Continuing threats from the Trump Administration are likely to increase anti-American sentiment in Pakistan that will have a direct impact on the war against polio in the country, experts say.
According to a report in The Guardian, the fight against polio in Pakistan suffered its biggest blow in 2011 when the US Central Intelligence Agency (CIA) concocted a fake hepatitis vaccination campaign as part of its efforts to find Osama bin Laden. The Taliban issued fatwas and murdered dozens of health workers. In 2014, Pakistan recorded more than 300 polio cases.
In his recently announced South Asia strategy, Trump signaled a tougher line on Pakistan.
“We have been paying Pakistan billions and billions of dollars at the same time they are housing the very terrorists that we are fighting. But that will have to change, and that will change immediately,” he said.
“It is hard to predict how local communities will respond to health workers if bombings pick up,” said Monica Martinez-Bravo, a researcher at CEMFI and co-author of a new paper on mistrust of vaccines in Pakistan. But she documented a clear correlation between support for militant groups at times a result of air campaigns, will decline in immunisation rates.
Bombings complicate access for immunisers, and insurgents have used polio to demand a halt to airstrikes in return for allowing vaccinations. This year, in Kunduz in northern Afghanistan, the Taliban banned inoculations for 15 months, relenting only when a 14-month-old girl contracted polio.
Since the Global Polio Eradication Initiative was launched in 1988, an estimated 16 million people have been saved from paralysis, and 1.5 million children from death. The virus loiters in the environment.
Last week, standing above a river in Rawalpindi overflowing with sewage after the monsoon rains, Sarwat Boobak, area coordinator for WHO, said her team had detected wild polio, a sign that people were still shedding the virus, even in the capital Islamabad.
A long-time polio worker, Boobak fled her home town of Karachi in 2012 after the CIA vaccination scheme was revealed.
“Our work suffered so much after that,” she said.
The backlash predominantly hit female health workers who make up the backbone of vaccination teams. Since then, at least 41 polio workers have been killed in Pakistan, as have several polio workers in Afghanistan. An overwhelming majority of Pakistanis welcome vaccination workers, a few refusals can keep the disease alive.
“Polio vaccines are produced in western countries, and are made out of pig fat or contain alcohol, the two things that are forbidden in Islam,” said Akbar Wazir, a tribal elder from North Waziristan. Equally false are beliefs that vaccines transmit HIV or cause sterilisation.
Such misconceptions grew stronger after the CIA ruse, said Martinez-Bravo. “Once people found credible evidence for one claim, it lent credibility to the others,” she said. This year, 250,000 Pakistani polio workers will target 38 million children who require a course of 10-15 vaccinations. A campaign of that magnitude requires goodwill from communities.
“Certain elements don’t want the Pakistani government to succeed, including in polio campaigns,” said Rana Muhammad Safdar, emergency coordinator for polio eradication in Pakistan. He would not rule out that military operations could endanger vaccination campaigns.
“By now we have been able to prevent 500,000 paralysis cases in Pakistan alone,” he said. “We all must be extra careful.”
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