BATAKAYE, Nigeria -- In this village of 3,000 people, 12 cars, one college graduate, and no telephones, the final push to erase polio from the earth hit a dead end.
The poliomyelitis virus zigzagged down one alley to the next several months ago, almost surely carried along in a fetid ribbon of water polluted with human waste. Children drank from it, splashed in it, rubbed their dirty hands in it, and that was the virus's opportunity. It infected four of the village's youngest residents, who lost the use of one or two limbs.
The virus thrived here in part because of the usual obstacles to better health care: internal political struggles, misspent money, alleged corruption. But an unusual additional factor came into play in the hamlets along the fault line between Christians and Muslims in West Africa: Local Muslim clerics told villagers to reject the polio vaccine because it was part of an American plot.
Muslim leaders in hundreds of northern Nigerian communities such as Batakaye limited or halted door-to-door polio immunization last year. They told millions of faithful in this Muslim-dominated region that the American government had tainted the vaccine with either infertility drugs or HIV, the virus that causes AIDS -- statements later proved false by independent laboratory tests.
Some leaders admitted in interviews late last year that they never believed such a thing. But they remained silent, they said, in order to stop anything associated with the United States. The US-led wars in Iraq and Afghanistan, several said, had led them to believe that America wants to control the Islamic world, and the polio vaccination effort gave them an opportunity to resist a US-funded initiative.
They vowed to preach against polio vaccinations as long as the United States pays for them, even though it puts their own children at risk.
"People believe that America hates Muslims, and so whatever comes from the United States, no matter how good it is, people will reject it," said Sheik Muhammed Nasir Muhammed, the chief imam at the second largest mosque in Kano, the Muslim political center in northern Nigeria.
The global fight to eradicate polio has been defined by the World Health Organization as one of its two greatest public health challenges, the other being the AIDS epidemic.
"We are on the verge [of] removing polio from the face of the earth. We are on the last mile," said Dr. Lola Mabogunje, a pediatrician who is leading Kano's polio eradication team.
But the polio battle, down to its last 667 cases worldwide, faces its most difficult task since the campaign to eradicate it started in 1988 -- when the virus was transmitted in 125 countries and infected 370,000 children. Nearly half of the remaining cases are in Nigeria and neighboring Niger.
This week, the World Health Organization will convene a meeting of health ministers and local officials from the last six countries where polio is still transmitted -- Nigeria, Niger, India, Afghanistan, Pakistan, and Egypt. The goal of the meeting in Geneva is to win a commitment to end transmission of the virus by the end of 2004.
"The last places are going to be the toughest," said Bruce Aylward, who leads WHO's polio fight. "But we have a very strong motivation: This is an opportunity to get something finished. The international health community made a promise a long time ago, and we aim to keep it."
The partnership involves a variety of powerful players, ranging from the US and European governments to Rotary International to UN organizations such as UNICEF and WHO. They hope to make polio the second disease afflicting humans ever eradicated; the first was smallpox.
But privately, many leading the polio effort worry that they won't stop transmission by the end of this year, and that could spell deeper trouble ahead. Funding has been cut in recent years, which was a factor in the cancellation of door-to-door immunization efforts in about 100 countries last year. Millions of children didn't receive the vaccine and are unprotected if the virus spreads more widely.
Secondly, groups know that the longer they hold such intensive immunization efforts in a country, the more difficult they become. Organizers tire of huge efforts needed to reach every child under age 5. Residents become suspicious about why international groups care so much about a disease that seems barely to affect them, while killer diseases, such as measles and malaria, receive far less attention.
In northern Nigeria's Kano state, organizers have held 20 polio immunization rounds in the past five years. Before last year, the rounds reached well below 80 percent of the children, the minimum needed to stop the virus from spreading. Last year, the efforts fell apart, largely because of the politically driven doubts about the vaccine's safety. The virus not only infected dozens of children here, but also spread into southern Nigeria, as well as Ghana, Burkina Faso, Chad, Togo, Benin, and Cameroon.
Leaders in northern Nigeria have seen their political influence wane during the nearly five years of rule by President Olusegun Obasanjo, a Christian from the south, and officials in his administration say the north is using the embarrassment over the polio campaign for political gain.
Handling the funds has been problematic. The European Commission decided last fall to give 12.9 million euros (roughly $14 million) through a third party, WHO, instead of to the Nigerian government because of questions on how its money was spent earlier. The decision delayed the release of the money, halting immunization rounds last fall.
Asked about the European decision, Dr. Dere Awosika, head of Nigeria's immunization program, angrily denied any financial impropriety. During the interview, a representative of the European Union, Gerald Moore, was sitting in the room. Moore confirmed the EU is giving money for polio immunizations, but acknowledged that he knew of no other cases where the EU used a third-party channel because of concerns over spending. Hearing this, Awosika buried her head in her hands.
Suspicions about US
On top of those problems come the feelings of anti-Americanism. Mabogunje, the Kano state polio team leader, has met with several Muslim clerics seeking their help.
"What most of them are worried about now is this gulf between the Americans and the Islamic world," she said. "To them, almost all the difficulties are caused by some Americans. It's the only language people seem to know."
But she said she would try to challenge the anti-American feelings. "Let's agree, for instance, that the Americans are waging a new war against fertility. Do they ask children, `Which of you are Muslim, and which are you are Christian?' No, they don't. Then how can you say this is aimed against Muslims?"
Aylward, the head of polio efforts at WHO, said the vaccine itself is not made or manufactured by a US company. Most of the batches, produced by French pharmaceutical company Aventis Pasteur, are produced in Europe, he said.
The US Centers for Disease Control and the Agency for International Development are major funders of the global eradication effort, giving $120 million in 2003; in Nigeria, the two agencies gave about $7 million.
Some Muslim leaders said that the US funding makes them suspicious, and a minority still believe the vaccine is unsafe.
Datti Ahmed, a Muslim physician who is president of Nigeria's Supreme Council for Sharia Law, said in an interview in his courtyard in Kano that he doubts the validity of independent tests on the vaccine, which were examined by WHO, a university lab in Lagos, and by a Muslim pathologist, Abdulmumini Hassan Rafindadi, in three laboratories in northern Nigeria.
"A lot of money is being spent by interested parties to make sure they got the results they want," he said.
He also believed a US motivation existed to promote infertility drugs. "Just look at the Internet," Ahmed said. "There's strong proof that the US government, dating back to 35 years ago, with Kissinger and Nixon, believed that population is the most important factor for US hegemony in the world. Since they cannot rapidly increase the US population, the only way for them to dominate is to depopulate the Third World. This is the motive, as far as we are concerned."
Asked Sheik Muhammed, the chief imam at Waje Central Mosque: "How do you deal with an enemy? Muslims, we hate America. Everything is aggravated now. How can we trust this nation, especially when it helps buy the polio vaccine and then puts drops of the vaccine into our children's mouths?"
'An act of God'
In the village of Batakaye, about 10 miles south of Kano, parents, all Muslims, said they would welcome those drops.
Mallam Ibrahim Wada, 52, the community leader, said that because of the crippling of four children -- three of whom were just a year old when they were infected last May -- everyone realizes the vaccine's value.
Wada said opinions on the United States are divided. He said many people are angry about the wars in Iraq and Afghanistan, but nearly everyone in his small village also is aware of the US record of giving aid to poor countries.
Standing next to him was Abdul Kareem Sha'aibu, 38, a farmer, who held in his arms his son, Kamzullahi, nearly 2. Kamzullahi's left leg and right arm became partly paralyzed from polio in May.
The father has devoted himself to the son's care, taking him every week for physical therapy in a hospital about five miles away.
"What happened was an act of God," Sha'aibu said, as a crowd of more than 50 villagers gathered around the door of his mud hut. "When they come around with the vaccine again, all of our children will take it. They see Kamzullahi, and the other three children. But I haven't given up on my child. I am optimist he will walk again, God willing."
He smiled broadly. "I am optimistic that my son will be someone important, the leader of this village someday, polio or no polio," he said.
The father, still smiling, lowered his son to the ground. The boy's legs buckled, and his body sank to the ground, where he sat silently at his father's feet.
John Donnelly can be reached at firstname.lastname@example.org.