Na Plos Medicine desse mês há um relato muito interessante sobre o boicote à vacinação contra a poliomielite em cinco estados da região norte da Nigéria. O tema é interessante para verificar que não bastam recursos financeiros, mas sim uma rede mínima - social, política, cultural - para permitir políticas de saúde pública.
Community Prevent Further Boycotts? The vaccine boycott in Nigeria was influenced by a complex interplay of factors. These factors included lack of trust in modern medicine, political and religious motives, a history of perceived betrayal by the federal government, the medical establishment, and big business, and a conceivably genuine—albeit misplaced and ineffective—attempt by the local leadership to protect its people. A recent editorial in The Lancet argued that “few data exist on the best way to stop the spread of false information” . One lesson from the Kano boycott is that research is needed to investigate why people have concerns and fears about vaccination, and what steps should be taken to avoid boycotts in the future. Other lessons are discussed below. Governments should be sensitive to local politics, especially as they affect health-care delivery Immunization campaign programs should be a participatory event involving state and local governments, community leaders, and parents. There are three types of community leaders in northern Nigeria—traditional rulers, political leaders, and religious leaders. Traditional rulers acquire their status through succession and their authority is rooted in traditions and customs [40–42]. Political leaders acquire their status through the political process and religious leaders do so on a religious basis. Among the three, the traditional ruler is best placed to represent the interests of children. Community leaders may contribute to the success or failure of health research and delivery . Public awareness campaigns about vaccination are crucial. These should stress the value of immunization and involve the media. Reaching the community requires radio, television, and folk media (such as local music, theatre, and festivals). Immunization messages can be packaged into songs by local musicians and can be communicated through drama in the language that local people understand. Research ethics committees should be established in each local government. These committees would examine and approve or reject health research in its sphere of influence. Members of these community-based ethics committees should include volunteers who are ready to undergo basic ethics training relevant to their duties. The committees should be under the supervision of, and funded by, the local government's councils, and the committees should work with local medical associations. They should choose their own chairperson and determine their own agenda in line with the national ethics code. Barriers to the formation of local ethics committees include inadequate capacity, funding, and communication.