Takashi Tamai

Promoting mass vaccination against certain infectious diseases is not easy for governments, despite clarity regarding the nature of the disease or innovative advancements in medical technology. In developing countries, where health systems are not well developed and the international community has invested much aid, complex political dynamics exist in the interaction between international organizations, governments, communities, and individuals, as several resources are mobilized to promote vaccination. Since the 1990s, particularly polio has been addressed by several international actors. Therefore, this study examines the political dynamics surrounding polio vaccination in Nigeria, the last polio-endemic country in Africa, which achieved eradication in 2020. It focuses on the reasons and mechanisms of Nigeria's polio eradication efforts that have had a major impact on both promoting vaccination, which was their original purpose, and expanding general healthcare services to improve the people's health problems in local communities. Global health governance involves two approaches to tackle infectious diseases and improve health systems: the vertical approach, which relies on top-down implementation of specific disease control measures according to manuals provided by the international community and governments; and the horizontal approach, which aims to solve people's health problems with the participation and cooperation of local communities. Thus, polio is considered a typical example of a vertical approach, where national governments implemented mass vaccination in a top-down manner. Despite this, it is noteworthy that polio eradication initiatives in Nigeria were based on a horizontal approach, considering the overall health environment of the local community and extending healthcare services to the population. Most studies have focused on the technical aspects of medical and public health policy. In countries without adequate modern Western means of population control, including Nigeria, the health infrastructure is inadequate and the number of children targeted for vaccination is inaccurate. Since the late 2000s, policies based on the horizontal approach have been implemented in Nigeria because they have empirically demonstrated to be the most effective means of developing statistical data on the target population and ensuring vaccination. In contrast, this study argues that vaccination efforts in Nigeria were implemented as a tool of colonial power, resulting in a strong distrust of modern medicine in local society and massive vaccine refusal. Further, the study argues that the measures to consider the healthcare environment in local communities were implemented to address the conflict caused by such vertical approach-based policies.