Pakistan’s heroic polio workers undeterred by death threats

Pakistan polio vaccination - main
Polio immunisation in Pakistan. Copyright: Almeena Ahmed/Sanaullah Afridi/Sanofi Pasteur, CC BY-NC-ND 2.0. This image has been cropped.

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  • Polio workers in Pakistan face death threats with over 100 killed doing their job
  • Pakistan is now one of the last refuges of the wild polio virus
  • Religious leaders are being roped in to support vaccination drives

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Pakistan remains a refuge for the wild polio virus as deep distrust blocks efforts to stamp out the disease.

[ISLAMABAD] As a health worker administering polio vaccines in Pakistan since 2011, Sabina Gul is sure to have saved thousands of children from the crippling disease.  But her own life is under constant threat from militants and residents opposed to vaccination.
“Last year, when I knocked on the door of a resident of the Khyber Pakhtunkhwa (KP) province to administer polio drops to his children, he threatened to shoot me,” says Gul. Such threats are deadly serious and frequently carried out in KP. 

“Without urgent, fundamental changes, including tighter security measures for polio workers, strengthened surveillance and monitoring systems and proper management of cold chains, Pakistan will become the last country on earth to host polio”

Muhammad Atif Habib, Aga Khan University

At least 100 vaccinators have been shot dead by radical Islamists enforcing a ban on immunisations, which they ordered after US intelligence agencies allegedly used a fake vaccination drive to track down Al-Qaeda leader Osama Bin Laden to Abbottabad, Pakistan, where US forces killed him in 2011.
In the latest assault on vaccinators, gunmen shot dead a female health worker and injured another in March. They also shot dead, in a separate incident, two policemen assigned to protect vaccination teams, forcing authorities to temporarily suspend immunisations. 
Gul has a special reason to ignore the dire fundamentalist threats — her own daughter was crippled by polio because her father-in-law would not hear of vaccinations. “I don’t wish to see another child ending up with the same fate as my daughter,” she tells SciDev.Net.
The extreme hostility to vaccination has not been without consequences — Pakistan and adjoining Afghanistan are now the last refuges in the world of the wild polio virus.
Rana Safdar, a polio coordinator at the National Emergency Operations Centre, Islamabad, says immunisation services, especially in the KP province, continue to be low, with children not receiving the required number of doses to ensure replacement of the wild virus with the attenuated vaccine virus in the community.
“Low public trust in the government’s polio immunisation efforts is a grave challenge and we are actively engaging with parents, teachers, religious leaders and the media to support advocacy and awareness programmes to improve public trust to ensure that no child is left behind,” Safdar says.
Using vaccination teams as cover for security operations has shattered public trust in immunisation drives, says Sahibzada Muhammad Umar Khayyam, assistant professor of pharmacy at the Kohat University of Science and Technology and author of a study on challenges faced by polio workers and programmes.
Khayyam tells SciDev.Net that fundamentalist militants of the banned Tehreek-i-Taliban and other organisations have not only assaulted polio health workers but also spread rumours that immunisation using oral polio drops was part of a conspiracy to sterilise Muslim children.
Security guards assigned to protect vaccination teams have not deterred radicals. “Polio workers have continued to be killed or injured by those opposed to polio vaccination,” says Shehzad Afzal, national programme manager of the country's Expanded Programme on Immunisation.
Afzal recalls that the March attacks in KP — which resulted in the death of Nasreen Bibi, a 35-year-old polio worker, and serious injuries to her co-worker Rashida — took place, despite security support, forcing suspension of the nationwide polio campaign to protect some 270,000 polio field workers.
Extreme hostility towards vaccinations has so affected the country’s polio eradication programme that the disease remains endemic in Pakistan despite the more than 100 rounds of vaccinations since 1994. This year, 80 wild poliovirus cases have been reported from different parts of the country, with KP accounting for most of them.
“Without urgent, fundamental changes, including tighter security measures for polio workers, strengthened surveillance and monitoring systems and proper management of cold chains, Pakistan will become the last country on earth to host polio,” says Muhammad Atif Habib, assistant professor at the Aga Khan University’s paediatrics and child health department.
Tariq Iqbal Bhutta, a former advisor to WHO on polio eradication, feels that far from achieving eradication by 2020, Pakistan may even see the number of cases increasing. “Averting a surge would need immediate and prompt action with a focused strategy in the high-risk zones to fix public mistrust and ensure every child gets polio vaccination,” he says.

To transform the misconceptions or fears of parents regarding polio vaccination, religious scholars and prayer leaders have been roped in through a  Religious Leaders Initiative to build support for protecting children against polio through vaccination. 
“Since we have long realised that religious beliefs and political affiliations influence public opinion about polio vaccination, we engaged with religious leaders through advocacy and awareness and capacity building programmes,” says Zafar Mirza, the prime minister’s special assistant on health and head of the federal health ministry. 
“We have seen many of them joining our war against polio by reassuring everyone through all possible means, including Friday sermons, that no medical side-effects, social or religious harm can come from the life-saving vaccines,” Mirza says.
This piece was produced by SciDev.Net’s Asia & Pacific desk.