Democracy in Nigeria: the challenge of infectious disease control

The relationship between democracy and health outcomes has been the focus of recent research interest [1,2]. With an estimated 140 million people, Nigeria is the most populous country in Africa. In May 2007, it marked eight years of unbroken civilian government, the longest period of civilian rule in its post-independence history with the noticeably peaceful handover of power from President Obasanjo to President Yar’adua. These eight years of relative peace and democratic governance in Nigeria have seen changes in the economy with steady growth, a large reduction in external debt, and structural reforms of the financial and telecommunications sectors. These changes, however, have had little impact on the lives of ordinary Nigerians [3]. In the health sector, progress has been slow and many challenges remain: from weak health systems to tackling HIV/AIDS; from improving immunization coverage (which in the past has impeded the global goal of eradicating polio) to implementing the new International Health Regulations (IHR); from achieving the Millennium Developmental Goals (MDGs) to preparing for pandemic flu. We examine the progress made and challenges faced from an infectious diseases perspective in Nigeria over the past eight years.In northern Nigeria in 2003, concerns about vaccine safety, i.e. rumours that the polio vaccine caused sterility, led to a halt in polio immunization. This led to the resurgence of the disease in Nigeria, and the re-infection of several neighbouring countries, setting back the entire global eradication programme [4]. While the last two years have witnessed a renewed response with reinvigorated vaccination campaigns, the disease has persisted and Nigeria remains one of four countries in which the circulation of the wild poliovirus has never been interrupted, recording the highest number of confirmed polio cases in 2006 and 2007 [5]. Routine immunisations for other vaccine preventable diseases remain below 50% (most recent data 2005) [6]. Outbreaks of measles, for which a cheap, safe and easily administered vaccine has been available for two decades, continue to occur with unacceptable mortality rates [7].In February 2006, the first case of highly pathogenic H5N1 avian influenza in domestic birds in Africa was reported from a poultry farm in Nigeria [8]. The case took 5 weeks to be confirmed. Health officials were quickly overwhelmed by the challenge of culling thousands of chickens, responding too late and with too little as the disease spread. Each week brought new anxiety and weird responses [9]. The response to this outbreak