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Polio immunization campaigns, despite registering landmark successes worldwide in Pakistan, have come under fire in a military conflict in North Western Pakistan. Taliban commanders, holding sway over large tracts of tribal belts, have outlawed access to children for polio immunization teams. Later, Tribal jirga (assembly) echoed the sentiments of Taliban commanders and put directed tribal populations to refrain from having children immunized. On 19th July 2012, an expat physician came under fire while moving in his UN marked vehicle in Karachi for an immunization drive. 

Polio is a crippling human disease. It can afflict children indiscriminately of all ethnicities, nationalities, religions or races. In 1916, New York alone registered more than 2000 deaths in America’s first and the deadliest Polio epidemic to date. Later, Paralytic Polio would assume epidemic proportions, not just in the developing world, but also across Europe, North America, and Austrialia. The disease has a long and a frightening history of mass suffrage, crippled survivors, and children either succumbing to the disease or made unable to play, learn, grow, or even breathe.

But Polio also has a cherished history of bringing humanity together, for it were the Polio survivors who grew up with their own versions of childhood, who ingrained into the public consciousness the need for equal opportunities, empathy and philanthropy. It laid the foundation for development of varied medical fields, including rehabilitative medicine and surgery, Intensive Care Unit facilities and its most lasting legacy –widespread public immunization efforts.

Not all epidemic diseases respond equally to immunization programs. HIV, another viral disease, remains still elusive for vaccine developers despite massive research. Malaria –subject to widespread public health initiatives across the world leading to dramatic improvements, made a strong resurgence further on. Tuberculosis is experiencing a second coming amid increasing drug resistance, deteriorating living conditions in the Third World and a weakening public commitment. What makes Polio stand out, in that an immunization campaign brought a global killer down to its present figures of under 1000 a year?

Polio Vaccine is unlike Any Other Vaccine

Polio is one of the few communicable diseases that can be entirely eradicated by immunization programs. The shear importance of this vital public health realization can simply not be underestimated. Immunization offers a tremendous opportunity in ushering a new era in human history –one without a disease that has been a scourge throughout times. Iin the 30’s when this was realized, the efforts it spurred in vaccine development were phenomenal.

There are several reasons for Polio’s vulnerability to vaccination. While Malaria can hide in (obviously unvaccinated) monkeys, and several other communicable diseases can propagate in animals only to be reintroduced in human populations, Poliovirus has no other non-human reserves. Also, the body’s immune response is particularly geared to defend against viral invasion in a particular way –one that is specifically bolstered by the immunization. The Virus is also very vulnerable to environmental factors and so cannot ‘stay out’ for long –it has to quickly move from one human to another (usually by fecal contamination of drinking water). We had finally found a missing link in Poliovirus’ strategy; now we knew where to strike to achieve results –putting brakes on the transmission from one human to the next.

The Oral Polio Vaccine (OPV) basically delivers a small dose of inactivated Poliovirus to the body’s digestive system. The idea is to allow the body to ‘know’ the virus beforehand, so that when similarly, the digestive system is faced by much bigger actual challenge by Poliovirus (via drinking water contamination), it knows the virus well enough to mount a defensive immune response.

When the digestive system is well protected, the most important entry and exit routes for the poliovirus are secured. It’s a typical military strategy, and I reckon Taliban should learn to appreciate it.

The Taliban Got It Wrong

Polio Vaccination has a long history of philanthropy, of shared human efforts shaped by universal suffrage, and of the principle that ‘No one is safe until everyone is safe’.  Pin it down to a general lack of education and awareness, to the popularity of conspiracy theories or to the actual recent CIA espionage under cover of vaccination drive, the Pakistan Tribal and militant Islamists came to very wrong conclusions indeed.

Polio immunization campaigns had been viewed as a concerted effort to harm the Muslims by reducing their fertility. However, it bears mentions that any chemical that would selectively reduce human fertility at such low doses which are so sparsely timed, and at such a young age simply does not have a scientific precedent. Most drugs and foreign chemicals are metabolized by liver or tissues or cleared by kidneys in a matter of hours, or at most, days. No wonder, we have to take three separate doses to keep even the slightest of pains under control. Polio vaccine itself does not stay in the body for much longer; all it does is induce a change in body’s immune system that outlives the original dose.

Polio campaigners themselves are smeared by many orthodox Muslims, despite the heroic and commendable job they carry out (I myself have been part of a immunization monitoring program and have experienced how hard this job is). This partly arise from the more secular motivations of such workers –of reducing Pakistan’s disease burden, of improving child health, and bringing Pakistan to the fore of global health initiatives. The opposition also arises from an inherent ‘fear of the unknown/different’ that is omnipresent in the Pakistani environment –these health workers are seen as promoting West’s agenda, or sowing discontent, and of harming the true dwellers of this land. It was exactly this fear of the unknown which was confirmed by CIA’s rash undercover effort to collect OBL’s whereabouts in the garb of immunization campaign.

Political Expediency

A large part of the current opposition to Polio drive stems not from such ideological rhetoric or fears, but rather brash displays of political expediency. Polio eradication is an international concern. The Taliban or their likes may not stand up to the task, but the rest of the world care about finishing the job. Unless completely eradicated, the risk of transmission for the world remains. The Taliban or the tribal elders may not know the exact science, but they sure would have realized the sincere commitments of those personnel working in anti-polio efforts. Plain and simple, they are directing previously neutral polio initiative to take sides in a military conflict.

“Drones martyr so many children, while polio afflicts one or two out of hundreds of thousands,”  -Mamoor Khan, Tribal elder, about Jirga’s decision to back Taliban imposed ban

The Debate that Would Follow

By their very nature, such moves are made to spark debate. The insurgents aspire that the ‘audience’ of the wider ‘theater of war’ to question enemy moves including the drone strikes. Winning over the audience remains the prime motive of any insurgency struggle, and the Taliban move to discredit vaccination would surely renew efforts towards cessation of drone strikes –particularly by Islamists groups.

However, this is also a time to question the way a public health initiative for the benefit of all of humanity is dragged into a divisive civil or military conflict. A year earlier, I wrote about how the CIA effort can undermine the integrity and political neutrality of an already endangered public health initiative. This fresh assault arises from a similar approach to conflict –that some military goals hold supremacy over general humanitarian efforts led by dedicated, non-partisan activists. It’s time that the contribution of such activists is brought to the public light, and the history and the scientific perspective of their contributions made known. The CIA or Taliban may win the turf war, but the public must remain committed to the idea of concerted efforts for the betterment of all.

About Author: Hasan Iftikhar is a final year medical student. He has interests in public health and legislation, acute care and trauma surgery. He blogs at & can be reached by twitter at @hasandoctor