Sean Rehaag, York University, Canada

Shobana Shankar, Stony Brook University (The State University of New York)

To consider that Nigeria, infamous for anti-vaxx campaigns leading to polio outbreaks, has any lessons for Americans may be shocking.

But as measles cases in the U.S. climb to an all-time high after the disease was declared eliminated in 2000, U.S. public health officials have been looking for ways to address the problem.

As a researcher on religious politics and health, I believe that Nigeria’s highly mobilized efforts to eliminate polio can teach America how to reverse the increase in measles cases and shore up its public health infrastructure. Working with international partners, Nigerians have combated misinformation, suspicion of vaccine science and religion-based boycotts to go from ground zero for polio on the African continent in 2003 to nearly polio-free in 2019.

Comparing Nigeria and the US

When the Global Polio Eradication Initiative (GPEI) was established in 1988 with the goal of complete eradication by 2000, several countries could not meet the target.

India needed another 14 years, while Nigeria, Pakistan and Afghanistan faced stiff internal opposition to immunization. GPEI’s big 2003 push came shortly after Nigeria’s northern states implemented Sharia (Islamic law). Some clerics and political leaders encouraged boycotting immunization, citing contaminants that could reduce the Muslim population and mistrust of the government.

The U.S. is facing similar resistance now. Under scrutiny are anti-vaxx Orthodox and Hasidic Jews in New York City and Rockland County, but The New York Times has also uncovered resistance among Muslims, Catholics, Waldorf school parents and other cultural dissenters.

Anti-vaxxers in Clark County, Washington, are not religious opponents but rather Russian-speaking immigrants who, according to a report, harbor “mistrust of government that built up after being exposed to years of propaganda and oppression in the Soviet Union.” A doctor in their community blames tribalism for suspicion of “people coming from outside.”

Tackling tribalism

Nigerians understood that simply ostracizing religious communities would not work. Anti-vaxx politics tapped into mistrust of government and “others” that ran deep in a diverse but divided society, where religious, regional and ethnic loyalties took priority over national unity.

Nigerians know the ravages of tribalism better than most Americans. By conservative estimates, their nation is home to more than 250 ethnolinguistic groups. The civil war, lasting from 1966 to 1970 after anti-Igbo pogroms in the Hausa-majority north, was a terrifying manifestation of the hatred of difference and a total lack of faith in the government.

To foster reconciliation, Nigerians engaged in efforts to break down tribalism. One experiment, started in 1973 and still going, is compulsory service of college graduates in the National Youth Service Corps in “states other than their own and outside their cultural boundaries to learn the ways of life of other Nigerians.” Notwithstanding problems, the program has instilled in Nigerians a sense that education alone is not enough to build a healthy society. Sometimes it is the source of social separation.

Using this logic to combat polio, Nigerian public health officials took themselves to anti-vaxxers, leaving behind their offices in the city to visit villages with reported polio cases. Their mobility built the “polio infrastructure” that “intensified political and managerial support from all levels of the Nigerian government,” according to a Gates Foundation white paper that analyzed global polio eradication. Traditional leaders like the Sultan of Sokoto also invested time and energy into immunization campaigns and social engagement.

Intensive socialization across class, education and other divisions were as important as traditional public health measures such as scale-up of local technical capabilities and independent monitoring.

Nigerian physicians in the field

I accompanied a team to a village outside Kano city in 2011, after years of public health interventions had reduced reported cases of polio to 20 in all of Nigeria for a 13-month period. The doctor leading the team leader had met four chiefs regularly; the eldest was the most supportive, the youngest the least.

The doctor asked the young man to roll up his left sleeve and pointed to a round scar on his upper arm, remarking, “Your parents had you vaccinated against smallpox. This campaign, though for a different disease, is the same. What’s the problem?” The young chief shrugged, ashamed at direct confrontation and unwilling to insult his parents. They bantered for a bit before we left in the Ministry of Health truck, having accomplished seemingly nothing but a social visit.

“Some may never vaccinate,” the doctor told me, “but I feel better equipped than you or another stranger to talk to them about this issue.”

Between mass immunization campaigns, he visited the villagers. “I know them now, their excuses, habits. Some men say the women are unreasonable. Others don’t care. I know their different personalities. And they know I know them.”

The polio infrastructure in Nigeria immerses experts and local communities in an ongoing relationship. It is an elaborate multilayered surveillance system, with many strategies and functions, from mundane visits to weekly record reviews at health centers in polio-affected areas.

Good strategies matter more than good stories

The media in the West tend to talk about anti-vaxxers as weird and foreign, because they “make a good story,” writes researcher Amanda Vanderslott. She describes common hidden problems like vaccine delays and equipment shortage that sometimes prevent full immunization coverage, but these reasons are less sexy than anti-vaxxers, who are themselves a tribe sharing false beliefs peddled online by discredited doctors like Andrew Wakefield.

Criticism of parents not vaccinating their children may now be commingling with broader mistrust of, say, Facebook. Propaganda and tribal isolation have always existed but now are proliferating with social media that is, paradoxically, fostering anti-social tendencies.

Fearing negative attention would isolate anti-vaxxers and drive them underground, Nigeria fostered greater social engagement in the public health system. The nation’s polio infrastructure was tested in 2017 by new cases in the Lake Chad basin where Boko Haram’s violence reigned. Although international political observers feared the public health effects of Islamist-inspired terrorism, a common element in the remaining polio-affected countries, Nigeria’s disease surveillance capabilities held strong and surpassed those of Pakistan and Afghanistan in its polio surveillance capabilities in 2018.

One clear lesson for the U.S. from Nigeria’s experience with expanding vaccinations is that we should work to depoliticize public health. Scapegoating religious communities evokes ugly histories of anti-Semitism and Islamophobia.

Tribalism and insularity affect many communities, even the educated and political classes. Nigerians have rarely held back criticism of the elites who blame the masses for their own poverty and illnesses. Ordinary Nigerians, in turn, blame elite corruption for destroying the public sector including public health. Nigeria’s postwar efforts to reduce social stigma and scapegoating are unfinished business, but the polio eradication campaign is continuing the good fight.

Few American college grads will spend years immersed in a social experiment, but public health officials can prioritize resocialization around measles. For America to strengthen its measles infrastructure, trust to discuss and debate vaccine science needs to develop.

GPEI had to rejigger its own understanding of the interactions between monovalent oral polio vaccine and wild polio behavior. Like it or not, American public health officials must answer American advocacy groups like Informed Choice that highlight “the messy conundrum” of exposure to wild measles versus the existing measles-mumps-rubella vaccination strain. A disease infrastructure built on human capacity can handle disagreement.

It can also adapt. Nigeria spent over US$8 million on surveillance alone and expanded polio capabilities to fight other diseases like measles and rubella. While the system puts a heavy workload on health officials, it points the way for how the American public health system can reshape existing structures for the current era. America led international health partnerships for decades, but the time has come to follow other countries’ lead.

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Shobana Shankar, Associate Professor, History/Africana Studies, Stony Brook University (The State University of New York)

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A 68-year-old retired American teacher Kathy Coll has sued a Nigerian Catholic Priest, Fr. Cyprian Duru for alleged rape in 2016.

In the 13-count suit, Coll also sued the Catholic Diocese of Pittsburgh, Bishop David Zubik, and St. Teresa of Avila Roman Catholic Parish, her Ross Township church.

Coll was a retired high school English teacher and Eucharistic minister who sang in the choir, taught CCD classes and volunteered countless hours for her church.

She said her life changed for worse after the sexual assault by Father Duru, who was studying at Duquesne University and assisting her North Hills parish.

The widowed mother of two adult sons said she still has trouble processing how the Catholic Church responded two years ago when she reported she had been raped in 2016 by a Nigerian priest.

Kathy Coll: says no one listened to her in the Catholic Church making her resort to self -help

Her complaint, according to a report by triblive.com charges that the diocese failed to properly vet Duru before assigning him to a parish where she and others were asked to give support and assist to a predator priest from a region where clergy were known to prey on older women. She alleges that the assault occurred in December 2016. The suit was published by other Pittsburg media including CBS News and WTAE Pittsburgh.

“I spent 2 ½ years trying to get someone to listen to me,” Coll said. “No one was listening to me, so I decided it was time to say I want to make something happen here.”

She alleges that the church heard complaints from others about Duru’s inappropriate behavior toward older women, failed to act quickly, and later neglected to explain why Duru was removed from ministry after she reported her assault.

TV Screen grab of St Teresa of Avila Church: Kathy Coll’s church

Her complaint bears echoes of hundreds of allegations in last summer’s Pennsylvania grand jury report that detailed decades of church inaction against priests accused of child sexual abuse in Catholic dioceses across the state.

Coll’s suit details her account of how Duru — whom she agreed to tutor in English and occasionally transported to Pittsburgh — began taking frequent walks through her neighborhood that fall. On Dec. 11, 2016, Coll said Duru stopped by her home on the pretence of giving her a Christmas card. She said when she offered him a cold drink, he followed her to her family room, overpowered her and assaulted her as she screamed for him to stop.

Duru, who remains at Duquesne on a student visa, could not be reached for comment.

Coll’s lawyer, Pittsburgh attorney Sharon Smith, said the Allegheny County District Attorney’s Office declined to prosecute Duru.

Although Coll underwent a rape kit exam at UPMC Passavant hospital that showed evidence of intercourse, she said authorities said it would come down to a “he-said-she said” case with Duru claiming it was consensual.

A spokesman for Allegheny County District Attorney Stephen Zappala told the Trib prosecutors met with Ross Township Police, Coll and her attorney to go over the case.

“After reviewing the evidence and the investigation, we informed the victim and her attorney that based on the evidence as it exists, we cannot move forward with any charges,” said Zappala spokesman Mike Manko.

An award-winning teacher who once led active outdoor tours with her late husband, Ed, Coll said she’s reclaimed her life after months of therapy and prayer.

But she worries that a lack of diligence on the part of a church struggling to fill pulpits could expose others to danger.

“The crux of our complaint is the church’s failure to vet Duru,” said Smith. “He is a predator and shouldn’t have been here.”

A spokesman for the Pittsburgh Diocese insisted the church was never made aware of any other allegations against Duru and has been supportive of Coll.

“When the Diocese of Pittsburgh learned of the allegation against Cyprian Duru, he was immediately removed from the parish where he was in residence and his faculties were suspended,” said diocesan spokesman the Rev. Nicholas Vaskov. “He cannot function as a priest or dress in clerical attire. He is not in active ministry in the Diocese of Pittsburgh.”

He said the diocese also alerted Duru’s bishop in Nigeria of the allegations.

Duquesne University also was alerted to the allegations.

University President Kenneth Gormley said Duru is still a student at the university, but is not and has not been associated with Duquesne’s Spiritan fathers.

Gormley said he has no knowledge of Duru’s residence and declined to comment further, citing federal student privacy protections.

Vaskov said many priests from around the world have traveled to Pittsburgh to study at local universities and have taken up residence in local parishes.

Visiting priests are required to undergo FBI fingerprinting, a state criminal background check and child abuse clearance and must complete Protecting God’s Children and Mandated Reporter training and sign the diocesan Code of Pastoral Conduct, Vaskov said.

He said the Diocese also requires a reference from the sending bishop that the priest is in good standing and faces no allegations of inappropriate behavior.

“Fr. Cyprian Duru was one such student at Duquesne University,” Vaskov said. “He had residence in a parish where he would assist in the celebration of the sacraments. His bishop testified to the fact that he was in good standing as a priest before he took up residence.”

Thilina Bandara, University of Saskatchewan

Ontario recently announced that it will reduce funding towards public health agencies across the province to the tune of $200 million.

The Ford government also proposes to reduce the amount of public health units from 35 down to 10 over the next two years.

This has caused an uproar in the province, and generated anger from big-city mayors, concern from local health officials and expressions of public protest — due to the amount of funding being cut and the speed at which these cuts are occurring.

The cuts come as a surprise to many and will create a period of public vulnerability, as officials scramble to reorient around a new fiscal environment.

Read more: Explainer: How we all benefit from the public health system

This is an issue worth careful consideration. Not only is public health essential for a healthy state in general, but we are in a moment in time that requires especially strong public health infrastructure.

Public health averts large-scale disasters

As Toronto’s medical officer of health, Dr. Eileen de Villa explained to the Toronto Star, public health is invisible in its effectiveness. That is because public health personnel are in charge of large-scale issues like environmental hazard mitigation, disease prevention, food safety and health surveillance.

When these health issues are managed correctly, large-scale disasters are averted. Ironically, it’s exactly these merits that make public health a target for cuts.

David Hemenway, professor of health policy at the Harvard T.H. Chan School of Public Health, suggests that in the United States reductions in public health resources are not only dangerous to society, they are predictable due to the non-personalized, politically unpopular and long-term nature of up-front investment into public health interventions.

In the United Kingdom, public health budgets are also reportedly considered a “politically soft target,” especially after the 2008 global financial crisis.

Cuts to public health in Canada occur in an already resource-strapped environment. The Canadian Institute for Health Information reports that the public health system represented only 5.5 per cent of total health expenditures in 2017.

This is despite public health being arguably responsible for the largest contingent of patients in the health-care system: everybody.

Public health investment pays for itself

As microbes are becoming resistant to treatment, income inequality increases, the climate shifts, measles re-emerges around the world and substance abuse devastates a generation, public health officials need not only resources, but the confidence to mount meaningful long-term initiatives to protect the public.

And they don’t do it alone. Public health also serves as a connection point for other agencies who must work together to tackle these “wicked” problems.

Read more: Wicked problems and how to solve them

And while public health deals with the threats of today, this activity also reduces future burdens that the province will have to pay for in the form of overcrowded hospitals — an issue the Ford government is specifically looking to remedy.

A systematic review of the cost effectiveness of public health interventions suggests that cuts to public health activities for the sake of cost-saving represent a false economy. This is because public health interventions pay for themselves in future health-care costs at a staggering 14.3:1 ratio.

Findings like these reveal a deep and re-occurring misunderstanding of what constitutes value in health-care spending.

Rife with confusion and instability

It is difficult to articulate the level of discrepancy between the current Ontario administration’s priorities and best practice in public health.

Ceasing funding to some supervised injection sites while loosening public alcohol consumption restrictions is an exemplary case of such a paradox.

The most recent cuts continue this narrative of a new direction for public health infrastructure in Ontario, one that is rife with confusion, restructuring and instability.

A deficient, paranoid public health system may create short-term budget savings, but will create huge problems in the long term.

Thilina Bandara, PhD, Community and Population Health Sciences, University of Saskatchewan

This article is republished from The Conversation under a Creative Commons license. Read the original article.