Who can make polio history?

Gordon Brown's $4bn vaccination programme is being resisted in some parts of Africa.

As a child, I remember thinking there was something miraculous about the polio vaccination. Nobody enjoys injections, so it seemed particularly wonderful: place the sugar cube on your tongue, a quick suck, and hey presto, you're protected for the next ten years from a crippling disease.

At that stage I had no real idea what polio could actually do to the human body. When, visiting Africa for the first time, I saw beggars with stout upper bodies and legs like twigs pushing themselves around on wheeled pallets, the vaccination seemed all the more miraculous. They had never received the magic sugar cube.

That image returned last week when Gordon Brown formally launched $4bn in government-backed bonds to fund a ten-year immunisation programme for 500 million children. Presenting it as "probably the best Christmas present for every child in the world", the Chancellor said he was delivering on promises made to supporters of last year's "Make Poverty History" campaign. "We have it in our power, in this world, to prevent these diseases of polio, tuberculosis, of diphtheria, of tetanus. It is possible."

He was certainly correct in one regard. The bonds-for-vaccination project has the "Make Poverty History" brand plastered all over it. Which is to say that while worthy in intent, it comes across as lordly and top-down, treating African governance as of virtually no relevance in determining the continent's future. Once again, a piteous, passive continent will be saved by the generous, wealthy west.

So let me tell you a desperately sad story about sugar cubes, peasant fatalism and political cynicism which suggests that, au contraire, strong and inspired African leadership, rather than western patronage, holds the key to the continent's well-being.

Back in 1988, the World Health Organisation (WHO), Unicef, Rotary International and the Commonwealth Development Corporation, together with donor governments, launched a campaign to hunt the polio bacterium down to extinction. Infection rates stood at 350,000 new cases a year then, so the campaign would not be cheap. By 2003, that campaign was on the verge of success, with the number of countries where polio was endemic reduced from 125 to seven. WHO officials confidently expected to be able to announce polio's disappearance in 2005.

Then they hit an iceberg. Islamic clerics in Kano, a Muslim state in northern Nigeria, started counselling parents against the vaccination. Far from protecting their infants, it would render their children infertile, infect them with HIV, the elders said. WHO, the UN, the US - they made no distinction - the vaccinations were all part of an American plot to sterilise Muslim youth.

Local parents obeyed, even when exasperated health officials resorted to parading polio victims, withered limbs a-dangle, as a warning. Polio victims and blind men are a familiar fixture at crossroads in northern Nigeria, where giving alms is regarded as a social duty. "Allah knows better than all western powers combined," a theology student in Kano was quoted as saying. "He has guided the Muslim community since the time of old. This he did without immunisation."

Firm leadership was desperately needed, if not from the federal government in Abuja - always nervous of confronting Nigeria's volatile Muslim community - then from respected regional leaders. Instead, Kano's governor Ibrahim She karau supported the clerics, as did the emir, both men seizing an opportunity to demonstrate their clout to the government down south. By the time Shekarau had relented, ten months later, allowing a vaccine imported from Muslim Indonesia to be used, three other northern states had joined the boycott.

Nigeria, now the largest reservoir of polio in Africa, last year accounted for 70 per cent of the world's polio cases. But that is barely the issue. The states where local leaders played politics with their citizens' health have reinfected the world. Carried in the intestinal tract and saliva, the poliomyelitis bacterium spreads easily, particularly in the age of air travel. After the boycott, it skipped from Nigeria to Ivory Coast, from West Africa to Sudan, then across the Red Sea into Saudi Arabia and Yemen - polio-free for a decade - even jumping continents to surface in Indonesia. Since the 2003 boycott, about 25 countries previously declared polio-free have been reinfected. Numbers are low - last year saw only 1,973 new cases - but experts at a WHO meeting last month warned they could rise to 250,000 a year if eradication is not completed.

One must assume that the memory of this sorry tale lies behind Gordon Brown's decision to get the entire faith community to endorse the vaccination programme, with Christian, Muslim, Jewish and Hindu leaders all signing up for the bonds. That was canny. But it is a shame the Chancellor didn't spend as much time highlighting the key role that African governments and regional leaders must play for the scheme to work as he did congratulating himself for his financial ingenuity.

Afflicted by a strange form of megalomanic magnanimity, the west continues to assume it can deliver peace, prosperity - and now good health - to Africa pretty much irrespective of African participation. How much the western public is ready to give, rather than how Africans govern, is the only issue ever deemed worth fretting over. The polio story shows just how bizarrely misguided that assumption is.

This article first appeared in the 20 November 2006 issue of the New Statesman, Missing presumed tortured