Pakistan is one of two countries in the world where polio remains endemic, the other being its neighbor Afghanistan.
Last year, Somalia became polio-free, and the World Health Organization (WHO) removed Nigeria from the polio-endemic list, thanks to government-led efforts in those countries to launch cross-nation immunization campaigns against the disease.
Pakistan, however, faces several challenges that have impeded the government’s plans to eradicate polio. Sceptics have claimed that such a drive is another CIA plot. They base their claims on an admission by the U.S. intelligence agency that it used the Hepatitis B vaccination program in 2010 to track down Osama bin Laden.
As such, opponents of an immunization campaign have actively spread rumors across Pakistani communities claiming the vaccine will make their girls infertile.
Furthermore, the Pakistani Taliban have said that they can only be fully supportive of vaccinations once the U.S. ceases its drone strikes in Pakistan.
Polio, a devastating disease that affects children, leads to deformed limbs, paralysis and, in extreme cases, death. The virus thrives as a result of the country’s low immunity levels as well as poor hygiene and sanitation conditions.
Among the most affected areas are Khyber Pakhtunkhwa (KPK), Baluchistan and Karachi, mostly due to inaccessibility of religious conservatism and the sheer number of children.
Vaccination campaigns are launched regularly across Pakistan, but are constantly marred by violence.
In January, a Taliban suicide bomber attacked a heavily guarded polio eradication center, in Baluchistan’s capital Quetta, killing 15 people most of whom were security personnel.
In February 2015, a vaccination team was attacked in the northwest of the country, and four workers in Baluchistan were also kidnapped and killed. In 2014, more than 80 people were killed in polio-related attacks—higher than the number of deaths caused by the disease itself.
It’s difficult not to wonder just how welcoming religious communities are of the campaign. There are many conservative pockets where religion and a tribal culture dominate public opinion, particularly in KPK and Quetta.
“This is largely to do with a sense of alienation from the central government, and the lack of support [for immunization] from religious groups is often politically motivated. The vast majority of scholars are very supportive,” said Sona Bari, a spokesperson for the Global Polio Eradication Initiative at WHO.
A pro-immunization network of Religious Support Persons (RSPs) was set up, creating a sense of trust and understanding in conservative areas. Religious scholars and imams are mobilized before, during and after the campaigns to help change misconceptions and reassure people that vaccination is not against Islam. The question now is: Has polio become a Muslim problem in Pakistan? In 2012, the Taliban issued fatwas that prohibited polio vaccinations, causing a major setback after years of steady progress.
Polio is not an international Muslim problem, but the failure to eradicate the disease in Pakistan comes down to, in many cases, religious belief and a lack of education, or an attitude that “the Quran forbids x, doesn’t mention y and if z happens it is all part of God’s plan.”
But this has not, and cannot, deter those working to eradicate the disease.
Instead, security has been ramped up and extra precautions are taken at all times. The continuous work of the government-led End Polio Pakistan initiative, supported by WHO, UNICEF, the Center for Disease Control and Prevention (CDC) and Bill and Melinda Gates, is crucial to ensure the eradication of the virus, but carries a great risk.
“Pakistan has experienced frequent attacks against the polio teams in previous years. In 2015, better security was provided to the teams, and in some areas the army has been involved,” said Mazhar Nisar, director for communications at the Pakistan Polio Program.
“The major problems we’ve had in the past have been security and access, which have been met with better governance.”
Bari added, “It’s a dangerous job and we have to take several precautions… In some areas we don’t carry out visible campaigns but instead enlist members of the local community for help, which creates a greater level of trust and understanding.”
A vaccination team that hails from the same community is more likely to be accepted and be heard.
The first exchange with a family is the most crucial; it is when the team has a narrow window of opportunity to establish trust and gain permission to immunize the children—just a few drops on the tongue to be administered on at least five separate occasions.
If the initial interaction is hostile or negative, the team then does not stand a chance.
Outright refusal of vaccination currently stands at 0.08 percent of the target population. The majority of refusals are now down to families either objecting to multiple doses, or telling the vaccinator the children are not home in order to avoid it.
“Some people think if their child has received one vaccination, they don’t need another. They don’t realize their child needs to receive the vaccine regularly” until he or she is five years old, said Nisar.
“Now, the vaccinator tells the family at the first meeting they will be returning, and their children must receive it every time. It’s only to boost the child’s immunity and each dose fortifies the child’s defences against the disease,” she added.
Although the vaccination refusal rate is less than 1 percent, it is still high enough to keep the virus alive and to create a greater challenge to reach Pakistan’s 36 million children under the age of five.
Last year alone, 55 new cases were reported in the country and there is still a long road ahead. However, a drop from 306 cases in 2014 bodes well for the campaign.
“The current vaccination rate in Pakistan is the highest it’s ever been,” said Bari. “It is logistically very difficult but it’s essential we reach every last child.”