Quack Science

Science and the giant rubber duck… He's watching..

Wheelchairs for Nigeria: The true cost of polio inaction

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“You stay here while we go into the bush and hunt for the food, we’ll come back for you when we find something”. In most cases they never came. If I insisted on going with them, it would take the whole day. So they would say, “Ready, one, two, three!” and then they would take off running. Sometimes I would just break down crying and have to crawl back home alone, very slowly and sadly.”

It is the 1980s. We are in a small village in a rural part of Nigeria, and this tale of disability is one of many like it. It belongs to a small boy, Ayuba Gufwan, suffering from the crippling effects of poliomyelitis; an acute paralysing disease that took the use of his legs. His nickname as a child was “Burki”, meaning to apply the brakes, and it was polio that put the brakes on his progress in life.  He eventually managed to get his first wheelchair at age 19. Before that he wasn’t even able to attend school. Thirty years later and Ayuba Gufwan is a grown man, but he still carries this story with him wherever he goes.

When I started writing about technological injustice, it was his story that came to my mind. I’m not going to argue that injustice has to be about some infrastructural project or a scientific marvel. It can come down to something as small and as simple as this: a polio vaccine.

It was just three decades ago that polio was one of the greatest blights of the developing world. With an estimated 600,000 cases per year and endemic in 100 countries, this disease was spreading through towns and villages, destroying lives. In agricultural areas of Africa, polio could devastate an individual’s ability to provide for their family and force them into vicious cycles of poverty almost impossible to escape from. With one paralytic case occurring every 3 minutes there seemed no way in which this cycle of disease and poverty could be broken.

Now the story has changed. As of 2012, polio remains endemic in just 3 countries; Nigeria, Afghanistan, and Pakistan, and with Nigeria being the only African country never to have stopped endemic polio transmission things have improved. In January 2011, wild type polio was eradicated from India and with annual reported cases fewer than 1000 globally there has been a more than 99% reduction in the world’s polio burden over the past thirty years.

How did we get to this point? This was possible thanks to what is perhaps the most organised and comprehensive international vaccination programme ever undertaken: the global polio eradication initiative (GPEI). Starting in 1988, their strategy of routine infant immunisation, supplementary vaccination, virus surveillance and simple door to door leg work has become one of the most effective public health stories in history. Yet polio is still with us, and the eradication campaign has run into difficulties. Social unrest and instability have caused new outbreaks in parts of Africa and the Middle East, and attempts at total eradication in the last decade have been unsuccessful.

Herein lies the problem; polio vaccination programmes are costly and developing nations are bearing  high costs, both financially and in human life. Politicians are reluctant to spend public money on polio vaccinations when there are often more immediate and pressing health issues at stake. Asking them to divert vital health resources to preventative vaccines is simply not sustainable.

This drain on healthcare also affects nations that have already eradicated polio, because the cost of sustaining vaccination of their population is enormous. National polio immunisation in the United States alone costs $280 million dollars annually (equal to about 76% of USAID contributions worldwide). This coupled with the losses due to  disability adjusted life years (DALYs) and the cost to developing nations becomes even greater. It has been estimated that global savings made through complete polio-eradication could be in excess of $128 Billion by 2050. These are savings made by developing nations around the globe, savings which could be channeled into malaria and AIDS campaigns and which could prevent Ayuba’s story from repeating itself.

However here the problem becomes twofold: international donations have waned due to recession; and wavering commitments are not only creating greater cumulative costs but also leaving areas susceptible to the return of polio. It is hiding in the shadows and without our full commitment there is no question it will return.

Something needs to change. We need improved international aid commitments to reinforce the campaign, and make sustainable provision for polio survivors and other diseases in these regions. We need high-level political commitment and community involvement in the decision-making process. We need a final push towards eradication.

Ayuba Gufwan the closest thing to a hero I have ever had. Despite his disability he managed to get an education and study law at the University of Jos. But one thought stuck in his mind; “what about the hundreds of other kids who have polio?” Recognising the joy he felt on his 19th birthday when he received his first wheelchair, he set about doing something to help the thousands of other polio survivors. He uses his talents to provide wheelchairs for polio survivors and through his charity ‘Wheelchairs for Nigeria’ he spreads the message of immunisation. His story of hardship became one of triumph.

Ayuba Gufwan

Ayuba Gufwan,
Photo: Maggie Fick

I highlight his story because it shows that even in the face of great suffering there can be a message of hope. To do with polio what we have done with smallpox, would be one of the greatest humanitarian efforts medicine has ever undertaken, and one that we should be proud to be part of. We owe it to each and every person to make sure that in our world, and in our lifetime, something this horrible can no longer exist. Only then can we say we are on the path toward technological justice.

*Quote from Ayuba Gufwan is paraphrased and was originally published at One.org

Image credit:  GPEI/ Scientific Declaration on Polio Eradication

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