Polio vaccination in Khyber Pakhtunkhwa has turned hugely controversial due to a series of unfortunate events. A police officer responsible for protecting polio workers was killed in Bannu on April 23. Same day, another police officer was gunned down in Buner. Killings in KP, along with incidents of attacks on polio workers and police in other parts of the country, forced the federal government to halt the campaign to immunise about 40 million children across the country.

So far in 2019, Pakistan has reported eight polio cases, including two from Bannu, and one each from Karachi, Hangu, North Waziristan, Lahore, Bajaur and Khyber tribal districts. Along with Afghanistan and Nigeria, Pakistan is one of the three countries in the world where the polio virus still exists. The authorities are still struggling to wipe out this wild, paralysing virus that deforms the limbs of mostly poor children under five, despite decades of untiring efforts and colossal funding.

On the first day of the three-day National Immunisation Days (NIDs) on April 22, thousands of children were rushed to a government-run hospital in Peshawar after unfounded rumours about children falling sick due to vaccination went viral. A video of a scaremongering man, who claimed the children had been poisoned by the drops administered in a private school, caused panic among the people. Children were hurried to the hospital by parents and family members and some angry villagers in nearby Masho Khel set a Basic Health Unit (BHU) on fire.

According to Provincial Health Minister, Dr Hisham Inamullah Khan, 44,000 children were taken to hospitals in KP, and 25,000 of them were shifted to the four hospitals in Peshawar.

Later, the government formed a committee to probe complaints on the aftereffects of the polio vaccine. The committee concluded in a report that the panic and scare was pre-planned and based on rumours.

It noted that the principals of the two private schools, owned by a religious political party, first refused to allow polio workers to enter the schools to vaccinate their schoolchildren and then started complaining the vaccine had spread a reaction among the children.

The provincial government arrested 12 people, including the man who recorded the video.

Those involved in the polio eradication efforts are afraid that Pakistan may report more polio cases this year, particularly from KP. The task to reach out to every child is gradually becoming difficult for polio workers in many places of KP, including erstwhile Fata, as elements of vested interests continue to spread scandalous rumours and doubts about the vaccine in peoples’ minds.

Almost eight years ago, the May 2, 2011, Abbottabad operation, conducted by the US Special Forces to kill al-Qaeda leader Osama bin Laden used an immunization drive (hepatitis, not polio as is widely believed) to trace the world’s most-wanted terrorist. Ever since, the polio vaccination campaign has been mired in controversy.

According to government officials, it was after the Abbottabad operation that attacks on polio workers started in Pakistan, as the "CIA" employed Dr Shakil Afridi in a "fake vaccination drive" to track down bin Laden and his family members.

"The Abbottabad operation was a turning point," says an official of the Emergency Operation Center (EOC) in Peshawar. "It made the polio programme controversial as after that some of the religious circles publicly announced their opposition to the vaccination campaign."

Clearly, several determined efforts led by immunization teams in countering the anti-polio propaganda have gone to waste in Pakistan. Back in 2014 Imam-e-Kaaba Sheikh Abdur Rehman As-Sudais was invited to Pakistan as part of the government’s efforts to address misconceptions about the polio vaccine. Additionally, renowned Islamic scholars gave fatwas in favour of the vaccine. Despite these efforts, polio workers have remained vulnerable, and, according to official data shared by government officials in Peshawar with TNS, 97 people, majority of them female health workers and members of law enforcement agencies, have lost their lives in attacks on polio teams ever since the Abbottabad operation.

Besides, certain elements continue to oppose polio vaccination on the basis of misperceptions, holding it as a foreign ploy to sterilise Muslim children. An official from the government who did not want to be named told TNS that acceptance for the vaccine is very high but "we need to follow a low-key communication strategy to handle small pockets of refusals irrespective of reason, whether religious, misperception or something else". She feels that a localised intervention is better than broadcasting on national tv or social media which creates suspicions even in the minds of those who had no issues with the vaccine to begin with. "Keeping in view the low level of literacy and easy belief in conspiracies, the program needs less visibility and needs to work quietly."

But this view can also have its pitfalls. A campaign that is as widespread as the polio one cannot help but be visible, and official narratives that provide solid evidence in favour of the vaccine through trusted local and national figures can help to counter ambiguity-generating ideas spewed by tv pundits like Orya Maqbool Jan.

"There is a visible behavioural change among parents. Even the educated ones refused to get their children vaccinated when we visited them this time," remarks a female polio worker in Peshawar’s posh Hayatabad township. "When we pass through the streets, people pass offensive comments."

The anti-polio campaign has caused a huge loss to the polio vaccination efforts in KP, as in Peshawar alone, 11,00,000 children out of 16,00,000 have refused to be vaccinated in the latest round of the vaccination drive, a KP Health Department official tells TNS on condition of anonymity. "Please don’t ask me about the figures, as the data about refusals is the worst ever in the history of the polio immunisation campaign in KP. We have never faced such a situation before," he says.

Out of 1.8 million children in Peshawar, 800,000 were from zero to five years while the remaining 800,000 were between five and 10 years.

He adds, "the biggest challenge is to reach out to the children, followed by the security of the polio workers, as certain elements are still operating out there to malign the polio vaccine".

The World Health Organisation (WHO) had recently declared that the polio virus had been interrupted and for the first time the sewage water sample collected from Shaheen Muslim Town in Peshawar had shown no strain of the wild polio virus, but with this recent turn of events it is feared that this progress may be reversed.

Sewage samples are collected and evaluated every month from 59 locations throughout the country.

The sample from Peshawar was collected on April 10, 2019, which clearly shows the quality of the polio vaccine being administered in Pakistan as well as the hard work that had been done in this regard.

However, health experts fear the recent resistance to polio vaccination may damage these untiring efforts. They are reminded of 2014, when 306 polio cases were reported in Pakistan after the Taliban banned the vaccine for two years in North and South Waziristan. Health workers were only given access to the area after the Zarb-e-Azb military operation against the militants.

While rejecting rumours, Babar bin Atta, the Prime Minister’s focal person on polio, says there is nothing wrong with the vaccine. "It is procured in Indonesia under the supervision of prominent religious scholars. The same vaccine is being used elsewhere in Pakistan and nothing has been reported so far against it".

Dr Ayub Rose, Director General Provincial Health Services Academy Peshawar, says the Pakistan Paediatric Association is planning to combat this issue through the ongoing education awareness campaign and by guiding health workers soon after Ramazan through a consortium of vaccinology that takes everyone on board.