Public Trust and the Rise of Polio in Pakistan

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.