December 20, 2012 Liz Borkowski, MPH 0Comment

Pakistan is one of only three countries where polio is still circulating (Afghanistan and Nigeria are the others), and its eradication efforts have just encountered a horrific setback: Over the course of 48 hours, gunmen shot and killed eight vaccination workers in and around Karachi and Peshawar. The United Nations has pulled off the streets all staff involved in the polio vaccination campaign. Jibran Ahmad reports for Reuters that the government is nonetheless determined to continue immunization efforts:

Karachi police spokesman Imran Shaukat said teams were supposed to tell police of their movements but had not done so.

“There has to be better coordination between the health department and police,” he said. “We have decided that we will be more forthcoming and contact polio team heads ourselves.”

Minister Khokhar said the drive would resume as soon as security was in place.

“The teams go into every little neighborhood. You can understand that enormous resources are needed if we have to protect each and every team and worker, which we will have to now,” he said.

On Wednesday, police said they killed two people and arrested 15 during raids connected to the shootings.

Authorities in the northern Khyber Paktunkhwa province, the capital of which is Peshawar, said they would not accept the U.N.’s recommendation to suspend the campaign.

“If we stopped the campaign it would encourage the forces opposing the polio vaccination,” said provincial official Javed Marwat.

But their insistence the campaign continue angered health workers who said their colleagues told officials in Charsadda about threats before Wednesday’s shootings. The officials insisted the vaccinations take place anyway.

In the New York Times, Declan Walsh and Donal G. McNeil, Jr. highlight the essential role that women who volunteer as vaccinators play an essential role in anti-polio efforts; unlike men, they can enter private homes in conservative rural areas. They write:

Yet again, Pakistani militants are making a point of attacking women who stand for something larger. In October, it was Malala Yousafzai, a schoolgirl advocate for education who was gunned down by a Pakistani Taliban attacker in the Swat Valley. She was grievously wounded, and the militants vowed they would try again until they had killed her. The result was a tidal wave of public anger that clearly unsettled the Pakistani Taliban.

In singling out the core workers in one of Pakistan’s most crucial public health initiatives, militants seem to have resolved to harden their stance against immunization drives, and declared anew that they consider women to be legitimate targets. Until this week, vaccinators had never been targeted with such violence in such numbers.

Government officials in Peshawar said that they believe a Taliban faction in Mohmand, a tribal area near Peshawar, was behind at least some of the shootings. Still, the Pakistani Taliban have been uncharacteristically silent about the attacks, with no official claims of responsibility. In staying quiet, the militants may be trying to blunt any public backlash like the huge demonstrations over the attack on Ms. Yousafzai.

Female polio workers here are easy targets. They wear no uniforms but are readily recognizable, with clipboards and refrigerated vaccine boxes, walking door to door. They work in pairs — including at least one woman — and are paid just over $2.50 a day. Most days one team can vaccinate 150 to 200 children.

Faced with suspicious or recalcitrant parents, their only weapon is reassurance: a gentle pat on the hand, a shared cup of tea, an offer to seek religious assurances from a pro-vaccine cleric. “The whole program is dependent on them,” said Mr. Shah, in Peshawar. “If they do good work, and talk well to the parents, then they will vaccinate the children.”

At Superbug, Maryn McKenna considers who is striking vaccinators and why:

While no one has yet claimed responsibility, it is widely assumed that the attackers have ties to the Taliban, which has opposed the polio-vaccination campaign as a Western plot and accused vaccinators of working as spies for the CIA.

This is grievous and appalling. Infuriatingly, it was also predictable. Constant readers will remember that, back in 2011, the CIA did use a vaccination campaign as a ruse to attempt to to find Osama bin Laden. The unsuccessful attempt was denounced all over the world for putting the polio campaign at risk, and news sources within Pakistan quickly began reporting that vaccinators were feeling threatened. Adding to the sense of threat, a Taliban commander blocked the campaign in one province last June, a United Nations doctor and his driver were fired on in July, and a vaccinator was executed in October by a man who roared up on a motorbike and dashed away.

… All political events are multi-factorial of course. The Taliban are reflexively opposed to the West, and may have been enraged that the majority of these vaccinators were women, whom they seek to expel from public life. But as a global health reporter, I cannot see how the CIA can escape some responsibility for these deaths, and for the discouragement and confusion that is certain to follow.

Successful eradication of diseases like polio requires massive mobilization of resources, both human and financial. It also requires trust. If someone knocked on your door and asked you to accept a vaccination, would you accept? The level of trust will determine the level of acceptance — and the CIA’s vaccination ruse dealt a severe blow to trust.

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