During the last four years, more than 60 security officials, health workers, and doctors associated with polio vaccination campaigns have been killed in Pakistan— especially in Khyber-Pakhtunkhwa and Karachi. In 2016, at least 40,000 children missed vaccinations either because they were marked as ‘absent’ from home or their parents outright refused.
The government of Pakistan has deployed police officials and paramilitary FC personnel with the polio vaccination teams to protect polio workers from violence and ensure parents vaccinate their children. So far more than 2,000 parents have been arrested from different parts of the country for obstructing the work.
Pakistan remains one of the three countries, the other two being Afghanistan and Nigeria, where polio cases were recorded in 2016. Even though the government regards the decrease in the number of polio cases in Pakistan since 2015 a “major success”, at best it can only be described as a relative success. The drop in the number of cases in 2015 and 2016, compared to those of 2014 cannot be taken as a “huge success”. At times numbers lie.
From 1955 to 1961, the US administered 300m doses of the inactivated polio vaccines (IPV). The nationwide campaign resulted in a 90% decrease in cases. IPV did not eradicate polio during that period, but there were fewer outbreaks in people who got at least three doses
The opposition to polio vaccination among certain communities, especially the Pukhtun community, is widespread. Conspiracy theories prevail. Whether we like it or not, there are hundreds of thousands of people who believe in those theories. Take for example, two recently uploaded anti-polio vaccination videos on Facebook that went viral.
One video features a woman introducing herself as a doctor. She claims that the polio vaccination is a conspiracy theory against the Muslim Ummah by the US and Jews. She asks questions like why do the US and international organizations not invest billions of dollars in other health sectors? Similarly, in another video, a woman, who is apparently from Karachi, refuses to vaccinate her children and throws the polio workers out of her house. These two videos give us a picture of the anti-polio conspiracy theories and opposition to vaccination in Pakistan. These videos tell us that the government of Pakistan and its partner international organizations have failed to persuade a large segment of the society that vaccinations are essential. Their communication campaigns have partially failed. They have not been able to answer the critical questions.
The failure of communication campaigns can be gauged from the fact that a majority of Pakistanis even don’t know what polio is, what causes it and why it is necessary to eradicate it. No one has adequately addressed people’s concerns for side-effects of the vaccination, and their suspicion over why the US invests millions. The media and health workers have not been able to do this either. The absence of basic information gives conspiracy theories space to thrive.
A significant controversy around the effectiveness and side-effects of the vaccination first erupted in the US when Rolling Stone magazine published an article accusing a polio scientist of exporting the HIV/AIDS virus from monkeys to human bodies through the oral polio vaccine
A history of the polio vaccine
The polio virus has existed since the prehistoric era; its presence remained unnoticed. Polio is itself an intestinal infection. The infection is caused by a virus that is transmittable from person to person via shared objects, contaminated water and food, and unwashed hands. It causes an infection that affects the nervous system. The nature of the damage posed by the disease is decided by the resistance offered by the nerves and muscles of the attacked body. Some infected nerves and muscles will fight and defeat the virus, and other will die. The infection can cause irreversible paralysis and even death.
Why is the US so interested in vaccination campaigns?
The US has been a major victim of the polio virus. Also, vaccines to counter polio were first discovered in the US. In 1916, the US faced its worst epidemic. The outbreak started in Pigtown, an immigrant populated area in Brooklyn, where parents started bringing their children to the hospital with a mysterious disease. Initially, 4,215 cases of polio were reported in upscale New York, including Pigtown. The number increased in the following months. At least 8,900 cases of polio, including 2,400 deaths, a majority children, were reported in New York City alone. By the end of the year, the epidemic had killed 27,000 people.
The disease also affected many parts of the country at the peak of the Cold War. Those were the times when it was dealt with as a national crisis. The government, industries, and scientists started investing more time and money in finding a cure. The disease struck terror and challenged American values. American scientists who were leading the world of science and technology at that time were left with many unanswered questions. The disease was randomly targeting the country’s children. No one felt safe as the disease could target anyone at any time. People in wheelchairs, leg braces, and with deformed limbs could be seen everywhere in the affected areas. In the period 1917-50, annually one to 68 cases per 100,000 people were recorded. These included paralytic, non-paralytic, and not stated cases. On average, 55% of cases reported between 1940 to 1950 were people who were crippled. The ten years after the end of World War II, from 1946-1955, were the worst in US history. Polio wreaked havoc in many regions. For example, San Angelo hospitals started receiving children with fever, fatigue, and aches. Twenty-five cases of polio were registered in one hospital in a day. The doctors knew that the disease had crossed epidemic levels in the area, but they did not know how to cure the disease.
Enter Jonas Salk, a 39-year-old scientist, with a grant from National Foundation. He started research on an anti-polio vaccination and invented one that killed the virus. In 1951-52 he tested his vaccine on 161 children enrolled in different institutions and got positive results without any side-effects. From 1955 to 1961, the government administered 300 million doses of the inactivated polio vaccines (IPV). The nationwide campaign led to a 90% drop in cases. IPV did not eradicate polio during that period, but there were fewer outbreaks in people who got at least three doses.
They are my kids. If they die of polio I am responsible, not the government, said this woman, whose video of refusing the vaccination went viral. She claimed that it gave her children diarrhea
No en masse refusals were registered in the world until 2003, when a few religious groups in Northern Nigeria boycotted the polio vaccination campaigns
Resistance to the vaccination
A significant controversy around the effectiveness and side-effects of the vaccination first erupted in the US when Rolling Stone magazine published an article accusing a polio scientist of exporting HIV/AIDS virus from monkeys to human bodies through the oral polio vaccine. The magazine did not have scientific evidence to support its claims, but the damage was done. In 2000, TheAtlantic magazine published an article linking oral polio vaccination with diseases including lung cancer. This added to the problem. However, no en masse refusals were registered in the world until 2003, when a few religious groups in Northern Nigeria boycotted the vaccination campaigns. Influential religious scholars who also had strong support in the communities managed to persuade residents that the vaccination was forbidden in Islam, harmful to their children, caused AIDS and infertility. The boycott led to an increase in the number of recorded polio cases. The conspiracy theories that started in Nigeria later reached Pakistan and India.
Resistance to vaccinations in Pakistan increased manifold after the US military operation in Pakistan killing Osama bin Laden. Conspiracy theories were fed by the news that the US allegedly used a team of vaccinators to track OBL. What ensued was targeted violence against polio workers, especially in Pukhtun-populated communities.
The solution
The government of Pakistan and its international partners have failed to realize that deploying security personnel to protect polio teams is not a solution. It needed a strong communication strategy to counter the conspiracy theories. Instead of sending out the message, however, it chose to respond to violence with violence by cracking down on parents. This might improve vaccination rates in the short term but in the long run these tactics lead to more resistance.
The government and non-profit communication strategy is limited to posters and advertisements that picture disabled children with catchlines like “Polio can disable your child for life”. The best communication strategy would be to listen to communities and answer their questions and concerns. Fear tactics will not work for long especially in a country where a majority of the people does not trust the government.
The writer is a researcher with a focus on the intersection of race, health, gender and journalism
