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holds productive agricultural land and immense deposits of oil and natural gas.12 With an 
urbanization rate of close to 50% and a population whose median age is 17.9 years, Nigeria seems 
poised for economic prosperity.23 Already the largest oil producer in Africa, Nigeria's economy has 
been growing at a rate of 6 to 7 percent per year and is well placed to soon overtake South Africa as 
Africa's largest economy?"' 
Nigeria also views itself as the natural leader of the African continent, in part due to these 
demographic and economic realities. It possess one of Africa's strongest and most capable militaries 
which regularly plays an active role in peace operations abroad. At the international level, Nigeria has 
been recognized for its leadership in major organizations such as the Organization of the Islamic 
Conference (OIC), the Organization of Petroleum Exporting Countries (OPEC), the African Union (AU) 
and the Economic Community for West African States!' 
All of these accomplishments come despite endemic corruption, grinding poverty, and sectarian 
violence that has plagued Nigeria for decades.26 In fact, the roots of Nigeria's dysfunction, and the 
fault lines along which Nigeria may be torn apart can be traced to the very process of its formation.27
As McLoughlin and Bouchat explain: 
Like most post-colonial African states, Nigeria is both a mosaic of tribes, related or 
allied ethnic or ideological groups, and nations now linked economically and 
politically under a common government in a colonially imposed territorial unit. 
The British colonial government created a unified Nigeria in 1914 to demarcate its 
area of control from those of its European competitors and because its northern 
protectorate was too poorly resourced to stand on its own. It was therefore 
created as a state by externally imposted fiat, not for any internal, organic reason. 
Before the British arrived, there was no shared national consciousness, culture, or 
language in Nigeria, nor was there any sentiment to coalesce its peoples into a 
coherent nation under colonial rule? 
History 
53 years into independence, it is no small wonder that Nigeria remains a single state. While the 
Biafran war of the late 1960s is the most high-profile manifestation of regionalist and sectarian 
impulses in post-colonial Nigeria, it is by no means the only one. Even today, the Federal Government 
continues to face challenges to its authority from a number of armed groups based on regional, 
ethnic, ideological and religious identity. 
These movements include the Movement for the 
Actualization of the Sovereign State of Biafra (MASSOB) in the south-east, the Movement for the 
Survival of the Ogoni People (MOSOP) and the Movement for the Emancipation of the Niger Delta 
(MEND) in the south, and an Islamist insurgency in the north all of which are fighting in different 
ways to wrest control of territory away from the central government in Abuja? 
22 Central Intelligence Agency (CIA), The 2012 World Factbook, 2012, Nigeria. 
httns://www.cia.govilibrarv/mblications/the-world-factbookigeosini.html 
° Central Intelligence Agency (CIA), The 2012 World Factbook, 2012. Nigeria. 
https://www.cia.govilibrary/publicationsithe-world-factbookigeosini.html 
24 Todd J. Moss, "BRICN? When Will Nigeria Pass South Africa?" Center for Global Development: Views from the 
Center, 8 August 2013. http://www.cgdev.orgiblogibricn-when-will-nigeria-pass-south-africa 
25 Clarence J Bouchat, The Causes of Instability in Nigeria and Implications for the United States," Strategic 
Studies Institute, 19 August 2013. 
26 See: Clarence J Bouchat, "The Causes of Instability in Nigeria and Implications for the United States," Strategic 
Studies Institute, 19 August 2013. 
Gerald McLoughlin and Clarence J. Bouchat, Nigerian Unity In The Balance." Strategic Studies Institute, June 
2013. 
23 Gerald McLoughlin and Clarence J. Bouchat, Nigerian Unity In The Balance," Strategic Studies Institute, June 
2013. 
23 Jonathan N.C. Hill, "Sufism In Northern Nigeria: Force For Counter-Radicalization? Strategic Studies Institute, 
May 2010. 
21 
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Many of the difficulties confronting Nigeria are at least partly of its own makine Governing such a 
divided state was never going to be an easy undertaking. The roster of military juntas that ran the 
country into the ground only gave way to democracy in 1999, but Nigeria's current government has 
done little to inspire confldence.n  Decades of corruption, abuse, and inept government have 
alienated large portions of the Nigerian population and left a chasm between the government and 
the governed.32
Government & Administration 
Nigeria's government is designed as a Federal Republic. Executive power resides with the President 
who is the head of state and head of government. Legislative power is divided among two chambers, 
a democratically elected House of Representatives and the Senate, which together form the law-
making body known as the National Assembly. The Supreme Court of Nigeria acts as the country's 
highest judiciary.33
Administratively, Nigeria is divided into 36 states that elect a governor and 1 territory (the capital, 
Abuja). Each state is further divided into 774 Local Government Areas known as LGAs. In turn, each 
LGA is divided into wards. 
Religion 
Islam was first introduced to northern Nigeria in the 11th century, becoming well established in the 
major urban centers across the north and gradually spreading south into what today is referred to as 
the "middle belt" of Nigeria by the 16th century.34 Today, about half of Nigeria's population is 
Muslim, the majority of whom live in northern Nigeria. 12 states in northern Nigeria have had sharia 
law codified within their legal code since 2000. Though the vast majority are Sunni Muslim, there is a 
significant Shia minority, and a wide array of brotherhoods and sects who preach various violent and 
non-violent forms of fundamentalist, conservative and moderate Islam. 
Northern Nigeria has a long tradition as a center of Islamist thought, including fundamentalist 
strands of Islam- One of the first and most famous instances of armed Islamist uprisings against the 
state came in the early 19th century when religious scholar Usman Dan Fodio led a group of Muslims 
from the Fulani tribe to revolt against the dominant Hausa sultanates and the sultanate of Borno.35
At the heart of Dan Fodio's political and social revolution stood the belief that the rulers of northern 
Nigeria were corrupt and were not true adherents to sharia because they allowed the practice of 
Islam to be mixed with traditional beliefs. After leading his followers into exile, Dan Fodio called for 
jihad and returned to launch a successful attack that would go on to establish the Sokoto Caliphate, 
stretching across northern Nigeria and its environs. The Caliphate represented an Islamic banner of 
resistance to colonial conquest, and a rejection of secular government.36 To this day, the Sultan of 
Sokoto remains one of the most important and influential religious leaders in northern Nigeria. 
3° Jonathan N.C. Hill, "Sufism In Northem Nigeria: Force For Counter-Radicalization' Strategic Studies Institute, 
May 2010. 
31 Carlo Davis, "Boko Haram: Africa's homegrown Terror Network," World Policy Journal 12 June 2012. 
32 Jennifer G. Cooke and Farha Tahir, "Polio Eradication in Nigeria: The Race to Eradication," CSIS Global Health 
Policy Center, February 2012. 
33 "Nigeria," CIA World Factbook, 28 January 2014. https://www.cia.govilibrary/publications/the-world-
factbookigeosini.html 
34 Emilie Oftedal, "Boko Haram: An Overview," Norwegian Defense Research Establishment (FFI) 31 May 2013. 
35 Emilie Oftedal, "Boko Haram: An Overview," Norwegian Defense Research Establishment (FFI) 31 May 2013. 
Abimbola Adesoji, -The Boko Haram Uprising and Islamic Revivalism in Nigeria," Africa Spectrum 45, no. 2 
(2010) 
22 
EFTA00615217

Colonialism 
In the early 1900s, the British Empire extended its colonial control northward from the Nigerian 
coast, eventually gaining control of the Sokoto Caliphate. Initially, the British decided to maintain 
northern and southern Nigeria as two separate protectorates due to their cultural differences. 
Economic calculations persuaded the British to merge the two in 1914. 
But even after unifying northern and southern Nigeria, Britain pursued a colonial system of indirect 
rule in the north, choosing to govern the area through hand-picked indigenous rulers. This policy 
institutionalized existing north-south divisions, the effects of which are prevalent to this day. 
Present Situation 
Nigeria's economic decline since independence has hit the north particularly hard. Per capita public 
expenditure on health in the north was less than half that in the country's south as recently as 
2003.37 Development indicators remain lower than in the south where there is far more public and 
private investment, infrastructure and health services. 
Nigeria's transition to democracy in 1999 saw the election of Olusegun Obasanjo, making him the 
first Christian and southerner to lead the federal government since his own tenure as a military ruler 
from 1976 to 1979. This shift in political power from northern political elites to southern political 
elites, combined with widening economic disparities between north and south, fueled a sense of 
political marginalization throughout much of northern Nigeria.38
With little faith left in government and politicians, hundreds of thousands, perhaps millions, of 
Nigerians have found themselves drawn to individuals and groups who advocate a radical alternative 
to the status quo, often expressed in religious or moral terms. Within Christian communities, which 
are predominantly but not exclusively based in southern Nigeria and constitute roughly 40% of the 
population, disillusionment with government has tracked with the rise of evangelical Christian 
movements advocating faith as an alternative means to health and economic prosperity. Among 
Nigerian Muslims, who make up approximately 50% of the population, there has been a surge in 
support for sharia law as an alternative to a corrupt and ineffectual secular judiciary.39
Researcher Peter Chalk identifies three main streams of Islamic thought in contemporary Nigeria: 
conservatism, modernism and fundamentalism. Fundamentalism in the Nigerian context, according 
to Chalk, focuses on "anti-system movements that articulate vehement opposition to the existing 
political (secular) status quo, the federal government, established (and perceived ineffectual) 
religious elites, modern-oriented Muslim identity, and foreign — mainly Western — influences."90 In 
other words, the fundamentalist strand of Islamist thinking in the north of the country says that the 
continued failures of the Nigerian government are evidence of inherent flaws with secular 
government. In recent years, a group called Boko Haram has emerged as the most salient and 
destructive manifestation of this philosophy. 
Boko Karam 
Boko Haram is an Islamist sect in northern Nigeria. Initially established as a religious movement in 
the late 1990s or early 2000s that sought to purify northern Nigeria from the corrupting influences of 
37 Jennifer G. Cooke and Farha Tahir, "Polio Eradication in Nigeria: The Race to Eradication," CSIS Global Health 
Policy Center, February 2012. 
38 Jennifer G. Cooke and Farha Tahir, "Polio Eradication in Nigeria: The Race to Eradication," CSIS Global Health 
Policy Center, February 2012. 
38 Jonathan N.C. Hill, "Sufism In Northam Nigeria: Force For Counter-Radicalization?" Strategic Studies Institute, 
May 2010. 
10 Peter Chalk, "Islam in West Africa: The Case of Nigeria," in The Muslim World after 9/11, ed. Angel M. Rabasa 
et al. (Santa Monica, CA: RAND, 2004). 
23 
EFTA00615218

Western culture, Boko Haram has since transformed into an armed insurgency determined to 
transform Nigeria into an Islamic state. 
Though the group had been carrying out violent attacks for the better part of a decade, Boko Haram 
burst onto the international scene in 2010 and 2011 when it carried out a string of deadly attacks 
against the Nigerian government and detonated a car bomb after crashing into a United Nations 
building in Abuja, killing 23 people in the process. 
Nigerian President Goodluck Jonathan has sought to crush Boko Haram through the enlistment of 
civilian vigilante groups and the deployment of some 8,000 soldiers supported by fighter jets and 
helicopter gunships to northern Nigeria. Due to a virtual media blackout northeast Nigeria, where a 
state of emergency has been in place since May 2013, very little information can be independently 
verified. Consequently, it is difficult to assess the effectiveness of the Nigerians government's heavy-
handed tactics, and the effects of fighting between the government and Boko Haram on the civilian 
population. 
As a result of the upsurge in violence, Nigerian citizens are openly wondering if their country is on 
the brink of a civil war. Amid checkpoints and constant security warnings, an air of apprehension 
pervades daily life throughout much of northern Nigeria, with social and economic activities in some 
northern states grinding to a halt and and bringing previously peaceful communities to the verge of 
fracture.0' 
The relative strength of Boko Haram is unclear. While Boko Haram appears to be growing more lethal 
-- the group is thought to have killed thousands since 2009 and carried out several audacious large 
scale attacks on heavily fortified military targets in the last few months -- precious little is known 
about its leadership, organizational structure, funding streams, and membership. At any given time, a 
patchwork of armed groups or individuals in northern Nigeria may be carrying out attacks under the 
banner of Boko Haram. 
Even its name, "Boko Haram" -- a phrase borrowed from the Hausa language native to northern 
Nigeria -- is an unofficial moniker ascribed from the outside that the group's core members do not 
use, preferring its official Arabic name of "Jamala AhI al-sunnah li-da'wa wa al-jihad" instead. 
Despite its Hausa name, the majority of its initial membership is believed to be ethnic Kanuri, from 
northeastern Nigeria. But over the course of the last decade, the group has metastasized, spreading 
throughout northern Nigeria and inserting itself within longstanding conflicts in the "middle-belt." 
Boko Haram has deployed suicide bombs and coordinated assaults aimed at an array of targets, 
including markets, schools, hospitals, clinics, banks, churches, mosques, police stations and military 
installations. And while the scope and intensity of Boko Haram's terror campaign is breathtaking, the 
movement is not without its antecedents. 
The previously discussed Sokoto Caliphate was an armed movement against what was perceived at 
the time to be the illegitimate rule of powerful elites who were misappropriating Islam. In fact, Dan 
Fodio's legacy of a purifying withdrawal from society in order to wage a righteous jihad against 
corrupting influences is seen by many northern Nigerian Muslims, including Boko Haram, as a 
template for a more just, prosperous and equitable northern Nigeria." 
41 Michael Olufemi Sodipo, "Mitigating Radicalism in Northern Nigeria, African Center for Strategic Studies. No. 
26. August 2013. 
J2
 
David Cook, "The Rise of Boko Haram in Nigeria", CTC Sentinel 4, no. 9 (2011). 
24 
EFTA00615219

More recently, there was the Maitatsine movement, which was led by a Cameroonian preacher 
named Mohammed Marwa who took up the teachings of Dan Fodio after arriving in the northern 
Nigerian city of Kano in 1945. Marwa's preaching, predicated on the belief that he himself was a 
prophet, earned him the name Maitatsine, which translates from Hausa to mean "he who curses" or 
"the one who damns." Much like Dan Fodio, Marwa's movement stood against Nigeria's corrupt 
secular government and its allies within the "moderate" religious establishment. Marwa was 
eventually forced into exile by the British colonial government, but returned to Kano shortly after 
independence. 
The Maitatsine message resonated with the young, poor and unemployed in the slums of Kano. 
Throughout the 1970s, the Maitatsine movement gradually turned violent, leading to clashes with 
police. Marwa was killed in 1980 during a confrontation with police, but even after his death, riots 
spread throughout northern Nigeria, claiming the lives of between 4,000 and 5,000 people.03 The 
movement never quite recovered, but isolated pockets of extremism remained, and Maitatsine 
teachings are thought to be a source of ideological inspiration for Boko Haram." 
The Maitatsine movement introduced many of the tactics that would become common in northern 
Nigeria's current wave of Islamic radicalization (both violent and non-violent), particularly the 
mobilization of poor communities against established, urban Muslim elites perceived to be colluding 
with a corrupt, secular government." 
Abimbola Adesoji, 'The Boko Haram Uprising and Islamic Revivalism in Nigeria," Africa Spectrum 45, no. 2 
(2010) 
• Abimbola Adesoji, 'The Boko Haram Uprising and Islamic Revivalism in Nigeria," Africa Spectrum 45, no. 2 
2010) 
• Abimbola Adesoji, The Boko Haram Uprising and Islamic Revivalism in Nigeria," Africa Spectrum 45, no. 2 
(2010) 
25 
EFTA00615220

The Nigerian government successfully crushed the Maitatsine movement with brute force.G6 The 
success of these heavy handed tactics may have given the Nigerian government a false sense that 
Boko Haram was merely the latest manifestation of a violent Islamist undercurrent that could be 
stemmed through similar means. 
Figure 4: Areas where access is limited due to security concernsd7
0 
STATES WHERE SOW HARAM THREAT PERSISTS 
▪ 
STATES WHERE SOKO HARAM THREAT IS HIGH 
▪ 
STATES WHERE SOKO HARAM THREAT IS MOST ACUTE 
• 
801(0 HARAM RELATED VIOLENCE 
But all accounts, attempts to crush Boko Haram through military might have proved unsuccessful, 
even counterproductive. Nigerian security forces cracked down on Boko Haram during mass uprisings 
in 2003-2004 and thought the problem had been dealt with, only to see Boko Haram re-emerge." A 
2009 attempt to deliver a decisive blow to Boko Haram in their stronghold of Maiduguri led to the 
death of at least 700 people. Boko Haram's then leader, Mohammed Yusuf, was captured by police 
and summarily executed." After that episode, Boko Haram faded from public view for close to a 
year, only to come back more determined and lethal than before.5°
" Andrew Walker. 'Special Report: What is Boko Haram?' United States Institute of Peace. June 2012. 
47 Figure 3 source, Council on Foreign Relations, with modifications by the author 
http://www.cfr.orginigerianigeria-security-tracker/p2948 
48 Alex Thurston, "Nigeria: An Ephemeral Peace," The Revealer, 22 June 2013. 
49 Rom Bhandari, "Boko Haram Infiltrates Government." Think Africa Press. 10 January 2012. 
so Alex Thurston, "Nigeria: An Ephemeral Peace," The Revealer, 22 June 2013. 
26 
EFTA00615221

As part of its operations against Boko Haram since 2009, the Nigerian government has allegedly killed 
hundreds of suspected militants and sympathizers, and have stood accused of extrajudicial killings as 
well as using Boko Haram as a cover for attacks on political rivals or as pretext for score-settling.°
During raids on suspected Boko Haram strongholds, the military has burned homes and summarily 
executed suspected Boko Haram members in front of their families. Nigerian authorities have cast a 
wide dragnet, arresting thousands of people across northern Nigeria, holding many of these 
prisoners incommunicado without charge or trial for months or even years. In some cases, prisoners 
have been detained in inhuman conditions, tortured or even killed.°  Amnesty International reported 
receiving credible evidence that over 950 people have died in military custody in the first six months 
of 2013 alone.°  The ongoing violence and abuse by government forces may even be driving new 
recruits into Boko Haram's arms's' 
In the wake of an escalation of violence, Boko Haram and its followers are all the more driven by a 
desire for vengeance against politicians, police, and Islamic authorities aligned with the state. 
Furthermore, Boko Haram has proved itself to be very adaptable, evolving its tactics swiftly and 
changing its targets at the behest of a charismatic, if opaque leadership.°
Part of what makes understanding and defining Boko Haram so difficult is the fact that it may very 
well be several different things at once. As former US ambassador to Nigeria John Campbell told 
reporter Andrew Walker, Boko Haram is certainly a grassroots movement that taps into anger over 
poor governance and a lack of development in northern Nigeria, but it is also a core of Mohammed 
Tustin followers who have reconvened around Abubakar Shekau to exact revenge on the Nigerian 
state. At the same time, it can be viewed as a kind of personality cult, an Islamic millenarianist sect 
inspired by a charismatic preacher.°
Boko Haram's increased deadliness and the sophistication of its attacks are widely cited as evidence 
that they are collaborating with foreign groups. Its violent campaign has expanded in scope and 
capability, and its membership is believed to have diversified, with anecdotal evidence suggesting 
that foreign fighters from Chad, Mauritania, Niger, Somalia and Sudan may be in Boko Haram's 
ranks 57
In recent years, northern Nigeria has also seen the formation of splinter groups emerging from Boko 
Haram, the most prominent being a group commonly referred to as Ansaru, though its full Arabic 
name Juma'atu Ansarul Muslimina Fi Biladis Sudan, translates to "Vanguards for the Protection of 
Muslims in Black Africa.x°
Formed in January 2012, Ansaru explicitly targets Westerners in Nigeria and neighboring countries. 
Some analysts cite this goal as possible evidence that the once parochial ambitions of Boko Haram, 
or factions within Boko Haram, may now be international. In fact, since 2011, there have been 
51 Andrew Walker, "Special Report: What is Boko Haramr United States Institute of Peace, June 2012. 
52 Human Rights Watch, "Nigeria: Massive Destruction, Deaths From Military Raid' 1 May 2013. 
53 Amnesty International, "Nigeria: Deaths of hundreds of Boko Haram supsects in custody requires investigation," 
15 October 2013. 
51 Alex Thurston, "Nigeria: An Ephemeral Peace," The Revealer, 22 June 2013. 
55 Andrew Walker, "Special Report: What is Boko Haramr United States Institute of Peace, June 2012. 
6 See John Campbell's quotes in Andrew Walker, "Special Report: What is Boko Haram?" United States Institute 
of Peace, June 2012. 
57 Abimbola Adesoji, 'The Boko Haram Uprising and Islamic Revivalism in Nigeria," Africa Spectrum 45, no. 2 
0010) 
Abimbola Adesoji, The Boko Haram Uprising and Islamic Revivalism in Nigeria," Africa Spectrum 45, no. 2 
(2010) 
27 
EFTA00615222

increasing signs of international collaboration between Boko Haram and militants from Niger, Mali, 
the broader Sahel, Somalia and other countries throughout the Muslim world." 
In tandem with its deployment of security forces to crush Boko Haram, the Nigerian government has 
simultaneously attempted to negotiate with the group. 
In 2011, democracy activist Shehu Sani attempted to broker exploratory talks between the former 
president Olusegun Obasanjo and Mohammed Yusuf's brother-in-law, Babakura Fugu. Soon after the 
meeting, gunmen stormed into Fugu's house and shot him dead. Boko Haram denied the killing and 
the assassins have not been identified." 
In January 2012, a group claiming to be a moderate breakaway faction of Boko Haram sent a tape to 
the National Television Authority saying it was ready to negotiate. Four days later a dozen people 
were publicly beheaded in Maiduguri by people claiming to be Boko Haram." 
Despite these setbacks, the administration of President Goodluck Jonathan has shown intermittent 
interest in the idea of dialogue with Boko Haram. The formation of the Committee on Dialogue and 
Peaceful Resolution of Security Challenges in the North of Nigeria, formed on April 24, 2013 is 
probably the most ambitious overture to date." But there are several practical and political barriers 
to productive negotiations taking place. 
To start with some of Boko Haram's stated demands are practically impossible to realize, and often 
contradictory.63 The demand that Nigeria implement Islamic law nationwide, for example, is a non-
starter. Second, finding credible representatives of Boko Haram who are serious about negotiations 
may not be possible, and even if it were, it is unclear that these representatives or interlocutors 
would be able to control other wings or factions within Boko Haram." 
There are some demands from Boko Haram which might be up for discussion, such as the release of 
senior members who are in captivity, the return of property taken from its members, and bring the 
people responsible for the extra-judicial execution of Mohammed Yusuf to justice.65 But it is unclear 
what exactly Boko Haram has to offer the government short of dropping its core demands in the first 
place. 
Second, offers of amnesty and calls for negotiations with Boko Haram may be politically unpopular 
with Christians and the vast majority of Muslims in Nigeria who oppose the group. The fact that 
previous ceasefires and attempts at negotiations have collapsed, and that communities affected by 
the crisis are growing impatient, may strengthen the hand of those who prefer a military solution to 
the crisis. As researcher Alex Thurston writes, "the limitations of military approaches may soon lead 
Nigeria back to the hope of dialogue, and the difficult question of how to break the cycle of 
ineffective crackdowns and inconclusive negotiations." 6
The Polio Epidemic in Context 
Despite an array of political and economic challenges, Nigeria had made significant strides in 
eradicating polio from 1996 to 2001, with a dramatic expansion of coverage via National and 
Subnational Immunization days. In the wake of a significant drop in reported cases, there was 
59 Jacob Zenn, "Boko Harem's International Connections," CTC Monitor. 14 January 2013. 
ce Andrew Walker. -Special Report: What is Boko Harem?" United States Institute of Peace. June 2012. 
61 Andrew Walker. 'Special Report: What is Boko Harem?" United States Institute of Peace. June 2012. 
62 Alex Thurston, "An Ephemeral Peace," The Revealer, 22 June 2013. 
63 Andrew Walker. 'Special Report: What is Boko Haram?' United States Institute of Peace. June 2012. 
64 Alex Thurston, "Nigeria: An Ephemeral Peace," The Revealer, 22 June 2013. 
65 Andrew Walker. 'Special Report: What is Boko Harem?" United States Institute of Peace. June 2012. 
66 Alex Thurston, "Nigeria: An Ephemeral Peace,' The Revealer, 22 June 2013. 
28 
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increasing optimism that the 2005 global eradication target might be met.67 Hopes of meeting that 
target, however, were subsequently dashed with the onset of a vaccination boycott throughout 
much of Nigeria. 
The 2003 Boycott 
In 2003, the political and religious leadership of Kano, Zamfara and Kaduna states in northern Nigeria 
brought the immunization campaign to a halt, urging parents not to immunize their children. Among 
the initial reasons listed for the boycott were allegations that the vaccine had been contaminated 
with anti-fertility agents, HIV, and could cause cancer." 
Local media at the time reported that the formal boycott began at a July 2003 meeting of an 
influential network of Muslim organizations called Jama'atul Nasril Islam (JNI), in which one of the 
Emirs in northern Nigeria "presented a memo on the concerns and apprehensions of his people on 
the allegations that the polio vaccination campaign was being used for the purposes of depopulating 
developing countries and especially Muslim countries."69
At the forefront of the boycott was Datti Ahmed, a physician based in Kano who heads a prominent 
Muslim group called the Supreme Council for Sharia in Nigeria (SCSN). At the time of the boycott, 
Ahmed was quoted in a South African news outlet asserting that vaccines were "corrupted and 
tainted by evildoers from America and their Western allies."70 Dr. Ahmed, who had only a year earlier 
called for a boycott of the Miss World pageant in Abuja on religious grounds, voiced his opposition to 
the polio vaccination in stark terms. "We believe that modern-day Hitlers have deliberately 
adulterated the oral polio vaccines with anti-fertility drugs and contaminated it with certain viruses 
which are known to cause HIV and AIDS."71
The ban quickly divided Muslim leaders, many of whom were embarrassed by the political undertone 
of the boycott.72 Prominent Islamic scholar Sheikh Yusuf Qaradawi was quoted as saying, "I was 
completely astonished about the attitude of our fellow scholars of Kano towards polio vaccine. I 
disapprove of their opinion, for the lawfulness of such vaccine in the point of view of Islam is as clear 
as sunlight." Citing the fact that the vaccine was administered in over 50 Muslim countries, Sheikh 
Qaradawi accused the SCSN of creating a negative images of Islam which "make it appear as if it 
contradicts science and medical practice."73
Despite widespread criticism of the ban, many local political, community and religious leaders began 
fueling rumors that the vaccines were unsafe, encouraging their followers and constituents to 
boycott. Kano's then-governor Ibrahim Sekarau suspended the administration of the vaccine, and 
state governments in Bauchi, Kaduna and Zamfara soon followed. 
This was not the first time that rumors about safety have plagued immunization campaigns, nor is 
skepticism about them confined to non-western countries. But the initial assumption that these 
87 Jennifer G. Cooke and Farha Tahir, "Polio Eradication in Nigeria: The Race to Eradication," CSIS Global Health 
Policy Center, February 2012. 
68 A.S. Jegede, 'What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Medicine 4, no. 3 
(2007) : e73; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC18317261 
"Nigeria Polio Vaccine: Controversy Over or Renewed?" Weekly Trust, 6 March 2004. 
hitp://allafrica.com/stories/200403080451.html 
" A.S. Jegede, "What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Medicine 4. no. 3 
? 007) : e73- htto://www.ncbi.nlm.nih.aoviomciarticles/PMC1831725/ 
Laurie Garret and Scott Rosenstein, "Polio's Return," The American Interest, 1 March 2006. aFUp:,:www.the-
iamerican-interest.com/articles/2006/03/01/oolios-returnfittooter 
" A.S. Jegede, 'What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Medicine 4, no. 3 
gag): e73- http://www.ncbi.nlm.nih.govipmciarticlestPMC1831725/ 
A.S. Jegede, 'What Led to the Nigerian Boycott of the Polio Vaccination Campaign?" PLoS Medicine 4, no. 3 
(2007) : e73- htto://www.ncbi.nlm.nih.aoWomc/articlesiPMC1831725/ 
29 
EFTA00615224

baseless rumors would be short-lived demonstrated a fundamental lack of understanding of the 
context within which these vaccination campaigns were taking place. 
The Nigerian director of the United Nations Children's Fund (UNICEF) told researchers Judith R. 
Kaufmann and Harley Feldbaum, "Our own Western-oriented...background tells us if vaccine is found 
to be good, then it's scientifically good, that's it. ...Instead, the population who rejected it was 
thinking in other terms, and we didn't realize the power of that and how disruptive that could have 
been. ...We didn't see it coming, and unfortunately that is quite normal."74
It soon became abundantly clear that the polio vaccination boycott was due to a combination of 
political, ethnic, and religious tensions brought to the fore by the April 2003 re-election of President 
Olusegun Obasanjo. 
A born-again Baptists Christian from southern Nigeria, Obasanjo's election to a second term over 
retired General Muhammadu Buhari, a Muslim from northern Nigeria, exacerbated existing tensions 
over regional disparities over government services, including health services." 
Upon losing the election, General Buhari's All Nigeria People's Party (ANPP) challenged the victory of 
President Obasanjo's People's Democratic Party (PDP) in Nigeria's Supreme Court. Kano, for example, 
was a state under the control of the ANPP challenged the polio vaccination exercise organized by the 
PDP-controlled federal government.76 Some observers suspected that northern political leaders 
calling for the boycott did so less out of concerns for community safety, and more as a means of the 
federal "southern" government." 
It is also important to take into account the fact that comparative rates of using health services in 
southern Nigeria versus northern Nigeria differ dramatically. In 1990, the comparative rates between 
north and south were 50% versus 18%. In 1999, the disparity had grown to 60% versus 11%. By 2003, 
at 
the 
time 
of 
the 
boycott, 
the 
gap 
had 
widened 
to 
64% 
versus 
8%." 
Nigeria's health system decentralizes administrative control over primary and secondary health to 
states, while the federal government maintains control of care at the tertiary level. As a result, states 
like Kano, Zamfara, Bauchi and Kaduna were able to halt immunization exercises planned by the 
federal government." 
As reports of the vaccine boycott spread, parents began actively refusing vaccination when health 
workers came to their homes, some going so far as to mark the doors of their homes to falsely signal 
that a health worker had already visited, and putting nail polish on their children's fingers to mimic 
the ink that signifies that a child has been vaccinated.8°
74 Judith R. Kaufmann and Harley Feldbaum. "Diplomacy And The Polio Immunization Boycott In Northern 
Nigeria: Health Affairs. 28. no.4 (2009):1091-1101 
75 Judith R. Kaufmann and Harley Feldbaum. "Diplomacy And The Polio Immunization Boycott In Northern 
Nigeria: Health Affairs. 28. no.4 (2009):1091-1101 
76 A.S. Jegede. "What Led to the Nigerian Boycott of the Polio Vaccination Campaign?" PLoS Medicine 4. no. 3 
(2007) : e73: httolAwww.ncbi.nlm.nihmov/mciarticles/PMC1831725/ 
'Jennifer G. Cooke and Farha Tahir, "Polio Eradication in Nigeria: The Race to Eradication." CSIS Global Health 
Policy Center. February 2012. 
78 A.S. Jegede. "What Led to the Nigerian Boycott of the Polio Vaccination Campaign?" PLoS Medicine 4. no. 3 
(007) : e73: http://www.ncbi.nlm.nih.gov/pmc/articlesIPMC1831725/ 
A.S. Jegede. "What Led to the Nigerian Boycott of the Polio Vaccination Campaign?" PLoS Medicine 4. no. 3 
(2007) : e73: httplAwww.ncbi.nlm.nih.gov/pmciarticles/PMC1831725/
Jennifer G. Cooke and Farha Tahir. "Polio Eradication in Nigeria: The Race to Eradication." CSIS Global Health 
Policy Center. February 2012. 
30 
EFTA00615225

1 CASE 
2 CASES 
> 3 CASES 
Figure 5: Restriction of wild polio virus spread in 2013, compared to 2012m
There is also an important historical and social context in which the boycott should be viewed. 
In 2000, Alhaji Najib Hussain Adamu, the Emir of Kazuare in Jigawa state in northern Nigeria and one 
of the first leaders to spearhead the anti-vaccination campaign in northern Nigeria, began taking 
notice of confusion within his community stemming from the arrival of outsiders coming to houses to 
vaccinate children with drops of oral polio vaccine. Relatively few people were afflicted with polio, 
whereas other health concerns, namely malaria, were widespread in their communities.82
It is not hard to imagine that an aggressive, mass immunization program based on door-to-door visits 
by strangers might illicit suspicion, especially in a context in which access to basic healthcare is not 
easily available.83 As John Murphy of the Baltimore Sun wrote at the time: 
The aggressive door-to-door mass immunizations that have slashed polio 
infections around the world also raise suspicions. From a Nigerian's 
perspective, to be offered free medicine is about as unusual as a stranger's 
going door to door in America and handing over $100 bills. It does not 
make any sense in a country where people struggle to obtain the most basic 
medicines and treatment at local clinics"84
A lawyer by training, Emir Adamu began to do research on the vaccine on the Internet, where he 
found a variety of sources and documents offering "evidence" of an ulterior motive behind polio 
vaccine campaigns. One such claim suggested that that the oral vaccine, which was created using 
monkey cells, was contaminated with a host of monkey viruses, including a close relative to HIV, thus 
supporting the theory that the polio vaccine spawned the modern AIDS pandemic.°
81 GPEI, 
htto://www.00lioeradication.orePortals/0/Document/InfectedCountries/NiReria/Niaeria NationalPolioEradicationEm eree 
vsyPlan 2014.pdf 
52 Laurie Garret and Scott Rosenstein, "Polio's Return: The American Interest, 1 March 2006. httpliwww.the-
Emerican-interest.com/articles/2006/03/01/oolios-returnfitfooter 
A.S. Jegede, "What Led to the Nigerian Boycott of the Polio Vaccination Campaign?' PLoS Medicine 4, no. 3 
007) : e73; htto://www.nobi.nlm.nih.00v/omdarticles/PMC1831725/
°- A.S. Jegede, "What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Medicine 4, no. 3 
(2007) : e73- httplNyww.ncbi.nlm.nih.goyipmciarlicles/PMC1831725/ 
Laurie Garret and Scott Rosenstein, "Polio's Return,' The American Interest, 1 March 2006. httpl/www.the-
american-interest.conVarticles/2006/03/01/oolios-returnirtfooter 
31 
EFTA00615226

Another document which caught the Emir's attention, which is not related to vaccination campaigns 
or HIV/AIDS, was the National Security Study Memorandum 200, authored in 1974 by then U.S. 
Secretary of State and National Security Advisor Henry Kissinger. The obscure memorandum suggests 
that rapid population increases in the developing world can generate threats to national security 
through regional destabilization and resource scarcity. The memo, which suggests that the U.S. 
promote family planning in certain countries, including Nigeria, has since gained notoriety in certain 
circles in Nigeria and is cited as evidence of a stealth policy by the U.S. to reduce Nigeria's 
population? 
Distrust of Western health interventions in northern Nigeria, however, predate the "investigative" 
work of Emir Adamu and Dr. Datti Ahmed. In 1996, the American pharmaceutical giant Pfizer began 
testing its drug Trovan on children in Kano during a bacterial meningitis outbreak in northern Nigeria. 
Years later, a suit filed on behalf of those children at the Federal District Court in Manhattan alleged 
that parents were not informed that the drug was experimental, nor that they could refuse the drug 
if they chose, or that another organization was offering an internationally approved treatment for 
free at the same site? 
The same suit also accused Pfizer of administering low dosages of the meningitis treatment 
ceftriaxone to improve the relative effectiveness of Trovan, and that these low doses of ceftriaxone 
were responsible for injuries and death, while Trovan was responsible for cases of brain damage, loss 
of motor skills and death of several of the participants of the study? 
Current polio eradication efforts should be sensitive to the legacy of distrust that many Nigerians 
have because of the Memorandum 200 affaire. When they cite Memorandum 200, even if they are 
misinterpreting its meaning, that document, which says that curbing Nigeria's population growth is in 
the U.S. national interest, actually exists. To dismiss the concerns of those who cite these examples 
outright is to fundamentally ignore the context within which vaccination campaigns in northern 
Nigeria must take place. It also fails to empathize with the northern Nigerian parent who, in the face 
of conflicting information from a range of sources, just wants to do what is best for his children and 
may err on the side of not letting a foreigner or outsider vaccinate them. 
In response to the public outcry about the polio vaccine, the Nigerian federal government set up a 
technical committee to assess the safety of the polio vaccine. A key component of the committee's 
work was to send samples of the vaccine for laboratory tests abroad to prove its safety. The results 
were rejected by the SCSN, however, on the grounds that the Muslim community was not adequately 
represented on the committee? 
Be For more on this subject, see: Laurie Garret and Scott Rosenstein, "Polio's Retum," The American Interest, 1 
March 2006. http://www.the-american-interest.comfarticles/2006(03/01/oolios-retumfitfooter 
B7 
 
Laurie Garret and Scott Rosenstein, "Polio's Return," The American Interest, 1 March 2006. http:PWww.the-
american-interest.corniarticlest2006/03/01/polios-returrVelooter 
se Laurie Garret and Scott Rosenstein, "Polio's Return," The American Interest, 1 March 2006. http://Www.the-
american-interesicomiarticles/2006/03/01/polios-returnielooter For more on the investigation, see: Joe Stephens, 
"Panel Faults Pfizer in '96 Clinical Trial in Nigeria," The Washington Post, 7 May 2006. 
http://vmw.washingtonpost.comiwp-dyrVcontentiarticle/2006/06/06/AR2006050601338.html• Joe Stephens, 
"Pfizer Faces Criminal Charges in Nigeria," The Washington Post, 30 May 2007 
http://www.washinatonoost.comiwo-dwVcontentiarticle/2007/05/29/AR2007052902107.html: Joe Stephens "Pfizer 
to Pay 375 Million to Settle Nigerian Tovan Suit," The Washington Post, 31 July 2009 
htto://vmw.washinatonoost.comiwo-dvn/contenVarticle/2009/07/30/AR2009073001847.html• and Donald G. 
McNeil Jr., "Nigerians Receive First Payments for Children Who Died in 1996 Meningitis Drug Trial," The New 
York limes, 11 August 2011 
http://vmw.nvtimes.com/2011/08/12/worldiafrica/12niaeria.html?gwh.CB2E73B8DBDC9A6FB7FBEA57C47A851 
A&owt=oav 
A.S. Jegede, 'What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Medicine 4, no. 3 
(2007) : e73- htto://www.ncbi.nlm.nih.aoWomc/articlesiPMC1831726/ 
32 
EFTA00615227

The federal government responded by forming another technical committee, which this time 
included members of JNI -- the Muslim group that initially spearheaded the boycott -- but the SCSN 
again rejected the committee, asking for the inclusion of its own nominees.90
Despite the fact that Kano saw a 30% increase in polio during this time, the Kano State Government 
justified its opposition at the time, arguing that it was the "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."91
The deadlock was eventually resolved in July 2004 when religious leaders were recruited to engage 
SCSN and those who opposed the vaccine. These meetings led to a consensus in February 2004 to 
test the vaccine independently in a Muslim country." Kano state governor Ibrahim Sekarau finally 
decided to end the 11-month boycott after the vaccine obtained a seal of approval from Biopharma, 
an Indonesian company which, thanks to the fad that Indonesia is a Muslim country, was 
recommended to become the new supplier of polio vaccines for the predominantly Muslim states in 
northern Nigeria.93
In retrospect, the major breakthroughs in ending the impasse had much more to do with diplomacy 
than the triumph of science. In the midst of the boycott, for example, U.S. Secretary of State Colin 
Powell and UNICEF headquarters suggested to UN Secretary-General Kofi Annan that he send 
Ibrahim Gambari, the secretary-general's advisor for African affairs, to Nigeria as a special envoy. As 
researcher's Judith R. Kaufman and Harley Feldbaum explain: 
Normally, the UN Secretariat would not send a national of a country to 
negotiate in his or her country of origin, for fear of conflict of 
interest or 
pressure being put on the individual. However, in this case, 
most felt that Gambari was uniquely qualified. Gambari's father was a 
Muslim 
northerner and Emir of florin, and his mother was a 
southerner. 
Gambari has 
served under virtually all of the surviving 
former Nigerian presidents, 
including those with presumed influence in 
the North, and had managed 
President Obasanjo's 1991 campaign to be 
UN secretary-general.90
Gambari was dispatched by Obasanjo to meet with the Sultan of Sokoto, the Emir of Kano, several 
high-profile traditional Muslim leaders, prominent politicians such as General Buhari, and even Datti 
Ahmed. During these trips, the complexity of the issue at hand became apparent. 
In Sokoto, for example, Gambari realized that although the Sultan of Sokoto is traditionally the 
spokesman for the Muslims of the region, he is also the head of JNI. The secretary-general of the JNI, 
however, was one of the earliest and most steadfast opponents of polio immunization. Though 
Gambari left Sokoto with assurances from the Sultan that he agreed the boycott was harmful to the 
population, it was possible that others within the religious establishment would continue to oppose 
polio vaccines.9S
wkS. Jegede, 'What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Medicine 4, no. 3 
52007) : e73; http://www.ncbi.nlm.nih.eov/pmc/articles/PMC1831725/
1 A.S. Jegede, 'What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Medicine 4, no. 3 
2007) : e73- htto:/Asww.ncbi.nlm.nih.eov/omciarticles/PMC18317251 
A.S. Jegede, 'What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Medicine 4, no. 3 
ir)07) : e73- http://www.nebi.nlm.nih.aoviomc/arlicles/PMC1831725/ 
A.S. Jegede, "What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Medicine 4, no. 3 
(?007) : e73* htte:theww.ncbi.nlm.nilteovipmciarticles/PMC18317251 
Judith R. Kaufmann and Harley Feldbaum, "Diplomacy And The Polio Immunization Boycott In Northern 
Nigeria," Health Affairs, 28, no.4 (2009)1091-1101 
9s Judith R. Kaufmann and Harley Feldbaum, "Diplomacy And The Polio Immunization Boycott In Northern 
Nigeria," Health Affairs, 28, no.4 (2009):1091-1101 
33 
EFTA00615228

Gambari's trip to Kano proved more difficult, and highlighted the political aspect of the boycott. The 
governor of Kano was a member of General Buhari's party and had political incentives to oppose 
President Obasanjo.96
In tandem with Gambari's shuttle diplomacy in northern Nigeria, the DPEI Secretariat reached out to 
the Organization of the Islamic Conference (OIC) to "defuse the idea that GPEI and WHO were 
controlled by Western donors."" This engagement eventually led to the OIC passing a resolution 
urging the remaining polio-endemic OIC countries to accelerate their efforts to eradicate polio." At 
the same time, the U.S. began putting diplomatic pressure on Nigeria by raising the profile of polio in 
its bilateral discussions, and having its ambassadors reach out to their counterparts in other 
countries to do the same." 
By April 2004, the governor of Kano was the sole government official opposing immunization, and it 
is impossible to know what exactly led to his decision to finally end the boycott. There may have 
been an internal Nigerian deal, or it could be that the official boycott had outlived its political 
usefulness. Another possibility could be Kano's negative image worldwide. The WHO reported that 
80% of global cases of polio paralysis in the world originated from Kano, and several countries were 
considering placing travel restrictions on travelers from Kano, which would have precluded those 
from Kano from participating in the Hajj (pilgrimage to Mecca) in Saudi Arabia unless they were 
vaccinated at the airport.10D
The external diplomatic efforts eventually helped bolster efforts from within Nigeria. Within a year of 
the formal end to the boycott, many of the same religious and political leaders who had questioned 
the safety of the vaccine became vocal proponents of polio vaccination.101 In 2004, both the governor 
and emir of Kano participated in national immunization drives, with Governor Shekarau even 
allowing President Obasanjo to publicly administer the drops to his one-year-old daughter. In 2006, 
the newly appointed Sultan of Sokoto also became a champion of polio immunization, working to 
convince local and traditional leaders of the merits of the campaign.102
Lessons and Outcomes from the Boycott 
The vaccine boycott in northern Nigeria was the result of a complex nexus of factors, including a lack 
of trust in modern medicine, political and religious motives, strained north-south relations, a history 
of perceived betrayal by the federal government, the medical establishment and big business, and a 
conceivably genuine, even if misguided attempt by the local leaders to protect their people.103
One of the key lessons of the boycott is that while public health officials might normally view polio 
eradication as a "technical" problem to be solved by science, innovation and effective program 
"Judith R. Kaufmann and Harley Feldbaum, "Diplomacy And The Polio Immunization Boycott In Northern 
Nigeria," Health Affairs, 28, no.4 (2009):1091-1101 
91 Judith R. Kaufmann and Harley Feldbaum, "Diplomacy And The Polio Immunization Boycott In Northern 
""Resolution 
Health Affairs, 28, no.4 (2009):1091-1101 
N. 14131-S&T on Global Cooperation In Polio Eradication Programme Among OIC Member States" 
Organization of the Islamic Conference, 14-16 June 2004. 
http://www.polioeradication.orgicontanffpubliCati0nS/OIC resolution 0604.pdf 
"Judith R. Kaufmann and Harley Feldbaum, "Diplomacy And The Polio Immunization Boycott In Northern 
Itgeria," Health Affairs, 28, no.4(2009)1091-1101 
II"  Judith R. Kaufmann and Harley Feldbaum, "Diplomacy And The Polio Immunization Boycott In Northern 
Nigeria" Health Affairs, 28, no.4 (2009)1091-1101 
10 Jennifer G. Cooke and Farha Tahir, "Polio Eradication in Nigeria: The Race to Eradication," CSIS Global 
Health Policy Center, February 2012. 
roe Jennifer G. Cooke and Farha Tahir, "Polio Eradication in Nigeria: The Race to Eradication," CSIS Global 
Health Policy Center, February 2012. 
Jegede, 'What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Medicine 4, no. 3 
(2007) : e73- htto://www.ncbi.nlm.nih.goviamc/articles/PMC1831726/ 
34 
EFTA00615229

implementation, in Nigeria, polio eradication is a political endeavor. It is also affected by an 
increasingly unstable security situation in the north. 
An outgrowth of this lesson was the realization that because the issue of polio eradication in 
northern Nigeria is a political issue as much as it is scientific one, diplomacy needs to be an essential 
component of eradication efforts. 
Though the boycott began at the subnational level in Nigeria, it has global ramifications and set back 
eradication efforts in other countries. It took a network of international organizations and NGOs, 
pressure from diplomats, and the enlistment of groups like the OIC that are not normally considered 
within the purview of global health to solve the crisis. 
The global public health community has since done an admirable job of taking the spread of false 
information seriously, and understanding that these rumors are often grounded in assertions that 
are either partially true, or make sense within their own context. Public health officials have become 
much better at engaging communities and coming to grips with the socio-political nature of this 
campaign. They have thought outside the box, reaching out to religious organizations, women's 
organizations, even artists to develop campaigns. 
Overall, far greater care has been taken to understand and respond to the concerns of communities 
at the micro-level and to work with and through those interlocutors who are best positioned to reach 
and persuade potentially reluctant families to participate. Efforts have been linked to incentives for 
parents, including cash transfers, vitamin A provisions, de-worming tablets, antimalarial bed nets."4
National authorities have also reaffirmed their commitment to eradicating polio, offering vocal 
advocacy and pledging considerable federal funds to eradication efforts. In recent years, there has 
been an increased, if intermittent, state-level commitment from governors who have become more 
energized and supportive of the campaign. Some states have even introduced elements of coercion. 
In mid-2011, three states threatened to fine or imprison parents who refuse to vaccinate their 
children and to prosecute public health workers who fail to report refusals.m
roa IRIN News, "Nigeria: Vitamin A Handouts Boost Polio Eradication Efforts," June 14, 2010, 
http://wwwirinnews.orgireport.aspx?reportid.89470.
1°5 IRIN News, "Nigeria: Jail Threat for Polio Vaccination Refuseniks: August 11, 2011, 
htto://vm/wirinnews.ora/reoortasox?Reoortid=93480.
35 
EFTA00615230

Findings from the Field: Existing Barriers, Emerging 
Challenges 
The field interviews carried out for this paper suggest that while the public health community has 
made considerable strides since the 2003 boycott, several barriers to polio eradication persist and 
new challenges to polio eradication in northern Nigeria are emerging. 
Health Care Infrastructure 
Overall dissatisfaction with the healthcare system 
One key finding that was evident across all of the states in northern Nigeria is broad dissatisfaction 
with the healthcare system. Most of those interviewed maintained that access to healthcare facilities 
are in poor condition and not keeping pace with population growth. Several of those interviewed 
suggested that health-workers and doctors seemed more trained and qualified than in previous 
years, but still lacked the equipment and facilities necessary to carry out their work.106
Poor health care Infrastructure 
While many governments in West Africa are nominally decentralized, Nigeria's governance structures 
are highly decentralized in a way that makes politics, and therefore health service delivery, a multi-
layered process with a complicated and unclear division of responsibilities. Funding flows are unclear 
and unpredictable, while accountability is almost non-existent.307
Working in the health sector requires engaging the Federal Government, State Government and 
lower levels such as LGAs and wards. At every level, government officials are entirely capable of 
blocking programs that they either do not approve of or feel were not sufficiently channeled through 
them. A considerable amount of time and energy is spent working with local governments and 
keeping them sufficiently satisfied. lm 
Every layer of government represents a potential new blockage, as many office holders and 
administrators view it as a legitimate right to hold processes up for personal gain. Matters are further 
complicated by deeply entrenched party politics and patronage networks. The GPEI must operate 
within these systems where patronage and corruption are not only endemic, but systemic. They are 
present at every level vertically, and sprawl horizontally.109
Negative public opinion 
Public opinion about vaccinations leading to refusal 
Refusal of vaccinations, or "non-compliance," was also widely cited as a major roadblock to polio 
eradication. However, some of the motivation commonly attributed to why people refuse to 
vaccinate their children did not come up in the interviews. Rumors of pork being in the vaccine or 
that the CIA uses health workers as spies (as was the case in Pakistan in the hunt for Osama Bin 
Laden) were not mentioned. 
The most common reason provided for non-compliance were that they believed that the polio 
vaccine was a "Western" or "American" attempt to sterilize Muslim children, so as to diminish the 
Muslim population. 
"We are meant to understand that it can make girls barren. They said it can also be used to transmit 
deadly disease so that our populations can be reduced," said a 45-year-old businessman and father 
of eight from Katsina state.u°
f06 Interviews in northern Nigeria. January, 2014. 
f07 Interviews with health-sector NGO workers in Abuja. December 2013. 
f08 Interviews with health-sector NGO workers in Abuja. December 2013. 
I°9 Interviews with health-sector NGO workers in Abuja. December 2013. 
II° Interview in Katsina, northern Nigeria. January 2014. 
36 
EFTA00615231

A 55-year-old Islamic cleric in Bauchi state, for example, claimed that polio is a 'Western creations" 
and described the vaccine as "un-Islamic," but couched his opposition in slightly different terms, 
highlighting the aspect of foreign imposition. "Polio campaign will still be 100% unsuccessful in 
northern Nigeria until and unless the issue is done with sincerity and honesty. It is a plan to 
undermine Muslims and our own values," he said.m
Field interviews also suggested that opposition to polio vaccination does not necessarily go hand in 
hand with opposition to modern medicine. Another man from Kano, for example, said that he trusts 
health workers, but not if they are working with polio campaigns. He asserts that polio is a "jinn 
related disease" (brought on by spiritual entities) and that the government is only championing polio 
because it is "another way of siphoning funds by government from foreign bodies."He does not 
vaccinate his children because he does not believe in the same way that "the government and white-
man are thinking.412 
Another interviewee in Kano state, expressed similar beliefs. He trusts healthcare workers, but not 
when they come with polio vaccines. "I was of the opinion that it was a jinn-related health problem. 
But I am beginning to be confused with the aggressive government media campaign about it."1/3
Several interviewees suggested that those who oppose the vaccine don't necessarily believe that 
polio does not exist, but that it does not exist in the way that the government and health care 
providers believe it does. 
A 32-year old father of six from Tudun Fulani, Kano, stated his opposition in more concrete terms. 
"Polio campaigns," Mr. Musa said, "is only government that is trying to deceive public with its 
campaign against the disease." When asked why he does not vaccinate his children, Mr. Musa 
offered a straight forward response. "It is against my culture," he said.n4
Other respondents who oppose the vaccine cited the fact that they do not trust putting the well-
being of their children in the hands of vaccinators. "I will not accept anything (sic) polio from 
anybody. They are my children so nobody has authority over them above me," said a 45 year-old civil 
servant from Kano. 
Another interviewee from Eudun Wada, Gusau, Zamfara state, also said he was suspicious about 
vaccinators. "Most of the workers are not friendly and there is a shortage of drugs," he explained, 
saying that "no concrete convincing explanation" has been given about polio vaccines.us
Though field interviews suggested that polio vaccination campaigns have a unique stigma, it is not an 
anomaly. Access to healthcare and delivery of healthcare services is nowhere near adequate in 
northern Nigeria. It is important to remember that GPEI is trying to eradicate polio within a 
healthcare framework that is failing to deliver even the most basic services. Improving over-all 
quality and capacity is necessary. Polio is a much bigger healthcare problem. 
Overemphasis on polio vaccinations fuels conspiracy theories 
Another key finding of the field interviews is the role that an disproportionate focus on polio within 
the context of a failing public health system plays in reinforcing conspiracy theories. None of the 
people interviewed listed polio as their number one health priority or health concern. Instead, the 
majority of respondents listed malaria typhoid and water sanitation as their main preoccupations. 
In Interview in Bauchi, northern Nigeria, January, 2014. 
72 Interview in Kano. January, 2014. 
73 Interview in Kano. January, 2014. 
70 Interview in Kano. January, 2014. 
"5  Interview in Zamfara, northern Nigeria. January 2014. 
37 
EFTA00615232

Another interviewee who opposes polio vaccines, cited the government's obsession with polio as 
evidence of a probably ulterior motive. "We also hear that countries like USA give [the vaccines to] 
Nigeria free. Why not give us drugs on malaria which is very prevalent," he asked.16
This line of thinking also translates to non-compliance for political, rather than religious or cultural 
reasons. Marginalized communities, who feel left behind by the state, are experiencing "eradication 
fatigue," and the perceived obsession by outsiders with vaccinations has alienated some 
communities, who view vaccinations as the only thing they ever get from the their government. 
The narrative coming out of some of these communities is that they ask for wells, they get 
vaccinations. They ask for paved roads, they get vaccinations. They ask for cash transfers, they get 
vaccinations. To that end, non-compliance is often a political statement rather than an expression of 
culture or religion. It is an act of protest born out of the fact that for some of these communities, it is 
the only opportunity they get to interact with and express displeasure with their government.'" 
The risk of continued politicization of the issue is particularly acute in the run-up to and in the wake 
of elections. 
Negative public opinion about polio vaccinations has different reasons 
In 8 of the 10 states where fieldwork was carried out for this report, those who refuse to vaccinate 
their children were almost always described as rural, undereducated or illiterate who were simply 
misinformed or following the guidance of misguided Imams. But in Borno state, interviews suggested 
a different narrative. 
According to officials at the Emergency Operation Centre (otherwise known as Child Survival Centre) 
within the Metropolis of MMC and Jere, "the highest level of resistance being recorded is in elite 
communities like the University of Maiduguri and other tertiary institutions of learning." In these 
settings, "elites still propagate the so-called conspiracy theory within the university environment and 
or the academics there look down on the local immunizers as not capable, given their little 
educational background, to administer any form of vaccine in their wards."18
Throughout Borno state, a range of barriers to polio eradication were cited by interviewees. In the 
city of Maiduguri, as stated above, resistance appears to stem from elites in academia, who are 
suspicious of the polio campaign. 
118 Interview in Katsina, northern Nigeria. January 2014. 
117 Interview with diplomat in Abuja, December 2013. 
1111 Interview in Borno, January 2014. 
38 
EFTA00615233

1 CASE 
I 2 CASES 
> 3 CASES 
a BOKO HARAM 
w RELATED VIOLENCE 
Figure 6: Comparing the intersection of polio cases with Boko Haram related violence, 2012-1379
Ongoing security challenges also limit the mobility of vaccinators, as shown clearly in the diagram 
above. In Jere, non-compliance is more often attributed to beliefs that the vaccine is a form of birth 
control. In Bama, extreme insecurity and ongoing violence prevent immunization rounds from taking 
place, whereas in Damboa and Dikwa, insecurity remains a serious barrier, in tandem with high rates 
of refusal as a means of protesting over the basic lack of health and social amenities.12°
"They want to know why polio vaccine is being given free while they have to pay for drugs for 
malaria, typhoid, diabetics, diarrhea, cold etc," said one local journalist. "They would want to know 
why the government is paying so much, going into nooks and cranny to eradicate a disease that is, to 
them, not visible or verifiable or even very common when they have more pressing needs like 
potable water, roads, dispensaries, and schools which have not been provided by the 
government."121
Another interviewee described the motives behind non-compliance in much more blunt, political 
terms referring to the local government. "You don't patronize us when you share food items during 
Sallah or Christmas celebrations, except your party followers," he said. "Now because this is polio, 
which will not fill our stomachs, you come knocking and begging us to take it in order to please 
America.."12
In Yobe state, which has also been hit hard by the ongoing war between Boko Haram and state 
security services, resistance to polio vaccines is thought to be less pronounced than in Borno, with 
high areas of non-compliance concentrated by the frontier towns near the border with the Republic 
of Niger.m
Taken together, the interviews conducted across all ten states indicate that awareness campaigns, 
community outreach, enlistment of religious leaders and micro-plans have significantly reduced rates 
of non-compliance. Several people interviewed claimed that they once opposed vaccinated their 
children, but have since become advocates.120 This is undoubtedly good news. 
119 Figure 6 overlays GPEI data shown in figure 4, with security data found in figure 3. 
120 Interview in Borno, January 2014. 
121 Interview in Borno, January 2014. 
122 Interview in Borno, January 2014. 
123 Interviews in Yobe, January 2014. 
f24 Interviews across northern Nigeria, December 2013 andJanuary 2014. 
39 
EFTA00615234

But it is important to keep in mind that Boko Haram challenges the legitimacy of not only the state, 
but also the traditional religious hierarchy within northern Nigeria which they see as corrupted by 
the political system. Their ideology is inherently subversive, and could potentially make the 
enlistment of prominent leaders such as the Sultan of Sokoto or Emir of Kano less effective in the 
future 325 
Unstable political and security situation 
Elections in 2015 are anticipated to slow polio eradication efforts down 
Several interviewees, including health workers, local politicians, and diplomats cited "2015," when 
hotly contested Presidential as well as a host of other national and local elections are slated to take 
place, as a potential problem for polio eradication. There remains a serious risk that north-south and 
state-federal battles may play out again in the public health arena!" 
The Federal Government is on board with efforts to eradicate polio. In fact, it considers failures to 
eradicate polio an embarrassment. Political will at the level of local governments, however, remains 
a roadblock. With the February 2015 campaign just around the corner, eradication is likely to 
become a lower priority, with energy and resources diverted elsewhere. Disruptions in health-
services delivery due to post-election violence is considered all but inevitable.'" 
Security situation making regions inaccessible for vaccinations 
In Borno state and Yobe state, where the war against Boko Haram has rendered entire swaths of 
territory off limits, the challenge of eradicating polio is has an added security dimension.18 Almost 
everyone interviewed in Borno and Yobe state listed security as their primary concern for themselves 
and their families, and worried that the security situation is likely to continue deteriorating." 
As one journalist in Maiduguri, the capital of Borno state explained, "Borno state is presently the 
epicenter of the Boko Haram terrorism... There is high tension and insecurity challenges have 
hampered development especially in the above mentioned areas [Maiduguri, Jere, Bama, Damboa 
and Dikwa] where there is a high rate of resistance to polio vaccines. The economy of the state which 
revolves around subsistence agriculture, fishing and commerce, has been nearly crippled due to the 
insurgency. In terms of development, government has not done very well in providing amenities like 
water, electricity, healthcare facilities, job for the youths, good roads, education facilities and 
security."'" 
"The security issue is even more disturbing," he continued, "as the major security agencies like the 
policy and army lack manpower to cover remote areas of the state; this also gives enough ground for 
the Boko Haram insurgency to thrive."'31
Lack of information and feedback about the security situation 
Health workers have to rely on day to day assessments from the civilian Joint Task Force (JTF), an 
ostensible state sanctioned militia for up to date security information. Some donors and 
implementers are reluctant to integrate their work with vigilante groups, as it may increase the 
chances that health workers will be targeted.'" 
129 Jennifer G. Cooke and Farha Tahir, "Polio Eradication in Nigeria: The Race to Eradication,' CSIS Global 
Health Policy Center, February 2012. 
129 Interviews in Abuja, December 2013. Interviews in northern Nigeria, January 2014. 
127 Interviews in Abuja, December 2013. Interviews in northern Nigeria, January 2014. 
129 Interviews in Abuja, December 2013. Interviews in northern Nigeria, January 2014. 
129 Interviews in Borno, January 2013. Interviews in Yobe, January 2013. 
Is° Interview in Borno, January 2013. 
f3' Interview in Borno, January 2013. 
132 Interviews in Abuja, December 2013. Interviews in northern Nigeria, January 2014. 
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