Photo: Kamila Hyat/IRIN
A mother and child at a WHO polio vaccination centre in NWFP. Mothers are generally keener to vaccinate their children than men.
PESHAWAR, 7 February 2007 (IRIN) - Two women slip into the polio vaccination centre at the Khyber Teaching Hospital in Peshawar, a baby hidden in a shawl. The women are scared and seem desperate to leave as soon as possible.
“My husband doesn’t know we are here. He does not want his children immunised against polio, because he says this is a western conspiracy to force birth control in a hidden form on people. But I want my son to be safe,” says Ajmeena Khan, 25.
She has smuggled her five-month-old son, Ozair, to the vaccination centre with her sister, while her husband is away at the shop he runs in a bazaar in the capital of the Pakistan’s North West Frontier Province (NWFP).
“I normally never leave the house without him. He would be furious if he found I had disobeyed him,” Khan explained.
NWFP is Pakistan’s most conservative province, and one of the manifestations of a Taliban resurgence has been a rising opposition to anything perceived as ‘western’ in origin – including polio drops.
Salaries exchanged for vaccines
Rizwan Ali, campaign manager with the United Nations World Health Organization (WHO) in Peshawar, says: “People refuse these drops for a variety of reasons. These include misconceptions or the notion that they are being promoted as part of an agenda against Islam or they believe that the drops could lead to infertility and are thus intended as a secret form of birth control.”
In addition, local communities have insisted certain demands be met before they allow their children to be immunised. According to WHO teams in Peshawar, these include provision of drinking water and salaries for government officials who have not been paid for months.
Polio in Pakistan
Polio remains endemic in the country.
US$196 million vaccination effort under way.
Most strains of the disease originate in Afghanistan, Pakistan, India or Nigeria.
At least 160,000 children in the country have not been immunised.
Pakistan reported 39 cases of polio in 2006, 15 in NWFP.
Ali said there had been 24,288 refusals in January 2007. Of these, in 2,238 cases people put forward several demands before agreeing to the vaccination. In another 1,347 cases, religious grounds were given for refusing the vaccine. The remainder cited misconceptions about the effect of the drops.
“The figures vary slightly from one drive to the next,” Ali explained, but presented a significant challenge for health workers on the ground.
Pakistani health officials say such refusals have left at least 160,000 children vulnerable to polio. In 2006, the Pakistani health ministry reported 39 cases of polio, 15 of them in NWFP. This was a 30 percent increase on 2005.
The South Asian nation is one of only four countries in the world where polio is endemic, according to the WHO. An international conference in Geneva heard in October 2006 that most strains of the disease originated in Afghanistan, Pakistan, India or Nigeria.
In Pakistan, there has been growing concern over the failure to eradicate the disease, despite a US$196 million annual campaign spearheaded by the WHO and supported by the government.
A Pakistani child is vaccinated against polio.
During anti-polio drives, the country’s leaders are regularly shown administering drops to children, in a bid to emphasise the anti-polio message.
The WHO confirms the most severe resistance is seen in the NWFP, although opposition has also been encountered in Punjab and Sindh. In 2006, 66 areas were not covered – most of them in the NWFP’s tribal areas.
Most refusals are covered in future visits, with social workers and local NGOs often called on to help change people’s minds. But these tactics are not always successful, and in at least four cases in the last year, immunisation teams were beaten up, abused or driven away by local people.
“This is quite a serious problem in some areas. While there is a lot of campaigning on television etc, people are not always convinced,” said Imran Khan, provincial coordinator for the Human Rights Commission of Pakistan in the NWFP.
Fighting the rumours
Arman Khan, from a village on the outskirts of Peshawar, is one example: “These polio drops, and other injections, are a conspiracy of the West. Our government is allied with them. They don’t want Muslims to have children, because these children will later join the ‘jihad’ [holy war] against the West.”
Khan’s two-year-old son has not been vaccinated and he has no intention of permitting the child his wife is expecting to be immunised either.
“Allah will protect our children. We don’t need the medicines of the Americans,” said Muhammad Sanullah, father-of-three, who works in Peshawar as a mason.
His family lives in the South Waziristan tribal area along the Afghan border – one of the regions that has seen a rapid rise in orthodoxy, spurred on by the presence of militants.
’’Allah will protect our children. We don’t need the medicines of the Americans.’’
Compared with fathers, however, mothers, when addressed alone, seem less hostile to the vaccine. “Women are often willing to have children vaccinated, but don’t dare defy their husbands or fathers-in-law,” said Shazia Irum, 27, a health worker in Pakistan’s programme to offer basic care to mothers and children.
But with women for the most part disempowered and unable to take an active role in decision-making, there is clearly a need to do more to counter the rumours and allegations about the polio vaccine.
WHO and the Pakistani government have for many years sought to quash the rumours and speculation. “We use social workers, local clerics, health department officials and others to counter such propaganda. When a message against polio is broadcast over a radio station, we try to get an announcement about the true position broadcast,” Ali from WHO explained.
The Pakistan government has also encouraged leading clerical figures to launch polio vaccination drives and messages about the benefits of the vaccine have been broadcast from mosques in many towns and villages.