An old enemy strikes again

Despite government efforts, two polio cases have surfaced in Khyber Pakhtunkhwa

An old enemy strikes again


here is a strange link between terrorism and polio in Pakistan. Whenever there is a glimmer of hope that they might end, they strike back. In 2021, we were described as being quite close to the finishing line in eradicating polio from the country. However, in 2022, two new cases of polio have been reported from North Waziristan.

Despite all efforts, Pakistan is still among a handful of countries affected by poliovirus. The areas worst hit by both polio and terrorism are Khyber Pakhtunkhwa and Balochistan, located along the border with Afghanistan.

Afghanistan is the only other country in the region that, like Pakistan, has failed to eradicate polio. There was a time when the poliovirus would somehow reach the border areas of Pakistan due to the evacuation of refugees fleeing the war in Afghanistan. The danger is still there, but we are now dealing mostly with a strain of poliovirus native to the southern districts of Pakhtunkhwa. The southern districts are also the most affected by terrorism. Official statistics show that since 2012, more than 70 participants in the anti-polio campaign have become victims of terrorism.

A polio eradication campaign has been going on in Pakistan for a long time. At one point malicious rumours were circulated to hinder universal vaccination. The gullible population was told that vaccination was an effort by the West to reduce the global Muslim population. Many bought into the propaganda. Some people found it hard to believe that the West could be spending billions of dollars for the welfare of people at war with it. Others questioned the government’s priorities and motivation. Religious leaders were then enlisted in support of the campaign and the problem has eased.

There was a general perception in the Tribal Areas that polio workers were spying for the West. The conspiracy theories got a boost after Al Qaeda leader Osama bin Laden was killed in Abbottabad in 2011 and US agencies acknowledged that a fake polio vaccination campaign was used as a means of locating him.

The government and some human rights groups tried to allay the fears but the damage had already been done. Following the revelation, the polio campaign across the country, including in Waziristan, was presented as an anti-Islam conspiracy. Pamphlets were distributed against polio eradication campaigns and warnings were issued to the government to end these campaigns.

In July 2012, a doctor was killed while administering polio drops to children in Karachi. Similar attacks were carried out against polio workers in Balochistan and Khyber Pakhtunkhwa as well.

The number of new polio cases increased from 93 in 2013 to 327 in 2014. It was the first substantial increase after years of improving numbers. Some clerics and politicians then launched a campaign to defeat the propaganda. When the efforts started bearing fruit, attacks against polio workers increased. From Khyber Pakhtunkhwa to Karachi, polio workers and the security personnel accompanying them began to be targetted. The biggest challenge was resistance by some parents to allow their children to be vaccinated. Despite some tough measures taken by the government and millions of dollars provided by international polio organizations, the eradication of polio has not been achieved. Instead, Pakistan has come to be known as a source of poliovirus.

More than 70 anti-polio campaign workers have become victims of terrorism since 2012. A human tragedy is unfolding in Pakistan’s neighbourhood that could contribute to both terrorism and polio in Pakistan.

When polio cases came to light in Iraq and Syria, those were linked to Pakistan. Several sources claimed that the militants who went from Pakistan to fight in Iraq and Syria carried the poliovirus to those countries. A case of polio has recently been reported from Africa as well. Health authorities in Malawi declared an outbreak of poliovirus after the case was detected in a child. This is the first case of wild poliovirus in Africa in more than five years after Africa was declared free of indigenous wild polio. Laboratory analysis shows that the strain detected in Malawi is linked to the one that has been circulating in Sindh.

Fifteen months later, with the return of polio cases in 2022, Pakistan is facing yet another challenge. An unstable Afghanistan in the neighborhood is struggling with terrorism as well as poliovirus. A human tragedy is unfolding in Pakistan’s neighborhood that could contribute to both terrorism and polio in Pakistan.

The question, of course, is why, despite the huge international assistance, the establishment of so many institutions, and sacrifices of so many workers polio has not been eradicated from Pakistan. There are four major reasons for this. First, some of the extremist organisations have declared polio workers their enemy after the killing of Bin Laden. The second reason is our social structure. The third reason is the scourge of corruption. The fourth reason is ineffective communication by the government and health authorities.

Extremist groups have always doubted the desirability of polio vaccination. Even as the government persuades some of the clerics to support vaccination, hundreds of teachers are graduating from unregistered madrassas that favour extremist narratives.

Graduates of these seminaries align themselves with various militant groups and have greater influence in tribal areas than of mainstream religious scholars. There are also clerics who pay lip service to anti-polio campaigns, but do not play an active role against the anti-vaccine narrative in their areas.

Poverty and ignorance continue to hold our collective consciousness to ransom. Logic and reason are not the determinants of our discussion and decisions. Numerous polio workers in Peshawar have reported that fake videos of children suffering harm after polio vaccinationin Badhaber have resulted in an increase in the number of women refusing vaccines.

In some places, people have started demanding an electricity transformer for instance to allow polio workers to enter the area.

Chronic refusals are also common. Many parents deny their children polio vaccines by hiding them.

Corruption is another major factor. Polio workers who carry out vaccination campaigns are paid around Rs 1,000 per day. These are the people we depend on for deliverables.

The fourth reason for low polio vaccination coverage is miscommunication. It will be fair to say that we have not been able to tell our people that the world is worried about our polio cases because their own gains are threatened by our failure. Already, several countries require polio vaccination certificates before allowing Pakistanis entry.

As far as coordination and communication are concerned, field workers have to ascertain the number of children in a household every time they administer polio drops. In Khyber Pakhtunkhwa and Balochistan, where there is a tribal system and joint family culture, this is not easy. So far, field workers lack access to National Database and Registration Authority (NADRA) records. Birth registration, too, is a problem.

I haven’t noticed any comprehensive training on capacity building for journalists. When have we asked the field or union council staff about the problems they face during vaccination campaigns? Expecting better results without improving our efforts is naïve at best.

The writer is a Peshawar-based journalist, researcher and trainer on conflict and peace development. He can be reached at

An old enemy strikes again