The politics of the 1996 cerebrospinal meningitis epidemic in Nigeria

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Abstract
The 1996 cerebrospinal meningitis epidemic in Nigeria exemplified a medical situation that was linked with political concerns at the local, national, and international levels. It is argued that these political aspects must be understood, as they have implications for the treatment of future outbreaks. This article examines local attempts to stem the epidemic, on the basis of participant observation and epidemiological data collected from the north of Kaduna State. The epidemic is then considered in the national context: general deterioration of the health care system associated with economic decline, a national structural adjustment programme and crisis of political leadership. The local and national contexts of the 1996 epidemic are related to the view, held by many Nigerians, that reports of the epidemic's severity and the subsequent Saudi ban on Nigerians making the pilgrimage to Mecca reflected international politics, particularly the uneasy relations between the Nigerian, Saudi Arabian, and US governments, as well as health concerns. The article concludes with some recommendations for a national policy and for community health initiatives that take the politics and economics of cerebrospinal meningitis immunisation and treatment into account.