the pilgrimage to Makkah and the surrounding holy sites, is the 5th pillar of Islam. It is obligatory once in a lifetime for Muslims who are financially and physically capable. It is an annual occurrence, as opposed to umrah, the lesser hajj, which may be performed at any time of the year, and is not obligatory but recommended.

Hajj takes place on days 8-12 of the Dhu Al-Hijji, literally the month possessing the Hajj, the 12th month of the Islamic lunar calendar, which numbers its years from the first year of the Prophet's hajj as a Muslim--the Hijri calendar. Prior to that time Makkah and the Kaaba were a site of annual pilgrimage for the pre-Islamic faiths.

2009 Hajj pilgrims, wearing masks for H1N1 prevention

In preparation for last year's hajj there was an international focus on the health requirements and challenges of Hajj, due to the H1N1 scare. The Saudi Ministry of Health took the lead in preventive measures, and other countries imposed their own. While not denying them, Saudi discouraged children younger than 12, people older than 65 or pregnant women from making the pilgrimage. Ultimately visas for these groups were restricted with the collaboration of other Arab countries. The Minister of Health, Dr Abdullah al-Rabeeah went on television with his daughters to receive the H1N1 vaccine, and allay fears.

I was surprised to read this year of another vaccination program which was markedly affected by Hajj over a number of years, and where the Saudi Ministry of Health once again was in the lead. Saudi's religious credibility and public health practices had a profound effect on reversing the devastating increase in polio cases after Islamists in Nigeria propagated false information about the polio vaccine. When people refuse the vaccine for themselves and their children, the already large number of cases ballooned there and in neighbouring African countries.

Saudi Arabia's practice of polio vaccination of pilgrims was a major factor in reversing that tragedy, as described below.

[...]
Nigeria, the most populous country on the continent, is the only African country that never managed to eliminate polio even briefly. It is also a prime example of how superstition and religious extremism have jeopardized the fight against polio.
Islamic leaders in northern Nigeria organized a boycott of polio vaccinations in 2003, claiming that the vaccines were a Western plot to infect Muslims and make them infertile. Polio cases soon skyrocketed and spilled over to other African countries.
The number of new polio cases in Nigeria jumped from 355 to 792 within a year of the boycott. Hundreds of children were crippled as a direct result.
As recently as 2008, there were still nearly 1,000 new cases of polio in Nigeria. But the progress in the past two years has been remarkable. This year, only nine new cases have been recorded, and campaigners are confident of eliminating the disease from the entire country by next year.
“We feel very proud of what we’ve done,” said Boubacar Dieng, immunization manager at the Nigeria office of Unicef, the United Nations children’s agency. “It’s still highly fragile, but I’m sure Nigeria will reach eradication. All indicators are very positive. I’m 100 per cent confident.”
Nigeria was one of the first countries to receive a new vaccine that has been powerfully effective in combatting polio. It’s a double-strain vaccine, allowing children to be simultaneously immunized against two of the three main polio strains with a single oral vaccine.
The vaccine has produced dramatic results in Nigeria and India during the past year. Only 39 new cases have been recorded in India this year, down from nearly 400 in the same period last year – similar to the decline in Nigeria. “It’s a very effective, very valuable vaccine,” Dr. Dieng said.
But the new vaccine is not the only reason for Nigeria’s success. The polio campaigners have been aggressive in educating communities about the need for immunization. They persuaded Muslim leaders to drop their boycott and support the campaign. Some traditional Muslim leaders held public meetings in which they swallowed the vaccine themselves – or vaccinated their own children in front of the whole community – to prove that it is harmless.
Many Nigerian Muslim leaders were shocked during the annual Hajj pilgrimage to Saudi Arabia when they were pulled aside and given the polio vaccine by Saudi Arabian officials. “When they witnessed this,” Dr. Dieng said, ‘they realized how serious it is.”
The education campaign in Nigeria was also boosted by polio victims themselves. Some victims went into villages, showing their withered legs, propelling themselves slowly on wheelchairs or rough blocks of wood. “Do you want your child to look like me?” they asked the villagers.
[...]
--from "Anti-polio battle on the verge of victory" by Geoffrey York, The Globe and Mail, November 1, 2010


III. Poliomyelitis

(A) All visitors age under 15 years travelling
to Saudi Arabia from countries reinfected with
poliomyelitis (list below) should be vaccinated
against poliomyelitis with the oral polio vaccine
(OPV). Proof of OPV vaccination is required 6 weeks
prior the application for entry visa. Irrespective of
previous immunization history, all visitors under 15
years arriving in Saudi Arabia will also receive a
dose of OPV at border points.

The following countries are considered to be
reinfected with poliomyelitis (as of 10th of September
2010).

Angola, Cameroon, Benin, Burkina Faso, Burundi,
Chad, Côte d’Ivoire, Democratic Republic of the
Congo, Central African Republic, Guinea, Kenya,
Liberia, Mali, Mauritania, Nepal, Niger, Russian Federation,
Senegal, Sierra Leone, Sudan, Tajikistan,
Togo, Turkmenistan, Uganda, Uzbekistan.

(B) All travellers from Afghanistan, India, Nigeria
and Pakistan: Regardless of age and vaccination
status, should receive 1 dose of OPV. Proof of OPV
vaccination at least 6 weeks prior departure is
required to apply for entry visa for Saudi Arabia.

These travellers will also receive a dose of OPV at
borders points when arriving in Saudi Arabia.



Polio remains a crippler and a killer in a number of countries, primarily African, war torn, and poor ones. The polio vaccine is highly effective, safe, economical, and relatively easy to administer by oral drops. Routine vaccination of infants against polio has eradicated the disease in countries where it is practiced. There is great and realistic hope that through systematic vaccination polio will go the way of smallpox--eliminated except for laboratory specimens. The WHO, UNESCO, and Rotary International are leaders in the vaccination programs.


Polio can be endemic to a country, as in the cases of Nigeria, India, Pakistan, and Afghanistan, or imported by cases from endemic areas, as in most other countries. It can be eradicted for years and recur as happened in Bangladesh among others. During the 2003-4 10 month ban on vaccinations in some states of Nigeria, due to the Islamist fundamentalisst-started rumours of vaccine-induced sterility, cases spiked not only in Nigeria and in 12 then polio-free countries nearby in Africa, but in Yemen, Sudan, and Indonesia, by importation of the Nigerian strain of the virus.

Muslim fundamentalists in other countries have harmed the efforts to eradicate polio, and thus harmed through death and disability the people of those countries. The Taliban in Pakistan and Afghanistan oppose vaccination through fatwas--arguing vaccination is an aversion of Allah's will, and an American plot to sterilize Muslims--and through violence, including beating, kidnapping, and killing of vaccination workers and public health officials. The first case of polio in Australia in 21 years was diagnosed in a Pakistani student in 2007 after his return to Melbourne from a visit home to the Punjab and tourism in the Swat Valley.

In the year 2009, 300,000 children could not be given polio vaccination in Swat valley due to the obstruction formed by militants including religious propaganda, violence, and blocking vaccination supplies. Rotarians organized a counter-campaign through religious leaders, "Battling Polio"

[...]
In Pakistan, the fight against polio is now approaching a critical phase. There has been a sudden increase in polio cases since 2009, which has caused an alarming situation in the country and the condition seems to be getting out of control. There are a number of reasons that have played an unconstructive role in hindering the war against polio. The war against terrorism, recent floods and the hurdles created by Taliban militants by their false preaching about the polio campaign have all contributed towards the swelling of the disease.

In the year 2009, 300,000 children could not be given polio vaccination in Swat valley due to obstruction formed by militants. A medical emergency was triggered in Swat as the militants across the valley preached the idea through mosques and illegal radio stations that the vaccinations cause infertility and are a part of US-subsidised anti-Muslim stratagem. “Our society is an Islamic one where people strictly follow ulemas. However, a few illiterate ulema misguide the less educated people who trust them blindly,” says Maulvi Jahanzeb from Khyber Pakhtoonkhwa. To clear the prevailing misconception, in 2009 the Rotarians held an ulema convention, wherein, according to Kidwai, ulemas from different regions were invited and given lectures. These lectures were under the light of fatwas given by ulemas from around the world especially from countries like Saudi Arabia which is most trusted. The convention succeeded in convincing the people and ulemas across the northern region. The convention also encouraged people to give a three-minute awareness message after every Friday prayer in the towns and also via text messages.

[...]

--from "Battling Polio", The Express Tribune, October 24th, 2010 [Emphasis on Saudi Arabia and text messaging added]

Pakistani volunteer administers polio vaccine in Mingora, Swat Valley (Abdullah Khan/Associated Press)

One can only hope the efforts by Muslim clerics, and the experience of  Hajj, can help mitigate these noxious teachings, and encourage vaccination.


Related Posts:
Saudi Arabia and Hajj
Eid Al-Adha
Hajj and Eid Al-Adha 2009—The Unforeseen: A Deluge of Rain and Flooding
Hajj--Some Elements of a Pictorial History: 7th-19th Centuries; 1885 Photos


Your comments, thoughts, impressions, experiences?

2 comments:

Majed said...

Chiara,

I really hope it is just rumours that vaccines induce sterility.

Whether it is desinged to that purpose or just as a side effect for some additives to make it more effective in preventing the diseases,I think that the rumours has some reality to it, may be not in all countries, only in countries with remarkably high population, like india and may be it is true with Nigeria too, in my family and city we hardly used to see or hear of couples without children, but in younger genereation (vaccined generation)it has become very common to see infertile couples, only in family I know many very young people married some since as long as 7 years who still without children, while our unvaccined ones just need a smell of male to get pregnant, while boxes of clomid are useless to provide any help for those vaccinated ones, any way I have vaccinated my children, because I prefer them to be alive and healthy than dead or lame, though I explained to my doctor the doubts I have of course, he said may be it is true with goverment hospitals not in private as he says they use very high quality vaccines and charge much,though not very convincing,I took his word for it.

Wendy said...

No sterility. Sterility can be cause from environmental damage such as the use of fertilizers and weed killers. Polio vaccines have been in use since the early 1950's and there has been no problems with it in regards to sterility.

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