Polio is an infectious viral disease which, if not prevented through administering polio drops in infants and children up to the age of five years, leads to lifelong disability of limbs. Pakistan up till some years back was well on the way of eradicating this affliction like several other developing countries through mass vaccination. However, in the context of increasing Talibanization of society, some stray and ill-informed religious leaders spread propaganda against the said vaccination claiming that it was a covert scheme of the government to cause infertility in later years. Since then, the spread of the disease has badly aggravated leading to numerous casualties in a short span of time.
According to the report of the Global Polio Eradication Initiative (GPEI), there are only three polio endemic countries worldwide namely Pakistan, Afghanistan and Nigeria – all because of misunderstandings about and lack of interest in or acceptance for polio vaccines in these countries. It must caution us that if we could not eradicate polio, the situation could become more lethal for the upcoming generation.
Unlike other diseases, polio patients are among the most vulnerable population in the world and includes pregnant women, and young children under the age of five. Those who are not immunized against polio have greater chances of catching the disease in contrast to those immunized timely. Other risk factors include traveling to places where polio is widespread, living with those infected with polio, working in laboratories where polio virus is kept.
In Pakistan, polio is becoming the fastest spreading infectious disease since 2007. Since 2010, Pakistan has the highest rate of polio cases as the polio endemic country in the world. Between 2010 and 2011, the number of polio cases increased from 144 to 198. Polio-affected areas of Pakistan are divided geographically into four regions – districts of Baluchistan; Peshawar and other districts of Khyber Pukhtoonkhwa (KPK); Mohmand, Bajaur, and Khyber agencies of the Federally Administered Tribal Areas (FATA); and some districts of Sindh. Security threats from armed groups like Taliban are the biggest hurdle in successful vaccination in most of these areas. Targeted killings of health workers in late 2012 and early 2013 made it very difficult to eradicate polio.
The greatest number of cases is registered in KPK, with many vaccine refusal cases emerging after 2007. In 2011, approximately 77% of the polio cases were reported from the Pukhtoon population. According to some Pukhtoon religious and religio-political leaders, polio vaccines are a Western conspiracy, and that they cause infertility among Muslims.
The worst result taken from all districts of KPK is from the most conservative southern district of Lakki Marwat (LM), as the local community is more orthodox and conservative-minded. LM has an important position with regard to the prevalence of polio due to its geographic location alongside the Taliban-controlled South Waziristan Agency. Therefore, due to a ban on polio vaccination in South Waziristan and North Waziristan, the local taliban of LM also imposed the same ban in the district. Taliban threatened families not to get their children immunized. This situation was worsened by the fact that most families in LM have blood relations with the Taliban. In this way, taliban prove to be an immense hurdle in polio eradication.
Research conducted by the National Research and Development Foundation (NRDF) in collaboration with the United Nations’ Children’s Fund (UNICEF) in 2013, found that 733 families in a single union council of LM refused to get their children immunized against polio. According to officials, there has been a sharp increase in the number of families refusing to have polio vaccination. The first propaganda against polio campaign was initiated in district LM, which then spread to the entire province. Every time the government officials failed to restore public trust regarding polio vaccination.
The above problem was quantitatively researched by a Quaid-i-Azam University Sociology graduate hailing from LM named Waliullah Marwat to explore the reasons behind growing refusals to polio vaccination in the district. The main objective was to study trust level of local people in having their children vaccinated. Target population of the researcher was the respondents of rural areas of LM. Data were collected from 110 respondents who were interviewed face-to-face employing a structured questionnaire. It helped encompass the panorama of a representative sample comprising literate and illiterate people.
Major findings of the research relate to people’s negative perceptions about the vaccination. Refusal to polio immunization has lately increased polio cases drastically. There are variations among the perceptions of educated classes about the vaccination against polio. Furthermore, different reasons found for the refusal to polio drops in LM include low literacy rate, lack of professional education, religious misconceptions, and concerns about infertility. Talibanization is also a major factor behind people’s unwillingness to avail polio vaccines as there are some religious and militant groups which are continually terrorizing parents and polio teams. These reasons pose huge barriers to polio vaccinators in their local campaigns.
Other reasons for refusal to polio drops are lack of trust and interest in effectiveness of the polio vaccines. People also have very little knowledge about polio itself. As clear from the research study, people in LM are unaware about the polio disease and its causes and consequences. About 60% people of the district do not know as to what the polio disease is. They are of the view that this disease has been imposed on them from God because of their misdeeds. 68% respondents hold that anti-polio campaign cannot eradicate the disease successfully, as according to them, it is an anti-religious activity and that the polio vaccines also cause different types of dangerous diseases.
As a result, the number of polio-based cases of paralysis is increasing in Pakistan. To cope with this situation, it is the duty of the government to come forward and take practical steps for the eradication of polio. Security of polio teams must be ensured to facilitate them in carrying out immunization process. Clergy of local areas must make people realize that polio vaccination is not an anti-religious phenomenon, and it is safe for health. This will go a long way in restoring public trust in polio vaccination in Pakistan.