The parents of 24,000 children in northern Pakistan refused to allow health workers to administer polio vaccinations last month, mostly because of rumours that the harmless vaccine was an American plot to sterilise Muslim children.
The disinformation—spread by extremist clerics using mosque loudspeakers and illegal radio stations, and by word of mouth—has caused a sharp jump in polio cases in Pakistan and damaged global efforts to eradicate the disease.
The World Health Organisation (WHO) recorded 39 cases of polio in Pakistan in 2006, up from 28 the previous year. The disease is concentrated in North-West Frontier Province, where 60% of the refusals were attributed to “religious reasons”.
“It was very striking. There was a lot of anti-American propaganda as well as some misconceptions about sterilisation,” said Dr Sarfaraz Afridi, a campaign manager with the WHO in Peshawar.
The scaremongering and appeals to Islam echoed a similar campaign in the Nigerian state of Kano in 2003; the disease then spread to 12 polio-free countries over the next 18 months. Pakistan is one of only four countries where polio remains endemic. The others are Nigeria, India and Afghanistan.
In 1988 the affected countries numbered 125. Since then more than 2 billion children have been immunised against the disease.
The North-West Frontier Province government made strenuous efforts to counter talk of an “infidel vaccine”. Health workers fanning across the province last month were equipped with copies of a fatwa, or religious order, endorsing the vaccinations and signed by Maulana Fazlur Rehman and Qazi Hussain Ahmed, the leaders of Pakistan’s most powerful religious parties.
The move reassured many doubters. More than 5.7 million children were vaccinated in January, with a further 3 million targeted in a second round due to start this week. “The elephant is over. We are left with just the tail,” said Dr Afridi.
But the tail has a deadly sting. Even though only 24,000 children have missed the vaccine so far, WHO officials said failure to vaccinate in small pockets of the country gave the virus a fresh toehold to spread.
The vaccination struggle is entangled with the confrontation between the government and powerful militants in the tribal areas. Refusals were highest in areas where conservative clerics and self-styled “Pakistani Taliban” fighters hold sway, flouting government authority and making their own strict laws.
Almost 2,000 children were not vaccinated in Bajaur, a tribal agency on the Afghan border where US warplanes bombed a house last year in the hope of killing al-Qaida’s No 2, Ayman al-Zawahiri. The jets missed al-Zawahiri, but inflamed extremist sentiment. Recently militants ordered Bajaur’s barbers to stop shaving beards on the grounds that it was “un-Islamic”. The barbers complied.
In nearby Swat Valley a young firebrand cleric, Maulana Fazlullah, denounced the polio campaign through a local radio station. His brother was killed in a Pakistani army attack on a madrasa (Islamic school) late last year. Almost 4,000 children were not vaccinated in Swat.
Imran Khan of the Human Rights Commission of Pakistan said: “Some people feel they are under attack here. . .. That is clouding their attitudes.”
Demands for “assistance” from local officials and elders were the other main factor behind the refusals. In the Mohmand tribal agency policemen demanded their salaries before allowing vaccination to proceed. Other villagers asked for money or the release of criminals from jail. “Demand” refusals accounted for about one-third of cases, according to the WHO.
But some brave women were uncowed by the extortion or demagoguery. Up to 200 babies a day are vaccinated at the Khyber teaching hospital in Peshawar, where burka-clad women arrive with children in their arms. Some arrive in secret, slipping into the clinic in defiance of male relatives who oppose vaccination. “One woman told me, ‘My husband is illiterate. He has no idea how important this vaccine is’,” said Muhammad Islam, a nurse.
Aid workers fear that they are being pushed into the front line of the struggle between the government and tribal militants, some of whom are linked to the Taliban and al-Qaida. This month a grenade was lobbed into a Red Crescent compound in Peshawar, damaging vehicles but killing nobody.
Some linked the attack to a fatwa issued in Dara Adam Khel, a lawless town famous for its gunsmiths, in December. A cleric named Mufti Khalid Shah declared a fatwa on employees of the UN, the WHO and all other foreign organisations. “Killing their employees is in line with the teachings of jihad in Islam,” said a notice.
“We are very worried,” said Mr Khan. “You have to be very careful about admitting to working for an NGO these days.”
Aid workers in Bannu, near North Waziristan, had been sent a letter and a 500 rupee ($10) note, he said. “The letter said they had a choice. They could either stop work or buy their own coffin.”
A senior government official was killed on Friday when a remote-controlled roadside bomb exploded in Salarzai, a village about 50 kilometres northeast of Khar, the main town in Bajur Agency, when he was returning from a jirga (tribal council) to convince people to immunise their children against polio, local administration officials said.
The blast killed Dr Abdul Ghani Khan, chief surgeon at the main government hospital in Bajur, at the scene and injured three others in his car, the officials said. One of the injured is critical, they added. “The surgeon was killed and three others injured in the blast in the Salarzai area at 3:30pm.”
Dr Amir Khan, medical superintendent (MS) at Khar District Headquarters Hospital, said that residents of Mullah Said Banda in the Salarzai area had earlier refused to get their children vaccinated against polio and added that Dr Ghani was visiting the area to allay misperceptions about the vaccination. “The locals had also warned polio teams against visiting the area,” the MS said.
Paramedic Hazrat Jamal, who is one of the three injured in the explosion, said that the residents of Mullah Said Banda were against the polio campaign. “As soon as we reached there, an armed prayer leader warned us against visiting the area. Some locals said: ‘On one hand, our enemy (a reference to the United States) is bombing us for no reason while on the other hand you are coming here disguised as polio campaigners to spread vulgarity,” he told Daily Times at the hospital.
No group has claimed responsibility for the explosion, but local tribal militants are suspected to be behind the attack. The Friday’s attack is the second since February 5 when a pro-government elder was killed in a similar fashion.