Polio vaccinators risk their lives to save lives in Pakistan

KARACHI, Pakistan — Tahira Yasmeen wraps a shawl around her face as the driver inches our car through mud and over rocks, maneuvering the bouncing white Corolla down a lane in Machar Colony, one of the most dangerous areas in Gadap Town’s Union Council 4 (UC-4). The impoverished accretion of settlements on the edge of Karachi is home to some 300,000 people, mostly Afghan refugees and, since 2008, tribal Pashtuns fleeing war in South Waziristan and other tribal areas. It is here, say United Nations health officials, that the global fight against the resurgent polio virus will be decided. So far, that fight is being lost.

Men peer into the car as they walk to attend Friday prayers in a ramshackle cinder-block mosque that sits on the ridge of a small hill. Below, sludge floats along a stream that routinely floods the area with raw sewage. Young children, ubiquitous, some blond and light-eyed, play barefoot outside small homes, many no more than wood planks topped with thatched palm fronds. Over the past three years, the Pakistani Taliban have extended their control in a part of this megacity long neglected by local and provincial governments, through intimidation and efficient, often brutal justice. 



Yasmeen, a UNICEF employee, has worked to eradicate polio in UC-4 for nearly five years, leading teams of young Pashtun women from Gadap. They work as “mobilizers” to persuade residents and influential local figures to vaccinate their children and support the campaign. “I have good contacts in Gadap — every child and influential person in every street knows me,” Yasmeen says as we drive past a small government-run dispensary where residents once brought their children for polio vaccinations. It now sits empty; posters exhorting Pakistanis to vaccinate their children hang ripped and peeling from its exterior walls.

After it was revealed in 2011 that the CIA had used a Pakistani doctor, Shakil Afridi, to run a fake hepatitis vaccination program as a ruse to collect DNA from Osama bin Laden’s suspected hideout, polio workers began to face violent resistance as militants thought they might be working to gather intelligence. "It is against Islam and our traditions. These foreign nongovernmental organizations can easily use polio as cover for spying,” a spokesman with the Tehrik-e-Taliban Pakistan (TTP), an assortment of militant groups based in the tribal areas, recently told The Wall Street Journal. 



The TTP, which began filling the vacuum of governance in parts of Karachi where many Pashtun migrants have settled, played off the fears long spread by right-wing clerics that the vaccine is part of a Western plot to sterilize Muslims. But the TTP’s opposition was less ideological than tactical. A militant commander, Hafiz Gul Bahadur, said in 2012 that polio vaccinators would be allowed into North Waziristan and other areas controlled by the TTP if the CIA stopped its drone strikes.

But while it is easy for health officials to blame Karachi’s police force, cops in the city are on the front lines of the fight against an amalgam of violent groups, including not only the Taliban and sectarian terrorists but also gangsters and political thugs. Criminal gangs view polio vaccinations in much the same way as the Taliban does: cover for intelligence gathering. With terrified judges and prosecutors unable to secure convictions in many cases, the police are left without protection from the state, and they die in greater numbers — more than 190 last year alone — than in any other city in the world outside of a war zone. 



Pakistan’s administrative bureaucracy also plays a role in the polio campaign’s struggles. While the provincial government has given more control to Karachi’s six district-level administrators to run the campaigns according to the specific needs of their areas, not all the commissioners have prioritized the vaccination campaigns. Qazi Jan Mohammed, the dapper, chain-smoking commissioner of district Malir, has made tackling polio a priority in the swath of Karachi under his control. He has employed creative tactics, like giving street children a few rupees each for taking the vaccination, that have rendered his domain polio-free. But other commissioners are not as motivated, and some even exaggerate the number of people who’ve received vaccinations in their areas.

At the street level, mismanagement is also a long-standing problem. Vaccinators complained of not being paid on time and facing trouble accessing the direct-deposit accounts created for them. Many quit; Yasmeen says she has had entire teams of workers desert after being trained.

The ultimate success of the polio eradication efforts in Karachi may well depend on the social mobilizers, in UC-4 and other parts of the country, who try to persuade families who’ve refused vaccinations. Sana, 20, is one of the five mobilizers in UC-4. She declined to give her real name out of concerns for her safety. Sana is from the Mehsud tribe and works more or less undercover, defying the TTP ban on tribal women working for the polio cause. She began as a vaccinator, but quit after a neighbor she says was a Taliban supporter took video of her with her vaccination kit on his mobile phone and threatened to send it to the local militant leader. Once, not long after, she was followed by a young man as she left for her college. At first she thought he was trying to flirt with her. “But he was just watching,” she says. “My brother told me he belongs to the TTP.”

Now, when Sana leaves home for her social mobilizing work in an adjacent zone of UC-4, she brings multiple changes of clothes and makeup, even though she wears a niqab and alters her routes daily. “My family tells me I must leave this job immediately, but I want (other Pashtuns) to be aware that this is very important for the children. I told my family that maybe because of me, many people will give their children the drops and many children will be safe from this disease.” 



Among Pakistani health officials, it seems to be an accepted fact that Pashtuns are ignorant, uneducated and a big reason why the polio campaign is struggling. But this analysis obscures the many reasons for their long-standing distrust of the government, says a journalist who lives in Gadap and is originally from South Waziristan. Today in Karachi, for example, Pashtuns are often unfairly targeted by the police. “Most Mehsud hate the TTP,” the journalist says, “but if the police humiliate me I have no choice but to join them to seek revenge.”



One afternoon I accompany Shoaib Khan, a young medical student from the Swat Valley, during his rounds as a mobilizer in Hijrat Colony, a Pashtun slum in central Karachi. He declined to give his real name, saying he was fearful of militants. We set out from a local health center with a burly police officer who says a prayer as we leave, and who carries his pistol unholstered, hidden in his jacket pocket. Our first stop is a cloth shop on the congested commercial lane. A man sits among reams of white and blue cotton reading a newspaper. Shoaib says the man’s father, who owns the store, beat his son for allowing his children to be vaccinated. The mobilizer asks the man where his father is, and the cloth merchant smiles nervously and says his father is away.