The study was conducted in three militancy-hit districts of Khyber Pakhtunkhwa (KP) province of Pakistan in 2007. The province, along with Pakistan's Federally Administered Tribal Areas (FATA), eastern and southern Afghanistan and northern Nigeria are the remaining regions where the crippling disease still thrives.
The findings were published as the World Health Organisation (WHO) certified last month its South-east Asia region – which includes India but excludes Pakistan and Afghanistan – polio-free as India reported no new polio case since January 2011.
The study by a team of researchers from Japan and Pakistan, in a March 2014 issue of Vaccine, found that a major reason for resistance to the polio campaign was misconception that the vaccine contained either a birth control substance or pork whose consumption is forbidden by Islam.
Another hurdle was the tendency to view female health workers who travel to administer the polio drops as 'immoral' as they were not accompanied by husbands. Male vaccinators, on the other hand, cannot enter the female quarters of households.
The study showed that one-third of the 600 female vaccinators surveyed faced refusals and up to 6 per cent of 630 mothers said they refused to vaccinate their children.
It was found that the reasons for refusing OPV in northern Nigeria were similar to those in Pakistan. "OPV refusal is a typical example of friction between global public health objectives and local priorities/local value system,” say the authors.
The study is significant because it illustrates the problem faced by the Pakistan government in 2007 and 2008 when the Taliban militants opposed to the polio campaign, says Ghulam Sarwar, a polio officer in Swat, a district in the KP province.
“We could only vaccinate 200,000 children of the targeted 500,000 during that period,” Sarwar tells SciDev.Net. Since 2009, however, after the army action against the militants, the polio vaccination campaign could get back on tracks, Sarwar says.
Jan Baz Afridi, head of the expanded programme on immunisation in KP province, welcomes the study’s recommendation that local value systems should be taken into account to make the polio campaign socially acceptable.
“Recently, we have launched 'health for all' programmes, under which 700,000 get OPV on every Sunday. A single-day campaign is being run in Peshawar. After 12 rounds, the campaign will be extended to other districts,” he says.
The polio eradication initiative needs to be linked to a broader development. National and international Islamic authorities, not organisations based in developed countries, should play a larger role in the campaign, says Hitoshi Murakami, lead author, who is with Japan's bureau of international medical cooperation, National Center for Global Health and Medicine, Tokyo.
> Link to abstract of the Vaccine paper