One policeman was killed and two others were injured on February 17, just as the nationwide anti-polio drive was launched in Pakistan. An IED went off near a police mobile van deployed for the security of polio inoculators canvassing in the Kulachi area of Dera Ismail Khan district of Khyber Pakhtunkhwa province. Earlier, in the same province, on January 29, two polio workers were killed when their team came under attack in Parmoli area of Swabi District.
In January 2020, a report stated that the overall tally of reported polio cases across the country had reached 134 in 2019: 91 cases in KP, 24 cases in Sindh, 11 in Balochistan and 8 in Punjab. 

The World Health Organization's Technical Advisory Group (TAG) on Polio Eradication said Khyber Pakhtunkhwa is a major barrier to the polio eradication efforts in Pakistan. Moreover, Afghan and Pakistani officials say most of the reported cases come from the predominantly ethnic Pashtun areas along the border between the two counties. Pakistan and Afghanistan, along with Nigeria, are the only three countries in the world where polio cases are still reported.

There are numerous conditions that make eradication of polio from Pakistan difficult: Pakistan’s weak state and health system, particularly in the tribal areas; the ongoing conflict in the region; the movement of refugees from Afghanistan and internally displaced people from the northern tribal areas; the movement of seasonal workers across the country; biases and misconception among the population against the polio vaccine; hostility towards polio vaccinators at family and community levels; and backlash against the use of health campaigns by security and intelligence agencies. All these factors threaten the effectiveness of Pakistan’s polio eradication efforts, and the people administering it.

Additionally, a key feature of Taliban militancy is the systematic attack on people suspected of behaviour in violation of the Taliban’s interpretation of the principles of Islam. The Taliban have prohibited vaccination campaigns for children, school-age girls, and women working outside the home.

The Taliban are bitterly opposed to any immunization drive because the US's Central Intelligence Agency (CIA) organised a fake hepatitis vaccination drive to help track down Osama bin Laden in the city of Abbottabad - with the help of Dr Shakil Afridi - where US forces later killed him in 2011. Polio workers have been accused of being CIA operatives and the campaign has suffered incalculable damage.

Health workers have been killed in targeted shootouts in various places in Pakistan, be it the urban metropolis of Karachi or in the interiors of tribal agencies in the north. Polio eradication efforts in Pakistan suffered a serious blow in 2012 when vaccination workers were targeted directly for the first time. That year, the Pakistan Taliban issued a threat against people working in polio vaccination campaigns, calling them a western conspiracy. Since then, at least 100 people have been killed in assaults targeting vaccine teams. The cases involving multiple shooters suggest that there is an organised attempt to target polio vaccinators by militant groups with the capability to direct such attacks.

Apart from being killed, health workers also face violence in the form of threats, shootings, abduction and explosions. Shooting is the most prominent method of attack, along with abduction and maltreatment (including torture and rape), bombing of polio-vaccination centres, roadside bomb explosions, attack with an axe, and stone-throwing.

Unfortunately, the issue of polio eradication is further dividing Pakistan’s conservative and moderate Muslims. Polio has become a controversial flashpoint. Many hardliners believe that polio drops are bio-weapons used against the Muslim population to exterminate them. They consider them an US-UN-Israeli Agenda against the Muslims. Incredibly, many conservatives preach that polio drops contain urine and alcohol.

Throughout Pakistan, an army of female health workers go from door to door, trying to ensure that every child is saved from the polio virus. Women are mostly allocated such tasks due to the conservative nature of Pakistani society, where unknown men are not invited inside the household. These women embark on their campaign daily knowing that they may not come back alive. Their task is tedious and thankless because many people in Pakistan have never been vaccinated against polio, making the risks higher, even for those who have been inoculated. Therefore, every child needs to be immunized multiple times, until they turn five.

The government has taken some steps for improved inoculation drives. Vaccinators have been stationed in all major transit points across the country. To help change attitudes, the government has enlisted religious figures to favour the anti-polio vaccination. Mufti Muhammad Naeeem, chief of the Jamia Binoria Aalimiyah, a famous Madrasa of Karachi, has, on many occasions, spoken about the effectiveness of polio vaccinations. Also, the government has made it compulsory for every child travelling out of tribal areas to get immunized.

The issue of polio eradication has taken a perilous form in Pakistan due to the deadly mixture of militancy and developmental issues. On one hand, the militants are extremely hostile to the entire immunization programme and, on the other, due to lack of proper sanitation facilities and severe malnourishment, the entire society is at high risk of polio transmission. And, in many cases, even the frequent dosage also doesn’t prevent the ailment among children. The WHO has been supervising the anti-polio drive in Pakistan since 1994, when the country recorded 20,000 cases. 

However, even after more than two decades, Pakistan’s goal of a polio-free nation appears distant.

Sadly, the vaccinators have become the victims in a long-running war between the militant groups and the state. Killing them creates chaos and tarnishes Pakistan’s international image and reputation. The militants get success in de-stabilising the already disordered society of Pakistan. Under such circumstances, until Pakistan wins its war against terrorism and extremism, it is unlikely to win its war against poliomyelitis.

(The writer is a Research Fellow, Institute for Conflict Management)