Pakistan: Mullahs and Militants Keep Polio Alive

Unidentified assailants have killed two more immunization workers in northwestern Pakistan’s Chardassa district, outside Peshawar, bringing the total number to eight. In response, the organizers of the three-day polio vaccination drive suspended the campaign nationwide. No armed group has claimed responsibility. Six health workers in Pakistan are the latest to be killed for trying to eradicate a crippling illness. Sami Yousafzai talks to the immunizers and their foes.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.”