Pakistan: Polio And Crippling Faith – Analysis

By Tushar Ranjan Mohanty

On June 8, 2024, five people, including two Policemen, were injured when unidentified assailants opened fire on a polio vaccination team in the Kulachi tehsil (revenue unit) of Dera Ismail Khan District in Khyber Pakhtunkhwa (KP). 

On June 4, 2024, a Policeman assigned to polio workers protection duty was shot dead by unidentified assailants in the Suleman Khel area of Peshawar, the provincial capital of KP. Policeman, identified as Shahnawaz, was killed in the Suleman Khel area when he was going to perform his duty. No one immediately claimed responsibility for the killing.

On June 3, 2024, four Levies Force personnel guarding the polio campaign team and two female polio drive team members were injured when a mob armed with sticks and batons attacked a polio vaccine team in the Chaman town (Chaman District) of Balochistan. Deputy Commissioner Raja Athar Abbas said the attackers were members of a sit-in protest being held in Chaman against the polio vaccination campaign, which began on June 3 in Balochistan. 

On June 3, 2024, an unidentified assailant was killed while one Policeman sustained injuries in a clash when a group of four assailants attacked a polio vaccination team in the Wargari Bhittani area of Lakki Marwat District in KP. While one assailant was killed in retaliatory fire by the Polio security team, the other three assailants managed to escape. 

These three attacks came against the backdrop of the 2024 Fourth Phase of the National five-day anti-polio vaccination drive which commenced on June 3, 2024, targeting around 16.5 million children across the country. “More than 16.5 million children under the age of five will be vaccinated in a crucial polio campaign beginning on June 3 in 66 Districts, ahead of the high-travel season of Eid-ul-Adha,” a Federal Ministry of Health press release stated. The press release further disclosed that the five-day campaign was to be implemented in 36 Districts in full, and partially in 30 Districts, including Islamabad, 20 Districts of Balochistan, 23 Districts of KP, 16 Districts of Sindh and six districts of Punjab were included in the campaign. 

Speaking on the occasion of the National anti-polio vaccination drive, the Prime Minister’s Coordinator on National Health Services, Malik Mukhtar Ahmed Bharath, called on parents and caregivers to ensure their children received the best care possible, adding, “Poliovirus has paralyzed 4 children this year and is consistently being detected in sewage samples, which means the risk to children remains very high.” The latest reports indicate that the country’s fifth case of polio this year has been detected in Quetta. 

Whenever a polio campaign is launched in the country, incidents of attack targeting polio vaccination teams and the Security Forces (SFs) giving protection to them are recorded. Earlier during the third phase of seven-day anti-polio drive began between April 29 and May 5, 2024, targeting more than 24.4 million children under 5 across 91 Districts, several incidents of attack on people associated with Polio campaign were recorded. On April 30, for instance, a Policeman, identified as Azam Khan, guarding a polio vaccination team, was shot dead by unidentified terrorists in the Mamund area of Bajaur District in KP. On May 2, a Police van guarding a Polio vaccination team came under heavy firing in the Tank District of KP. A deputy superintendent of Police (DSP) was also in the mobile van. The attackers managed to escape after retaliation by the Police. The members of the polio team and Police personnel did not sustain any injuries in this attack. 

The second phase of anti-polio drive, conducted from February 26 to March 3, and in 33 Districts of KP from March 2 to March 6, targeting more than 45.8 million children, also seen targeted attacks on Polio workers. On February 28-evening, a polio vaccinator was killed by unidentified assailants after he returned from his duty on in Bhittani subdivision of Lakki Marwat District in KP. The decapitated body was found close to his house in the early morning of February 29. On March 4, a polio vaccinator and a Policeman guarding polio teams were injured when unidentified assailants opened firing on them in Bar Qambarkhel area of Bara tehsil in Khyber District of KP. On March 5, a Policeman escorting a polio team was shot at and injured in an attack by unidentified assailants in Pirsadi area of Mardan District in KP. 

Similarly, the first phase of anti-polio drive, between January 8 and 14, was also marred by violence when, on January 8, at least seven Police personnel were killed and 22 were injured in a bomb attack on a Police vehicle, when they were on their way to perform security duties for polio vaccinators in the Mamond tehsil (revenue unit) of Bajaur District in KP. Both Tehreek-e-Taliban Pakistan (TTP) and Islamic State Khorasan Province (ISKP) separately claimed responsibility for the attack. On January 12, a Police constable, Jameel Ahmed, who was assigned to safeguard polio workers, was killed in a gun attack by unidentified motorcycle-borne assailants near the Eastern Bypass School in Quetta, the provincial capital of Balochistan. On January 9, two Policemen were killed and another two were injured, as terrorists attacked Policemen deployed for the protection of the Polio team in the Miryan area of Bannu District in KP. Two terrorists were also killed in the subsequent retaliation. 

Apart from these time attacks during anti-polio vaccination campaigns, people associated with Polio vaccination also faced hostility and attacks in other times. According to partial data compiled by the South Asia Terrorism Portal (SATP), at least 13 Policemen, three militants and two Polio workers have been killed in 16 incidents of attack in 2024, till date (Data till June 9, 2024). Another 40 persons, including 12 Policemen have sustained injuries during this period. 

In 2023, the polio immunization campaign, which was also held in four phases, was marred by terrorist violence. At least four Policemen and one Polio worker were killed during the 2023 campaign. While the first phase, January 15-18, was by and large peaceful, the second phase, May 15-June 6, claimed the life of one Policemen, while three others were injured. The third phase, between August 1-10, claimed the lives of three Policemen in two separate attacks. During the fourth phase, which was conducted between October 2 and 6, three incidents of attack were reported, in which one Polio worker was killed and two Polio workers sustained injuries. 

The 2022 polio immunization campaign was also no exception, with at least seven Policemen and two Polio workers killed during the campaign. While the first phase, January 17-January 24, was by and large peaceful, there was one incident of the killing of a Policeman, on January 25. The second phase, June 27-July 3, claimed three lives, including two policemen and one polio worker. Though the third phase, August 19-August 29, did not record any violence, two Policemen escorting a polio team for a survey in the area were killed by armed men on August 16, in the Tank District of KP. During the fourth phase, which was conducted between October 24 and 30, two incidents of attack were reported, in which two Policemen were killed. 

The first polio immunisation-linked incident of violence recorded by the SATP database was reported on July 20, 2012, when unidentified terrorists shot dead Doctor Ishaq, associated with the World Health Organization’s (WHO’s) Polio Prevention Campaign, at Al-Asif Square in Junejo Town, Karachi, the provincial capital of Sindh. The Polio immunisation programme in Pakistan has been under escalated threat from Islamist terrorists since the Central Intelligence Agency (CIA) reportedly organised a fake vaccination drive by Doctor Shakeel Afridi, to track down Al-Qaeda’s former chief Osama Bin Laden, who was killed at Abbottabad, KP, by United States SEALs in the intervening night of May 1-2, 2011. Polio vaccination has historically been resisted by fundamentalist and extremist elements in Pakistan, and the Polio vaccination were suspended for three years between 2009-2012 due to the hostility of militant elements. Terrorists and extremists also spread vicious propaganda against the vaccination campaigns, including the canard that the vaccination drops were part of a western plot to sterilise Muslims.

Since the first attack on Polio workers in 2012 recorded in the partial data compiled by SATP, at least 155 persons (91 Policemen, 61 health workers and three militants) have been killed in such violence (Data till June 9, 2024). Another 126 persons (83 health workers and 43 policemen) have been injured in such violence. 

According to a Dawn report of January 9, 2024, in KP province alone, 106 people have been killed in polio-related incidents since 2012. The report puts the number of injured Policemen and polio workers at 162 during this period. A total of 13 people have been kidnapped during vaccination drives. Vaccinators have fallen to bullets of unidentified assailants for long, but not as aggressively as they had been since 2012. The year 2014 recorded 17 deaths, the highest for any year since 2012. In each of 2013 and 2016, militants killed 13 people. According to the Dawn report, Peshawar has recorded 23 such killings since 2012; Charsadda, 12; Swabi and Dera Ismail Khan, 10 each; Bannu, nine; Bajaur, seven; Mardan six; Tank, five; Mansehra and North Waziristan, four each; Bannu and Buner, three each; Lower Dir, Swat and Khyber, two each; and one person each was killed during anti-polio campaigns in South Waziristan, Nowshera, Kurram and Lakki Marwat.

Pakistan is one of just two remaining countries in the world where polio is still categorized as ‘endemic’, the other one being Afghanistan. As of June 8, 2024, five polio cases have been detected in Pakistan. Two six cases were detected in the country in 2023, 20 in 2022, one in 2021, and 84 in 2020. 

Since 1994, the Pakistan Polio Eradication Programme has been driven by up to 339,521 trained and dedicated polio workers, the largest surveillance network in the world. The Government provided security to the vaccination teams. However, terrorists continue to hunt down both Polio workers as well as their security teams. A Hindustan Times report on April 13, 2023, stated that Police officials in the North Waziristan District of KP had refused to join polio vaccination duty, as they feared attacks by TTP terrorists. 

Not only SFs but also the parents are also afraid to get their children vaccinated, due to fear of Islamist terrorists, as well as due to their own blind belief. To deal with this, the Government of Pakistan has been considering a law to fine and imprison parents who refuse to get their children vaccinated. On August 25, 2023, the Sindh Governor signed the Sindh Immunization and Epidemics Control Bill 2023, under Section (1) of which the concerned deputy commissioner (DC) has been given powers to impose penalties. The accused parents can face a one-month jail term and PKR 50,000 in fines. According to a Pakistan Today report of April 13, 2024, over 63,000 parents across Pakistan refused to vaccinate their children during the second phase of national anti-polio drive in 2024. The breakdown of the refusal rates by province was: 38,749 parents in Sindh declined the drops, followed by 20,392 in KP and 4,081 in Balochistan; 175 in Punjab, 75 in Islamabad, and 24 in Pakistan Administered Kashmir.

While the sections of the general public remain hesitant in administering Polio drops to their children due to prevalent societal taboos, their blind beliefs are fuelled further by the elders of society. Thus, on November 29, 2023, the Utmanzai Jirga (council of tribal elders) of North Waziristan District in Khyber Pakhtunkhwa declared a fine of PKR 500,000 on parents who allowed their children to be vaccinated for polio. The Jirga spokesperson, Mufti Baitullah, announced a complete ban on the vaccination campaign, imposing heavy fines on violators. Adding to the gravity of the situation, the Jirga shut down the Bannu-Miranshah Road to all types of vehicular traffic, causing significant disruption. 

Having failed to address the taboo related to Polio vaccination, the Government has sought to blame others. On June 7, Pakistan Polio Eradication Program chief Dr. Shahzad Baig resigned from office, citing the ‘failure’ to contain the spread of the crippling virus. Dr. Shahzad Baig was asked to ‘quit’ by the Government on account of his ‘failure’. 

Similarly, on October 2023, the Pakistan Government blame Afghanistan for its Polio problem. Federal Interim Health Minister Dr. Nadeem Jan sated, on October 5, 2023, that 90 per cent of cases in the country were “imported from Afghanistan.” Speaking about the rising number of polio cases in an interview with the Dawn News programme ‘Doosra Rukh‘, the Health Minister claimed: “Our surveillance is optimal. Of the 34 samples that we have received, 90 per cent have come from Afghanistan… our own are even less than 10 per cent”. 

The structure of state power in Pakistan has been constructed on an Islamist fundamentalism that promotes blind belief and extreme prejudice. It is this environment that has allowed Polio to survive in this country and to continue to disable her children – even as a comparable environment of bigotry and fanaticism afflicts the only other country where this disease persists, Afghanistan. As long as the state itself continues to promote ideologies of extremism, it is unlikely that it will succeed in targeted campaigns to rid the country of this crippling disease.

• Tushar Ranjan Mohanty
  Research Associate, Institute for Conflict Management