Lesson for the world: Polio makes a comeback in Pakistan as misinformation, fear and mistrust power antivaxxer movements

From false videos to fake campaigns, trust in vaccines has been eroded

Lesson for the world: Polio makes a comeback in Pakistan as misinformation, fear and mistrust power antivaxxer movements
Lesson for the world: Polio makes a comeback in Pakistan as misinformation, fear and mistrust power antivaxxer movements
  • Fear of vaccines, unfounded beliefs have hurt Pakistan’s efforts to vaccinate people against polio.
  • A disease that has been eradicated in most of the world is making a resurgence, with 12 cases reported in 2018, 147 in 2019 and 55 so far this year
  • Misinformation, lack of knowledge, a fake vaccination campaign and religion are all among the factors that have led to weakened vaccination campaigns and the resurgence of polio.
  • At times, the opposition is not to the vaccines but to the way the vaccines are administered or how vaccination campaigns are carried out, which actually spread hate among people.

KARACHI. Nafees Khan Yousufzai lives in a neighbourhood in the west of Karachi, the biggest city in Pakistan. 

Forty years ago, Yousufzai fell victim to poliomyelitis. The crippling disease left him with a permanent paralysis on his left leg. 

Since then, a vaccine and a global multi-stakeholder campaign have helped eliminate polio in most of the world, but fears of vaccines or vaccination programs have made it possible for holes to emerge in the global net of protection.

Yousufzaiâ’s own 14-month-old child recently contracted the disease. 

“I refused the polio vaccine when my child was born. Even when the (vaccination) team came to my home I told them that there was no child in the house,” Yousufzai told Anticentric.

He believes the vaccine is not good for health. It damages your child’s fertility and, as an adult, the baby will not have the ability to have a child.

Beliefs like this one are not uncommon in Pakistan, particularly in the north of the country. People oppose the vaccine for myriad reasons that range from a lack of clear understanding of how the vaccine works to fear of government. 

“Unfortunately, immunization, especially polio, became a social stigma in our country,” said Dr. Iqbal Memon, a senior member and former president of the Pakistan Paediatric Association (PPA). 

“Anti-vaxxer sentiment or vaccine boycotts have been gain momentum for the last two decades,” said Memon. 

A number of factors have created fertile ground for anti-vaccine sentiment. These factors include religious orthodoxy, geopolitics and misinformation. 

“Initially, the religious orthodox started anti-vaccine campaigns in the northern or upper side of Pakistan like North Waziristan, (the former Federally Administered Tribal Areas), Banu and neighbouring areas of Khyber-Pakhtunkhwa Province,” he said.

This anti-vaccine sentiment spread further about a decade ago, for reasons that had nothing to do with health care and everything to do with global politics. 

“Secondly, the (anti-vaccine) sentiment was spread widely when Dr. Shakeel Afridi did a fake polio vaccination campaign (as part of the search for) Osama Bin Laden,” Memon added.

Afridi was a government physician who worked with the U.S. Central Intelligence Agency (CIA) to run a fake hepatitis vaccination campaign that was part of an effort to collect blood from the compound where Bin Laden was thought to be hiding. He was jailed a little under three weeks after Bin Laden was killed in 2011 and, according to the BBC, was never actually charged and remains in prison.

While that campaign helped the U.S. find one of its most wanted fugitives, it did little to shore up support for vaccines in Pakistan. Quite the opposite, it helped boost conspiracy theories. 

The fear of vaccines, particularly against polio, reached a fever pitch in April 2019 in Peshawar’s Mashokhel area. A video made by a man named Nazar Muhammad supposedly shows school children falling down after being vaccinated at the Hayatabad Medical Complex. 

In the video, Muhammad alleges that the administration of vaccines cause children to fall unconscious. He then turns to a group of children standing next to him and orders them to ‘fall asleep’. The children then lie down on a hospital bed as if they were unconscious. When a boy gets up, Nazar tells him to ‘fall asleep’ again. The video went viral. Within a week, 45,000 children had been taken to hospital by scared parents who thought their children had been poisoned. 

Police arrested Nazar for spreading misinformation.

The problem may stretch beyond Pakistan’s rural areas. 

“Unfortunately, the antivaxxer element prevails not only in rural areas but is spreading widely in urban areas of the country as well,”said Dr. Khalid Shafi, another senior member of the PPA. 

Pakistan's polio eradication programme
Pakistan’s polio eradication programme

The anti-vaccine sentiment can be very, very strong at tiHealth care workers involved in vaccination campaigns have been targeted and, at times, killed.  

The impact is also significant for the country’s vaccine coverage and efforts to eradicate polio. A Spokesman for the National Emergency Operation Cell for Polio (NEOCP) said 53 cases have been reported this year (the Polio Global Eradication Initiative puts the number at 55), adding to the 147 cases reported in 2019. In 2018, there were just 12 cases of polio in the country. While most countries have all but eliminated polio, the disease is considered endemic in Pakistan and neighbouring Afghanistan. 

After the Peshawar incident, there was a six-month gap in the National Immunization Days (NID) campaign and there are concerns that thousands of children may have gone unvaccinated as a result. That video and other anti-vaccination propaganda led to a significant uptick in the number of vaccination refusals, Shafi told Anticentric. 

For some, like 42-year-old banker and Karachi resident Bashire Ahmed, the issue is not so much the vaccine but the way the vaccination campaigns are run. 

“We are not against the polio vaccine but the way the anti-polio drive is worked, especially the repeated rounds which actually spread hate among people,” Ahmed said. 

The Pakistan government has stepped up efforts to vaccinate and reduce the incidence of polio in the country. 

“To effectively counter rumours and build the population’s resilience to misinformation, the (NEOCP) is focusing its efforts on trust-building work to help parents better understand the safety and benefits of polio vaccination,” said the spokesman. “In addition, to combat any misinformation on the polio vaccine spreading online, the government of Pakistan has launched an aggressive perception-management campaign regarding vaccines, which includes working closely with Google, Facebook, and Twitter, among others, to remove damaging anti-vaccine content from their channels.”

Still, the progress towards eliminating polio over the last few decades have been significant. A current community-based programme relies on health workers to administer the vaccine at the doorsteps of people throughout the country. Social mobilizers have also been hired to educate people in local dialects. 

The NEOCP made it possible to use national vaccination campaigns to reach more than 39 million children under the age of five through 260,000 polio frontline workers.