• Host of challenges, from violence to use of inoculation campaigns as ‘bargaining tool’ and data forgery, mean virus remains endemic despite three decades of efforts
• Officials still unable to counter propaganda about the vaccine

PAKISTAN’S efforts to eradicate the poliovirus have always been beset with challenges. But over the past few years, issues have become compounded as attacks on vaccinators continue to rise and disillusioned masses use the vaccination drive as a “bargaining chip” to have their voices heard.

So far this year, Pakistan has reported 17 cases of the crippling disease. In the face of a resurging virus, the government intensified the vaccination drives, during which 17 health workers have been killed so far.

The eradication efforts are also marred by the forgery of vaccination data by vaccinators and officials to show inflated coverage to foreign agencies and donors.

Khyber Pakhtunkhwa and Balochistan are the two provinces that have reported the highest number of cases over the past three years.

In 2022, all of Pakistan’s 20 cases came from three KP districts. In the following year, four out of six cases were from the province. This year, 12 of 17 cases have been reported from Balochistan.

Vaccinators under fire

The law and order situation in the two provinces makes polio workers a frequent target for militants.

Since 2012, 126 persons have been killed and 201 injured in attacks targeting healthcare workers and officials of the polio programme. In one of the most high-profile attacks, Dr Abdul Rehman, a polio programme official, was killed in Bajaur earlier this year.

“In each [vaccination] drive, our colleagues die and get injured,” said Shehnaz Bibi, a lady health worker.

The modus operandi of militants is simple, Ms Bibi said, adding that in most cases two assailants on a motorbike attack vaccinators and flee the scene.

Ms Bibi, 24, tells Dawn that the frequency of attacks means that health workers are “always gripped by fear”.

“The attackers are never brought to justice,” she claimed.

These continuous attacks also lead to a surge in refusals because militants warn people against vaccination and therefore, they turn away the immunisation teams of fear, according to officials.

Mullah Fazlullah, the late leader of the outlawed Tehreek-i-Taliban Pakistan, was the first to use polio vaccination for his campaign against the government in Malakand.

At the height of militancy in KP and tribal areas in the early 2010s, he used to warn people through FM radio to not get their children vaccinated.

As a result, Swat recorded over a dozen cases in 2010.

Misconceptions and propaganda

There are a number of misconceptions surrounding the polio vaccines in Pakistan. It is one of the reasons for a vast number of parents refusing to get their children inoculated.

The polio eradication initiative started in Pakistan in 1994. Initially, the vaccines were perceived to be a “foreign plot” to reduce the population of Muslims.

In some cases, parents also refused vaccination, claiming that they weren’t allowed in Islam, said Muhammad Rafiq, who supervises polio vaccination teams in Dera Ismail Khan.

He said parents’ apprehensions surrounding the vaccines have largely remained unaddressed over the years.

“There are certain areas where people refuse the drops,” he said, adding that misgivings about foreign donors also contribute to this attitude.

Some parents now ask why the Bill and Melinda Gates Foundation — one of the biggest contributors to Pakistan’s polio programme — isn’t keen on vaccinating children in Palestine, as per Mr Rafiq.

He feared that this argument would only gain more currency in the near future.

The propaganda against polio vaccines has become more pronounced in recent years.

Senior health worker Mushtaq Ali says videos on social media are one of the biggest reasons for parents’ refusals.

These videos make unfounded claims about the alleged side effects of vaccines.

‘Bargaining chip’

Pakistan is one of only two countries, Afghanistan being the other, where the poliovirus is still endemic.

Since humans are the virus carriers, the situation in Pakistan also puts other countries — which have successfully eradicated the disease — at risk.

This results in pressure from foreign donors and the government to show progress.

Over time, the masses have become cognisant of these compulsions and have started using vaccination drives as a tool to get their civic and social issues resolved, according to Prof Muhammad Hussain.

“Recently, even police in Khyber, Bajaur, and Bannu and Lakki Marwat district boycotted polio duties to get their demands accepted,” said Prof Hussain, who is the president of Pakistan Paediatrics Association.

Mr Rafiq, the vaccination supervisor, also said that people in many areas demand authorities to address civic issues like the construction of roads and provision of water and electricity before allowing their children to be vaccinated.

A senior official of the KP health department has conceded that opposition to polio vaccination has become a complicated issue.

The Kukikhel tribesmen of Khyber tribal have long been demanding the repatriation of locals displaced during military operations in the past.

Last week, they announced a boycott of the polio vaccination campaign till their demands were met.

“These are totally political issues but have been linked with polio. Boycotting polio vaccination is a big issue due to which the virus remains in the province despite three decades of efforts,” the health department official told Dawn.

Administrative issues

Robina Shah, a female vaccinator from Peshawar, claims that around 20,000 vaccination refusals are reported during each drive.

To cover this gap, vaccinators mark the fingers of children without actually administering them the vaccine, according to reports.

This discrepancy has also been pointed out by officials familiar with the polio programme. They said vaccination coverage has remained between 95 and 99 per cent on average, yet the virus has been found in sewage samples collected from 18 KP districts, including Peshawar.

An official told Dawn that these administrative issues have been brought to the notice of KP Chief Secretary Nadeem Aslam Chaudhry.

Last week, he warned deputy commissioners, district police chiefs and health officers to ensure proper vaccination campaigns.

Even though KP has not reported any cases of poliovirus this year, Mr Chaudhry conceded that the positive environmental samples are a “ticking bomb”.

Published in Dawn, September 16th, 2024