Sajida Bibi knocks on each door in Killi Shakar Khan Quetta to ask if there are children below five in the house. At a gesture of compliance she enters. She squeezes the cheeks of a child, presses the slender plastic bottle, drops three dots of anti-poliomyelitis vaccine and marks the vaccine with a marker on the little finger before moving on to the next one.
As she walks house after house vaccinating hundreds of children in a day, she is accompanied by two other shadows besides her own: two constables of Balochistan Police follow her holding their AK-47s with the safety catch lowered and all set to cock and fire.
This is Pakistan’s fight against polio. The country is one of only three nations after Afghanistan and Nigeria with the polio virus still endemic on their soil. The anti-polio campaign started in 1993 in Pakistan under the program of National Immunization Days (NIDs) and has been going on ever since.
The addition of armed guards to the campaign, however, is a relatively recent development. Targeted attacks on field workers have hampered the process of immunization and have made it an unsafe job. Religious militant groups have targeted anti-polio workers seeing them as under-cover espionage. According to media reports more than 60 people have lost their lives in the anti-polio campaign in Pakistan since 2012.
“I feel afraid even in the presence of policemen around me” Sajida Bibi told this author, saying that she and her colleagues had no intention of harming anyone nor did they want to be part of a conflict. “We are ordinary people trying to support our families with the little amount we get through this campaign,” she said.
Hundreds of volunteers like Sajida take part in the polio eradication campaign across Balochistan by vaccinating children under five years of age. The Provincial Coordinator of the Expanded Program on Immunization Dr. Ishaq Panezai said that volunteers make up the bulk of vaccinators in the province. “We train the volunteers before each campaign and officials accompany them in the field to monitor their work,” Dr. Panezai said.
Last year 25 cases of polio were reported from Balochistan — the highest in the last three years. Sources from the provincial health department say that most of the cases are reported from the areas where people are reluctant to vaccinate their children.
Asad Khan an official of the health department accompanying a polio team on Samungli Road said: “We face problems in vaccinating every child because some people do not cooperate with us thinking that the vaccine causes infertility and that we are promoting a foreign cause.”
A nationwide awareness campaign in support of anti-polio vaccination has been viral on television channels. There are short advertisements featuring messages from notable scholars asking parents to have their children vaccinated. At the same time in some regions local imams rouse hostility against the anti-polio campaign.
Only three months into 2015 more than 20 cases of polio infection had surfaced. Three of the cases were reported from Balochistan’s Loralai, Qilla Abdullah and Quetta districts. The major cause cited by the government once again was the refusal of parents to allow the visiting team to administer a vaccination to their children.
Akbar Khan — whose name has been changed on request — a pensioner in Pishin District, said people are risking the lives of their children only because they have been told that it is forbidden in Islam to vaccinate children.
“Some people have been spreading misconceptions against vaccination of children,” Akbar said, adding that local religious scholars should clarify the matter so that the disease can be eradicated.
According to End Polio Pakistan, a group of polio eradication partners in Pakistan that comprises the World Health Organization (WHO), United Nations International Children Emergency Fund (UNICEF) and the government of Pakistan, the number of polio cases had dropped from 20,000 a year before the campaign started to only 58 in 2012.
But as the partners were preparing to declare Pakistan a polio-free country the number of polio cases jumped to 93 in 2013. In the following year it jumped again to a shocking 306.
The Independent Monitoring Board (IMB) criticised the government's stance in its report and suggested travel restrictions for the country. The report cited that Pakistan had not done enough to fight the virus and had completely failed to keep its promise of eradicating polio in the country by December 2014.
While militancy and the refusal of families to participate in vaccination are cited as major impediments in the fight against polio, state incompetence has enabled the latest outbreak. Adequate planning and realistic awareness movements could prove more helpful in mobilizing support for the anti-polio campaign in the country.