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"If we continue like this, polio will not be eradicated," says Oliver Rosenbauer of the World Health Organization (WHO). He sounds a little angry.
The fight against polioviruses that cause polio is actually a worldwide success story: the disease has now been eradicated in almost all countries - except in Pakistan and Afghanistan. 2019 was to be the year of the breakthrough, the first year after 25 years of intensive campaigns and efforts to get rid of the highly contagious viral disease there as well.
And it looked good in the Islamic Republic of Pakistan until April 22, 2019. Since then, 91 new cases of poliomyelitis have occurred. That is more than seven times as many as in 2018 and more than four times as many as in 2016. Most of the new cases were in Khyber Pakhtunkhwa, an arch-conservative province in the north of the country that borders Afghanistan.
What happened and why is it not possible to get Pakistan polio-free?
Bahzad Khan
Two vaccinators on the edge of the Karachi Toll Plaza - children on passing buses must also be checked for polioviruses
In April 2019, the so-called National Vaccination Days (NIDs) started in the country for the second time this year. 260,000 helpers should vaccinate more than 37 million babies and children across Pakistan. They go from house to house to see children and give them the oral vaccine. In addition, there are vaccination options in health centers, mosques or hospitals.
Most of the vaccination workers come from the region in which they are used. They know the respective customs, are also trained in workshops for their assignments and learn in role plays to deal with negative attitudes of parents.
On April 22, the Pakistani Tayaba Gul reports, the vaccination workers also went to schools and madrasas - traditional Islamic educational institutions - in Khyber Pakhtunkhwa. Children from one of these schools were later taken to a hospital because they allegedly suffered from diarrhea, nausea and headache as a result of the swallowing vaccine.
This news, says Gul, spread like wildfire. Other parents then took their children to hospitals for no reason, and reports of the harmful effects of polio vaccinations appeared on Facebook within a few hours and continued to spread. Events rolled over, Gul said: Opponents of vaccination set fire to an infirmary. A vaccination worker and two police officers who accompanied helpers in Khyber Pakhtunkhwa for protection were killed.
As a result, around 100,000 parents refused to give their children the vital vaccination. The vaccination campaign was interrupted.
Aziz Memon still thinks hysteria is inappropriate. He has been at the head of Pakistan's "EndPolioNow" movement since the mid-1990s. He says, "We have had cases like this in the past." Only this time, the false news through social media would have spread even faster than before.
Bahzad Khan
The child's finger was marked in black as a sign that the girl had already received the polio vaccine
There are many reasons for vaccination resistance, according to the Pakistani. As again, the rejection is often based on Pashtuns, Sunni Muslims who are strongly influenced by Orthodox Islam. The schools where the students apparently fell ill due to pressure did not follow normal curricula, Memon said, but were among the country's radical traditional educational institutions.
Very often there are basically reservations about vaccines at such schools and among Pashtuns - rumors are circulating again and again that vaccinations can have a negative effect on family planning or are a "poison for the Americans". "Uneducated people are often carried away by senseless scaremongering," Memon describes one of his country's core problems.
Bahzad Khan
Young child being vaccinated against polio in a small health center in the south of Karachi city, Sindh province, Pakistan
Lack of education, especially among girls, is one of the biggest challenges in Pakistan. Only 39 percent of all girls and 46 percent of all boys attend secondary school at all. Overall, only 59 percent of the population can read and write.
In Khyber Pakhtunkhwa province, where most new polio cases have occurred since April, less than 20 percent of women in rural areas can read and write. The population is also growing particularly rapidly here, with an average of eight people living in one household, and children can be seen on every corner.
In addition, according to the WHO, many children have not yet been found and reached through the border crossings from Afghanistan to Pakistan. Environmental samples also showed that the virus can still be detected in a number of rivers, streams and especially in sewers.
WHO expert Oliver Rosenbauer sees another difficulty for the polio program in Pakistan: So far, the vaccination workers have only focused on polio. However, many families have completely different problems and are annoyed by the constant questions about the polio vaccination, Rosenbauer describes the feedback from the helpers from the country.
"We need to expand the vaccine support portfolio, much like we did in Nigeria," he believes. The emergency services there not only provide information about polio and vaccinate children, but also provide information about other vaccination requirements, family planning, preventive care during pregnancy and proper nutrition.
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So Nigeria - and thus all of Africa - could be declared polio-free this year. All of this is part of the global Global Polio Eradication Initiative (GPEI), which has been running in Pakistan since 1994. The GPEI is the largest global health initiative ever undertaken. Around 430 million children are now vaccinated against polio every year.
The initiative has cost approximately $ 16 billion over the 30 years of its existence, funded by private donors as well as by Unicef, WHO, Rotary International, the US Center for Disease Control, the Bill and Melinda Gates Foundation, and the global vaccination alliance.
By the end of the year, the WHO plans to reorganize the vaccination program in Pakistan together with the GPEI partner organizations. With a crowdsourcing competition this autumn, they want to find ideas for innovative technologies that should help put an end to vaccination opponents.
This contribution is part of the Global Society project, for which our reporters report from four continents. The project is long-term and is supported by the Bill & Melinda Gates Foundation.
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