The Current

Pakistan's fight against polio threatened by extremist violence, anti-vaccine sentiments

Polio has been eradicated in nearly every country in the world, but Pakistan is facing a surge in infections. Doctors and frontline workers are currently working to tame the surge, but their work has been complicated by conspiracy theories and fears of attacks.

10 confirmed cases of polio confirmed this year, leaving some children paralyzed

A health worker gives a polio vaccination to students in Peshawar, Pakistan, in 2019. (Muhammad Sajjad/Associated Press)

As frontline workers in Pakistan continue to treat those affected by a surge in polio cases, Dr. Shahzad Baig, who leads Pakistan's Polio Eradication Programme, said he and his colleagues are also dealing with death threats from religious extremists and people with anti-vaccine sentiments.

"Every team is escorted by security, by law enforcement agencies, either police [or] army," he told The Current guest host Duncan McCue.

"And I want to bring it on notice that, so far, the polio program has lost 50 lives in the line of duty" to extremist bombings and shootings, he said.

It's unfortunate news at a time when Pakistan needs all medical hands on deck. After 15 months without a single case of polio, the country has reported 10 new cases since April.

Baig said children make up the majority of the cases, and the affected children were reportedly partially or fully paralyzed.

An element of fear

Baig said there are a number of reasons why polio immunization numbers are low in North Waziristan District, where the majority of this year's polio cases were reported, and surrounding areas.

"This is an area where there were security challenges," he said. "There was an element of fear; threat[s] from the religious leaders not to vaccinate, threats from the violence."

Pakistani policemen stand guard as a health worker gives a child a polio vaccine in Karachi in 2014. (Fareed Khan / Associated Press)

Part of this fear stems from the conspiracy theories about vaccines, including that they are not safe. According to Baig, this fear is partly the fault of the CIA.

As part of extensive preparations for the raid that killed Osama bin Laden in May 2011, the American intelligence agency organized a fake vaccination program in the town the al-Qaeda leader was believed to have been hiding in, to try to obtain DNA from Bin Laden's family.

Baig said it had a wider negative impact on Pakistan's population.

"It is still in the mind of the people, and it is one of the reasons — although, the magnitude of this has decreased tremendously," he said.

As long as we have transmission anywhere, then we have [potential] risks everywhere.- Aidan O'Leary, director of the WHO Global Polio Eradication Initiative

There is also pressure from community members not to take the vaccine due to potential attacks from the Taliban and other religious extremists. In March, a female polio worker was killed by gunmen in northwestern Pakistan as she was returning home from work. 

Other attacks against frontline polio workers in the country include a roadside bombing that killed a policeman escorting health-care workers during an anti-polio vaccination campaign in 2020, and a 2016 suicide bombing near a polio vaccination centre in southwestern Pakistan that killed at least 15 people.

Pakistani children look at a damaged health centre torched by a mob following rumours of reactions by polio vaccination, on the outskirts of Peshawar, in 2019. (Abdul Majeed/AFP/Getty Images)

Baig said these legitimate threats of violence have scared some citizens and medical professionals into forging fake proof of vaccinations to dodge restrictions while avoiding threats of violence.

"These factors culminate into the community and vaccinators, conniving together, coming up with this solution so that the program is also satisfied, and on the other hand … the organization which is threatening, that is also satisfied," he said.

A lot of these children are also in the North Waziristan District, a former Taliban stronghold that borders Afghanistan where routine immunization is very low, according to Baig.

'Zero-dose children'

Pakistan is one of only two countries where polio is endemic, according to Aidan O'Leary, the director for the World Health Organization's Global Polio Eradication Initiative. But he warned that there's a real possibility of these cases spreading beyond Pakistan's borders.

"As long as we have transmission anywhere, then we have [potential] risks everywhere," he told McCue. 

This has already happened with some strains of the poliovirus. In February, a wild poliovirus made the leap from Pakistan to Malawi, where it paralyzed a 3-year-old girl.

It's the first wild polio case in Malawi since 1992, and the first case in Africa in half a decade.

O'Leary said the poliovirus still exists in other countries in forms other than the naturally-occurring wild polio variant, such as circulating vaccine-derived polioviruses.

"This is where we have a situation where [the] live elements of the virus circulate for very long, prolonged periods in populations that are either un-immunized or under-immunized and ultimately revert to a form that results in paralysis," he said.

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O'Leary said these cases are spreading in areas such as eastern Democratic Republic of Congo and northern Yemen.

"This is where we have very high concentrations of children who are un-immunized or under-immunized for a whole range of different factors, whether it's inaccessibility, whether it's insecurity, where it's very, very weak essential immunization systems," he said.

He added that once children in these areas have access to vaccination, "the outbreaks are very, very quickly stopped and curtailed."

Worker resilience

Getting to those children is easier said than done though, even in a country like Pakistan where the poliovirus may be highly localized.

"Every time when we talk about conducting a campaign in Pakistan, we are ultimately looking to reach more than 40 million children under five years of age across every single part of Pakistan. So it's not a small undertaking," O'Leary said.

Thanks to starting their vaccine campaign early, O'Leary explained, workers were able "to build momentum over time, which really started to deliver some of the really great results we saw in 2021 and which we're so anxious … [to] sustain through 2022 and beyond."

Baig couldn't be prouder of his team and co-workers helping make this progress, even in the face of threats of violence.

"This is the resilience of the polio workers and will to fight it, that in most of the cases — even in an area where there is a bomb blast or if there is a shooting or attack on our police personnel … the polio teams go back and start working," he said.

"So my salute to my frontline workers, that as far as the morale is concerned, they have never let the enemy succeed in achieving that goal."

Written by Mouhamad Rachini. Produced by Niza Lyapa Nondo.

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