We wrote about this last week, and The New York Times reported yesterday that Saudi Arabia is going to ask every haj pilgrim to Mecca to take the oral polio vaccine in front of Saudi health officials. This is excellent public health news, but it also illustrates the ways that health and human rights come together in strange ways.

On one hand, Muslims have shown distrust for the polio vaccine, with devastating results. In 2004, officials in the Muslim Nigeria state of Kano refused to allow children to be vaccinated. They believed that the vaccine would make the children infertile and/or spread AIDS. This led to a polio outbreak that spread to 15 countries and put over ten million children at risk. For Saudi Arabia, home of the holiest Muslim sites, to require polio vaccine is a powerful message of support for the vaccine. In addition, the polio vaccine requires a certain percentage of people to be vaccinated before it works. About two million people make haj every year; getting them vaccinated has to help with "herd immunity."

On the other hand, those two million people come from a whole lot of different countries. They won’t make that much difference to their vaccination rates at home. And the oral polio vaccine has risks. It can cause outbreaks of vaccine-derived polio. There have been 383 cases of vaccine-derived polio in the last ten years. Vaccinating haj pilgrims reduces their risk of getting wild polio but exposes them to the entirely new risk of vaccine-derived polio. Since making haj is a religious requirement for devout Muslims, you could argue that requiring the vaccination and attendant risks is coercive.

The Saudi authorities have decided that the large symbolic value of vaccinating haj pilgrims for polio, and the lesser epidemiological value, outweigh the risk to individuals of vaccine derived polio. I think they’re right, and it certainly fits with Islamic values of community. But it wasn’t a choice without trade-offs.

(photo credit: Number-8)