In Pakistan, polio vaccinators earn community trust in spite of danger

A vaccinator from a Rotary-supported polio resource center immunizes children against polio in a village in Balochistan, Pakistan.
Courtesy of Asher Ali
A father plays with his baby daughter, who contracted polio at age six months. He refused immunization for her because of rumors that the vaccine might contain animal urine.
Diego Ibarra Sánchez
A man prays at the grave of his wife, a polio worker who was killed in Karachi in 2013.
Diego Ibarra Sánchez
Polio workers, guarded by police, carry out an immunization campaign in an area of Karachi at high risk for the disease.
Diego Ibarra Sánchez
Parisa Waheed is immunized against polio near Karachi, Sind, Pakistan. Her father, Abdul Waheed Khan, a Rotary Community Corps member who headed a polio resource center in Karachi, died tragically in an attack last May that also wounded his daughter.
Diego Ibarra Sánchez

No polio vaccinator had ever set foot in Killi Baksho, near Pakistan's rugged northwest border with Afghanistan. Most people there have long opposed immunization, believing the polio vaccine causes infertility or AIDS.

The combination of that public mistrust and intimidation from militant groups has been nothing short of deadly. In 2013, 20 polio vaccinators and nine police officers assigned to guard them were killed in Pakistan. With that memory fresh in their minds, a team from a Rotary-supported polio resource center went to the village to promote acceptance of the vaccine. They expected an uphill, potentially life-threatening battle

It took the team a month just to persuade village elders and religious leaders to meet with them. But their persistence paid off. Immunizations were allowed to begin.

Then the campaign stalled again.

“After the team had covered half the children, some militants came and started investigating,” says Pakistan PolioPlus Committee Project Manager Asher Ali. “But the leaders of the community defended [the team] and, after an hour, convinced the militants to back off and allow the vaccine drops to be administered.”

Rotary members have established seven polio resource centers in Pakistan to build community trust in areas that are at high risk of the disease. The centers, along with individual Rotary clubs, sponsor health camps that offer immunization against polio, measles, and other diseases, as well as free checkups, medicine, vitamin A supplements, and eyeglasses. They also advocate for immunization of children in schools, and help to provide it.

Rotary members also work with leading Islamic scholars to form the Pakistan Ulema PolioPlus Committee, which strongly endorses the drive to rid the country of the disease.

These efforts are reaching children who would otherwise be missed, and help to change the minds of parents who once refused to let their children be vaccinated. Success in one community “has a ripple effect on adjoining communities,” says Ali.

Winning community trust is vital to carrying out the polio endgame plan worldwide. Rotary and its partners in the Global Polio Eradication Initiative are at the forefront, focused on countries where transmission of the wild poliovirus has never been stopped: Afghanistan, Nigeria, and Pakistan.

In Nigeria, a network of more than 3,000 volunteer community mobilizers, launched by UNICEF and funded by the Bill & Melinda Gates Foundation and U.S. Centers for Disease Control and Prevention, is promoting vaccination in high-risk areas. In Kano State, where more than half of the children are stunted by malnutrition, the volunteers are connecting families with community nutrition centers. As a result, parents who have opposed polio immunization in the past are allowing their children to be vaccinated.

In Afghanistan, not a single case of endemic polio occurred in 2013. Of the 11 cases reported, all were linked to cross-border transmission from neighboring Pakistan. This achievement reflects the success of social mobilizers, community elders, and religious leaders in forging community trust.

And though the Taliban has dropped its opposition to vaccination in some parts of the country, says Peter Crowley, UNICEF’s chief of polio, “this was a very highly reported reason for vaccinators missing children in southern and southeastern Afghanistan.” 

When a Taliban commander bars immunization in an area, UNICEF staff tries to find out why.

“[The commander] will say, ‘the people who are running the campaign are not trusted by the community,’ or ‘there’s corruption,’” Crowley says. “We looked into [one case] and worked with the government authorities to change campaign coordinators, and then areas that hadn’t been accessed for four years suddenly opened up.”
Globally, families in polio-affected areas who refuse immunization of their children dropped from 1.6 percent to .9 percent between January and September 2013, according to UNICEF.

In many countries, Rotary has enlisted celebrity polio eradication ambassadors to build trust. In Pakistan, international cricketing superstar Shahid Afridi has engaged the Pashtun community, which composes 15 percent of the population but contracts more than 80 percent of the polio cases. In Nigeria, actor Sani Danja is reaching out to Hausa-speaking people in the country’s northern states.

“Sani Danja has shown his love for children by his road shows in Kano as Rotary’s polio ambassador,” says Nigeria PolioPlus Committee Chair Tunji Funsho. Danja is “countering anti-OPV propaganda,” Funsho says, and sending communities a clear message: “Let’s protect our children from polio.” 

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