How false beliefs, terrorism have endangered lives of polio vaccinators in Pakistan

At least six police officers were killed and 27 others were injured in the Belot-Farsh Mamund neighbourhood of Bajaur district in the province of Khyber Pakhtunkhwa, about 10 miles from Pakistan’s border with Afghanistan, on January 8, when a roadside bomb exploded near the police van carrying them to provide security to polio vaccination workers. Pakistani Taliban militants claimed responsibility for the blast. The Tehrik-i-Taliban Pakistan (TTP), an umbrella group of militants known as the Pakistani Taliban, has in the past denounced the door-to-door vaccination campaign as a government conspiracy to spy on them. Motorbike-riding militants regularly open fire on polio vaccinators, but this attack is the bloodiest since the 2014 bomb blast that killed six polio guards and a bystander in Charsadda in KP. Unfortunately, Pakistan, and Afghanistan are the only remaining countries in the world where polio is still widespread. According to Global Polio Eradication Initiative: “Polio remains endemic in two countries Afghanistan and Pakistan. Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunisation services and travel or trade links to endemic countries.” A recent survey conducted by National Emergency Operations Centre (NEOC) regrettably, confirmed the presence of polio virus in sewage samples collected from 12 cities of Pakistan, including Sukkur, Rawalpindi, Lahore, Mardan, Peshawar, Bannu, Kambar, and Hyderabad. Pakistan is infected with wild poliovirus type I (WPV1), circulating vaccine-derived poliovirus type 1 (cVDPV1), or cVDPV3. The presence of viruses anywhere poses serious threats to the health of children and can place significant burdens on the health infrastructure and economy of the country. Throughout Pakistan, teams consisting of female health workers go door to door trying to make sure every child is safe from the polio virus. Generally, women are allocated such tasks due to the traditional culture of Pakistan, where unknown men are not invited inside the household. These women go out in their campaign with the awareness that they may not come back alive. Their task is dreary, because many in Pakistan have never been vaccinated against polio, the risks are higher even for those who had the drops. Therefore, every child needs to be immunised multiple times, till they turn five. Sadly, numerous polio workers and their guards have been killed by militants in Pakistan over anti-vaccine sentiment, which includes the belief that the vaccines contain pig fat. Moreover, hostility grew after the CIA staged a fake vaccination drive to help track down al-Qaeda founder Osama Bin Laden in Pakistan. Recent incidents of attack on polio vaccinators and their guards are as follows: On November 29, 2023: Mohammad Ashraf, a Frontier Reserve Police head constable, who was on way to the place of his deployment for polio duty, was killed when militants opened fire at him in Sabukhel locality of Bannu district of KP. On November 28, 2023: A policeman escorting a polio team was shot at and injured in an attack by unidentified militants in Bannu District of KP. The incident occurred near the basic health unit in Lalozai area in the limits of Basyakhel Police Station. On November 22, 2023: A polio worker, identified as Hassan Tawab, was shot dead by unidentified assailants in Miran Shah area of North Waziristan District of KP. Hassan was called out of this house by unidentified assailants and shot dead. On October 17, 2023: Four members of anti-polio eradication team were abducted from Umar Khan village in Tank District of KP. The team was conducting a quality assessment after the recently held polio campaign. On October 5, 2023: A female polio vaccinator associated with the Pakistan Polio Eradication Initiative was shot at when she was returning from her duty in Charsadda District in KP. There is an absence of awareness regarding the dangers of polio, and false religious beliefs are rather prevalent in the northern areas of Pakistan, particularly in places near the Pakistan-Afghan border. Most of the population is also not familiar with the consequences and transmission dynamics of polio virus. Recently, on November 29, 2023, the Utmanzai Jirga (an assembly of leaders that makes decisions by consensus according to Pashtunwali, the Pashtun social code) in North Waziristan District of KP declared a fine of PKR 500,000 on parents who allow anti-polio vaccination for their children. The Jirga spokesperson, Mufti Baitullah, announced a complete ban on the vaccination campaign, imposing heavy fines on violators. Adding to the gravity of the situation, the Jirga has closed the Bannu-Miranshah Road to all types of vehicular traffic, causing significant disruptions for commuters. Certain areas in Pakistan also lack effective water and sanitation infrastructure, subsequently becoming breeding ground for viruses. Furthermore, myths and conspiracy theories about the vaccine are widespread in few regions, leading people to believe that the polio vaccine is a Western intervention to sterilise the population or that taking the vaccine is haram, meaning it is forbidden for Muslims under the Islamic law. Therefore, these inputs often result in attacks on health care professionals and security forces accompanying the polio vaccination team, killing dozens of people in previous years and hampering eradication efforts. Established in 1994, Pakistan’s polio program demonstrated early accomplishment. From the year 2000, the eradication program was extended, counting an increase in personnel and the number of rounds, as well as the adoption of a door-to-door strategy. The national Polio eradication effort made major strides in reaching out to children with immunisation in all parts of the country as Polio cases reached a low of 28 in 2005 but the country has witnessed alarming increase in the number of Polio cases since 2009. Moreover, the health workers have been killed in target shoot-outs in various places of Pakistan, be it the urban metropolis of Karachi or in the interiors of tribal agencies of the north. In terms of attacks, Polio eradication efforts in Pakistan suffered a serious blow in 2012, when vaccination workers were targeted directly for the first time. The Pakistan Taliban in the same year issued a threat against people working in the polio vaccination campaign, calling it a Western conspiracy. The cases involving multiple shooters suggest that there is an organised attempt to target polio vaccinators by militant groups with the capability to direct such attacks. Apart from killing, several ways of violence meted against polio vaccination teams are targeted attack, threat, shooting, abduction, explosion, etc. Shooting is the most prominent method of attack, as explained, along with kidnapping and abuse (including torture and rape), attack with an axe, bombing of a polio-vaccination centre, roadside bomb explosion, and stone pelting. There are several reasons that make polio eradication from Pakistan difficult: Pakistan’s weak state administration and health system, mainly in the tribal areas; movement of refugees from Afghanistan and internally displaced people from the northern tribal areas; movement of seasonal workers across the country; prejudices and misconception among the population against the polio vaccine; anger towards polio vaccinators at family and community levels; and counterattack against the use of health campaigns by security and intelligence agencies. All these factors impend the efficacy of Pakistan’s polio eradication efforts, and the people managing it. Nevertheless, despite over 120 supplementary immunisation activities in the last decade, polio eradication efforts in Pakistan have been inept to attain their objective of halting polio transmission. Variable governance, and unpredictable leadership and accountability have also delayed the success of the polio program and the quality of the campaigns. Unfortunately, the vaccinators have become the sufferers in a long-drawn war between the militant groups and the state of Pakistan. Killing them creates chaos and tarnishes Pakistan’s international image and reputation. The militants and their fundamentalist cohorts often get success in de-stabilising the already disordered society of Pakistan. Under such conditions, until Pakistan wins its war against religious extremism, it is unlikely to win its war against poliomyelitis. The author is Research Fellow, Institute for Conflict Management, New Delhi. Views expressed in the above piece are personal and solely that of the author. They do not necessarily reflect Firstpost’s views.