Why have the majority of recent polio cases occurred in countries affected by Islamist militancy? A historical comparative analysis of the political determinants of polio in Nigeria, Somalia, Pakistan, Afghanistan and Syria.

This article aims to understand why the last few areas where polio remains are affected by armed conflicts involving militant organizations that use Islam to legitimize their activities. The first section critically analyses the argument that Muslims' animosity towards polio vaccination programmes is a consequence of their irrational, backward, anti-Western theology. This argument is depoliticizing, ahistorical and orientalist. Moreover, it does not explain why Islamist militant groups' attitudes to polio vaccination campaigns vary between countries. The second section analyses official documents, newspaper articles, interviews and historical and ethnographic accounts to understand the relationship between Islamist militant groups and polio in five countries - Nigeria, Somalia, Pakistan, Afghanistan and Syria - that account for 95% of the world's polio cases since 2012. I demonstrate that specific political grievances related to the postcolonial state and/or foreign military intervention help to explain variations in militant groups' attitudes to polio vaccination programmes. The paper concludes by considering the policy implications of the analysis. Improved access for polio vaccinators is not predicated on military victory against the militants but securing support of de facto political leaders. This can be achieved by developing a better understanding of the specific sociopolitical contexts in which immunization programmes operate.