Pakistan has virtually eliminated polio. Then things went wrong.

PESHAWAR, Pakistan – Nobody saw him coming.

The virus was about to be eliminated. Millions of young children have been inoculated several times and, in March, the older ones were added during a national vaccination campaign to ensure that Pakistan – one of three countries where polio is still endemic – can be officially declared polio-free.

But another danger was threatening in the same communities where vaccination efforts had been going on for a long time. It was a fear and a suspicion, and they were so visceral – and so fast in the digital age – that a single rumor that vaccinated children were getting sick in a village school last month sparked panic and violence throughout the country.

Since then, the anti-polio campaign has been suspended until July, when the authorities are struggling to regroup. Half a dozen vaccinators or their guards have been killed and new cases of children with numb or paralyzed limbs are reported weekly, delaying years of efforts to eliminate the virus, according to health workers.

"We have bad blunder. We wanted to achieve technical and operational success, a data-driven masterpiece. But we have forgotten that for a father and a mother, the most sensitive thing is their child, "said Babar bin Atta, the government's highest official in the fight against polio. Despite intense efforts to inform the public about the benefits and safety of the vaccine, he said, "We have underestimated the degree of community resistance."

At a time when fear and rejection of vaccines are increasing worldwide and measles cases are on the rise, polio is experiencing at least a momentary resurgence in Pakistan. Between 1994 and last year, the number of infected children in Pakistan increased from 20,000 to 12. But since the end of last month, 10 new cases have been reported. Unless the vaccination campaign resumes soon, some health experts fear that the new cases will exceed 50 cases this year.

The threat of polio remains relatively low compared to that of measles, officially eradicated in the United States in 2000 but appeared in 350 new cases in 2018 and more than 700 this year. In Europe, 34,000 cases of measles were reported in January and February alone.

Measles can be fatal, especially in babies, and has caused more than 110,000 deaths worldwide in 2017. Polio, although rarely fatal, is incurable and can permanently paralyze a child a few hours after the infection. 39; infection. It is spread by fecal matter, particularly in poor and unhealthy conditions, and is endemic only in Nigeria, Afghanistan and Pakistan.

A Pakistani police officer stands guard during a polio door-to-door vaccination campaign in the suburbs of Islamabad in April. (Aamir Qureshi / AFP / Getty Images)

"It's so depressing. A drama day has ruined three years of work, "said a Pakistani government epidemiologist, who requested anonymity because he is not allowed to speak to the media. "The people who welcomed our teams to their homes now are closing the doors."

The hysteria that began in a village school in Mashokhel, in the northwestern part of the country – and quickly spread through the mosque speakers and WhatsApp – had both unique cultural roots and larger and more modern lessons.

The northwestern tribal belt, a Pashtun ethnic area near the Afghan border and the epicenter of polio in Pakistan, is deeply conservative, religious and suspicious of authority. Polio vaccine refusals were once common in this country; many people suspected that these drops were part of a Western plot to control the birth rate of Muslims, and Islamist militants regularly attacked vaccination teams.

In recent years, Atta and health officials have said that educational campaigns and support from Muslim clerics have helped to change public opinion, that extremist groups have been driven out of the region and that the refusals of vaccination had greatly decreased. But this spring, when officials announced that all children under 10 would be forced to receive drops of polio, suspicions began to emerge.

"We created a nuisance," said Atta. "People have had enough that our teams make as many visits and ask as many questions. This only took a spark.

On April 22, the vaccinators spent the morning in a school in Mashokhel, a few kilometers from Peshawar, the capital of Khyber Pakhtunkhwa province. Shortly after leaving school administrators announced that dozens of students were vomiting and fainting. Among local residents, suspicions long repressed broke out in a frenzy. An angry mob attacked the school and burned down the local clinic.

"People were mooring my stone house," said Arshad Khan, 35, a long-time local health worker. He said that even during the years when Islamist militants attacked the vaccination teams, he remained in office. "There is nothing wrong with the drops," he said, "but this misunderstanding, these false reports have hurt our efforts throughout the country."

While news circulated that day on social networks and cell phones, scared parents rushed 40,000 children to hospitals in Peshawar. Health officials later said that almost all had been found healthy and sent home, but it was too late to contain the panic. Across the country, hundreds of thousands of parents refused to let their children receive the drops and the vaccination campaign was suspended.

Police arrested 16 people in connection with an alleged plot to sabotage the polio campaign, including several school staff members. Pernicious messages and videos have also been posted online, contributing to the crisis. One of them showed that a man, who was later arrested, orders the schoolchildren to lie on hospital beds and pretend to be dead. To be sick. Another showed a stranger who denounced polio vaccinators as pimps and prostitutes working for the United States.

Pakistani officials have blamed Facebook, saying they were asking the company to remove these publications. "They call it free expression, but there are crazy pages with people playing a dirty game," said Atta, adding that Facebook had millions of users in Pakistan. "They urge the anti-polio elements to take it from our workers. People are being killed.

In Peshawar, the fear of Mashokhel again shook the population. Some said that this week she had re-established their suspicions of polio drops. Even some local officials have announced their intention to refuse to vaccinate their children. Some demanded to know why the government was continuing to focus on this disease and not others that are more common, such as malaria or dengue fever.

"I do not understand why the government is forcing children to be vaccinated," said Ashraf Ali, 38, a shopkeeper who said that he had now decided not to let his 2-year-old daughter receive the drops . "They keep insisting, but I keep refusing. I am the father of my children and that is my choice. "

In Rawalpindi, a large city in Punjab province, water and sewage samples from many poor Pashtun communities have been repeatedly tested positive for the polio virus. Health officials said they hoped to vaccinate about 14,000 children in the country in the past month, but more than half of the parents refused. Several vaccinators have been beaten.

Noor Jahan, 30, an experienced vaccinator, toured last week in a Pashtun neighborhood that she visited several times. She spoke with the families, trying to convince them that the drops were safe and that their children still needed a series of doses to become immune. People were polite but not really influenced.

"Look how we live. The water is low, the sewers are in bad condition, there is no health care when you get sick. But the government continues to bring these drops to our homes and to pursue our children on the streets. Why? Ahsan Bahadur, 35, a father of two, said. "It's not about the vaccine or the virus. It's up to God. "

Constable reported to Rawalpindi, Pakistan.

Read more

Pakistan, on the verge of eradicating the polio virus, faces human obstacles

Pakistan is about to eradicate polio. A double assassination shows the dark challenges still to be met.

Today's coverage of Swiss Post correspondents around the world

Like Washington Post World on Facebook and stay informed about foreign news