The physician from the Pakistani Health Ministry acknowledges that he expected some of the country’s rural areas to be risky. Still, he had no idea how dangerous the cities would be. This week began with six polio-vaccination workers—five women and a man—being shot dead in four separate attacks in Karachi and Peshawar. On Wednesday a seventh polio worker was shot and seriously injured in Peshawar. “We were worried in the countryside and tribal areas,” says Dr. Jamshid, who for the sake of his own safety declines to use his full name. “This means even in the cities we will have trouble.”
The nationwide eradication drive, which had been in the second of three scheduled days, was quickly suspended in Karachi. “Police were on alert,” says Shahnaz Wazir Ali, the Pakistani prime minister’s chief adviser for the immunization effort, “but the polio teams are in the thousands. It would not be possible to keep police with each team. Tomorrow was to be the last day of the campaign, but we have suspended it in Karachi for the moment to protect our staff’s lives. We must secure the health of the future.”
But in authorities in Peshawar vowed to carry despite the threat, declaring that the eradication campaign is too important to stop. Pakistan is one of only three countries in the world where the crippling and possibly fatal poliomyelitis virus remains endemic (Afghanistan and Nigeria are the other two). The waterborne disease infects only humans, and for more than a decade the World Health Organization has been vowing to wipe it out globally.
Nevertheless, Pakistan’s eradication effort keeps encountering obstacles—sometimes in the form of superstitious fears and wild rumors and other times in the form of undisguised politics. Last summer a Pakistani Taliban leader in North Waziristan issued a decree forbidding any further vaccinations in his area until America ended its drone attacks against militants. Soon afterward gunmen in Karachi wounded a Ghanaian doctor for the World Health Organization and his driver.
The opposition is just as vicious in Afghanistan, where the insurgency prevents antipolio teams from visiting many areas. Early this month in Kapisa province, unidentified gunmen pumped six bullets into the stomach of a teenage immunization-program volunteer, killing her. A Taliban spokesman denied responsibility.
The biggest setback to date may have come with Pakistan’s arrest of Dr. Shakil Afridi. The Pakistani physician, an active participant in the country’s polio-eradication campaign, was revealed to have set up a minuscule vaccination drive against hepatitis in early 2011, in collaboration with America’s efforts to track down Osama bin Laden.
“The antipolio campaign was already controversial in some parts of Afghanistan and Pakistan, but Dr. Afridi’s involvement in bin Laden’s death brought even more trouble,” says Dr. Jamshid. Polio teams became unwelcome even in areas where the Pakistani Taliban had previously allowed them to work, he says, and inhabitants were warned not to let their children take the oral drops.
Now the outlook is still grimmer. “What happened today in Karachi and Peshawar is long-term bad news for the campaign against polio in Pakistan,” says Jamshid. “In many areas our volunteers are unwilling to work anymore. They have been warned by hard-line mullahs and the Taliban not to participate in antipolio programs. We were in the final stages of the effort to free Pakistan’s children from the virus. Now it’s looking like we will fail.”
Shazia Khan, a health worker in the northwestern Pakistan city of Mardan, has devoted the past five years to the campaign to eradicate polio. “As soon as my brother heard about the polio workers being killed, I had to stop,” she says. “I came back home, and I doubt that my mother and my brother will ever let me go back to distributing drops to the children in the street.”
It was never an easy job, she says: “Some parents slammed their doors in our faces rather than let us give the vaccine to their children. But attacking and killing female health workers is an assault against every child in Pakistan.”
The eradication campaign has inspired all sorts of paranoid theories, especially among less-educated Pakistanis. Khan says some people are convinced that the vaccine was created by non-Muslims to somehow weaken the physical strength and Islamic faith of Pakistan’s children, making them like kids in the West.
Others claim it’s all a plot by the World Health Organization to sterilize Muslim girls. “They think it’s an anti-Muslim conspiracy to reduce their birth rates and prevent girls from getting pregnant after they grow up and get married,” says Khan. “We were constantly going to homes where all the girls had disappeared.”
And that was before bin Laden’s death. Things got really difficult afterward, Khan says. “People began saying strange things to us. Last when I knocked at one man’s door he actually asked me: ‘Under cover of polio, are you looking for al Qaeda in my home?”
Azhar ul-Haq is fairly typical of parents in Pakistan who refuse to let their kids be immunized. The 50-year-old father of eight brags that he has never allowed his children to ingest what he calls the “non-halal” drops of oral vaccine—“And my kids are much stronger than the others,” he says. “I and my father and my grandfather grew up without polio vaccinations and the rest. Allah will make sure my kids grow up the same way.”
It’s entirely possible that his children won’t become seriously ill. Polio is a stealthy infection, often producing no symptoms or perhaps a slight fever and a sore throat. But its victims can pass the contagion to others around them, and some of those who contract the disease will suffer paralysis or death. Immunization doesn’t protect only the individual who takes the drops. It helps to protect the entire community.
Haq also blames the vaccine for bin Laden’s death, even though the immunization ruse at the Abbottabad compound had nothing to do with polio. “These dirty drops took the life of Osama bin Laden,” he declares. “We should not let anyone knock on our doors wanting to give polio vaccinations to our children.” I mention that the Pakistani government is threatening to fine or imprison parents who refuse to let their children be immunized against polio. “These are my kids,” he says. “I feed them by the labor of my own hands. The government has no right.”
As if the immunization teams weren’t facing opposition enough, hard-line mullahs are denouncing the eradication campaign. “Polio and the like are part of the anti-Islam efforts of Jews and infidels,” he says. “We should not take it. It’s an anti-Muslim conspiracy in the name of fighting polio. Otherwise they would not come door to door, begging people to accept polio drops for our kids.”
But even under threat of death, Pakistan’s health workers are not giving up. “Some people may have believed that killing a few polio workers could achieve the disgraceful aim of ending the campaign,” says Ali, the prime minister’s immunization adviser. “I believe they are mistaken. We will not stop. We have to eliminate polio from Pakistan.” The world is so close to a final victory against the disease. To fail now would be a tragedy.