Polio re-emerges amid paranoia in Pakistan

http://www.thestar.com/

When health workers approached Zulfikar Quaid about inoculating his three children against polio, Quaid picked up an old cricket bat and waved it at them. “Get out of my house,” he yelled. “My children are Muslim and we don’t need your dirty Hindu drugs.” The health workers were stunned — though they’d become accustomed to some resistance to vaccines, they’d never heard it linked to a Hindu conspiracy. Zarmina, the lead health worker, asked Quaid’s wife why they were refusing the drugs. “The Hindus are lacing it with pig’s blood to send us all to hell,” she explained. Quaid was still waving the bat menacingly. Zarmina, familiar with anti-vaccine fervour, decided a quick retreat was the safest option. In the past 18 months, 34 health workers had been killed for attempting to administer the polio vaccine.

Since 1978, when the World Health Organization’s Expanded Program for Immunization was launched in Pakistan, conspiracy theories about polio have been rampant. While the supposed conspirators change frequently, the myth usually involves someone attempting to rid the world of Muslims — Zarmina and her fellow health workers have heard that the polio vaccine is part of a Western (or U.S. or Jewish) conspiracy to sterilize all Muslims, or that Mossad or the CIA is orchestrating the campaign to kill Muslims outright. “When the polio vaccination program was initially launched, international organizations didn’t take into account that there was very little engagement with the local government,” said a senior World Health Organization official, speaking on the condition of anonymity. “Because the drugs and information was all coming from another country, people became very suspicious of vaccine programs.”

The bin Laden problem

The immunization effort in Pakistan took a major hit in 2007 when Maulana Fazlullah, the current chief of the Pakistani Taliban, announced a ban on polio vaccinations in Swat. After news broke that the CIA had launched a fake hepatitis-B vaccination program to obtain information about Osama bin Laden, the theories gained even more prominence in Pakistan. Since then, militants and religious leaders alike have warned people against the polio vaccine and targeted health workers like Zarmina for participating in the immunization campaign.

“In Pakistan, conspiracy theories are almost an Olympic sport,” explained C. Christine Fair, a Pakistan scholar and assistant professor at Georgetown University.

The problem isn’t confined to Pakistan. In Nigeria, Ibrahim Datti Ahmed, a physician and the president of Nigeria’s Supreme Council for Sharia Law, accused Americans of lacing the vaccination with an anti-fertility agent that sterilized children. It took years for international organizations to combat the rumour and polio is still endemic to Nigeria. India, too, battled conspiracy theories about sterilization and poisoning. Unlike Pakistan, however, India has a stronger local government program, which has aided the World Health Organization’s efforts to eradicate the disease.

“In Pakistan, conspiracy theories are almost an Olympic sport,” explained C. Christine Fair, a Pakistan scholar and assistant professor at Georgetown University. It’s not just vaccination campaigns that inspire bizarre rumours. Many people believe the CIA planted the Taliban to weaken the Pakistani state and that Malala Yousafzai, the schoolgirl who stood up to the Taliban, was a CIA agent. Four days after Osama bin Laden’s death was announced, a YouGov/University of Cambridge poll found that 66 per cent of Pakistanis did not believe he had really been killed.

The Pakistani media often magnifies disinformation rather than debunking it. In 2010, the Washington Post chronicled the frustration of the U.S. embassy in the country when confronted, for example, with reports in the media that all Pakistanis are stripped naked at American airports. Fair isn’t one to mince words: “Part of the problem is that in Pakistan, lies are built into the very fabric of the educational system,” she said, referring to reports that state textbooks often have factual inaccuracies about Pakistan’s national history, along with a great deal of anti-minority and anti-Western language. Many of the falsities about polio are spread by religious leaders, who often don’t have a formal education, but can disseminate information to a large number of people in their local language. Earlier this month, Maulana Sami-ul-Haq, a religious scholar and leader of a faction of the conservative political party Jamiat Ulema-e-Islam, came out in support of the polio vaccine, issuing a fatwa against polio. Though not many local clerics followed suit, his announcement was viewed as a major victory in the fight against polio. But the rumours are so pervasive, and the suspicion of officials so great, that in some Karachi neighbourhoods, residents aren’t swayed even by the fatwa.

“Why is the government giving me polio drops for free?” asked one resident of Orangi town, who wondered why the government would do this while not providing education, basic health care and access to water. For Zarmina the battle is personal. She became a community health worker — part of the WHO funded Lady Health Worker program — in 2002 after her eldest daughter died after contracting measles.

A few hours after her confrontation with Quaid, Zarmina heard that shots had been fired elsewhere in the city and that three people had died administering the vaccine. She’s not sure that she’ll participate in the next National Immunization Day drive. The consequences of people like her quitting have ripple effects across the globe. Late last year, a polio outbreak in Syria was linked to a strain from Peshawar. With both Nigeria and Afghanistan reducing the number of polio cases in 2013, health experts warn that Pakistan may become the only exporter of the polio virus in the world. “I used to think that by talking individually with the families in my neighbourhood, I could help stop this crippling disease,” Zarmina said. “Now, I’m not so sure.”