A few torn remnants of a government poster advertising an anti-polio drive conducted in 2012 are still visible on the gate of Sajjida Bibi’s house, and the impression given to passers-by is that years of vaccination drives have come to an end.

Bibi has delivered polio vaccines to children for over 12 years as part of government health teams. But this year things changed. Attacks on vaccination teams, militant threats and the abduction of teachers facilitating the campaign in November 2013 have handicapped efforts and led to a new strategy.

“I know polio vaccination is dangerous. My husband was reluctant to allow our daughter [who has just started working with her] to join the teams going into the field, but this work is important,” Sajjida Bibi, now aged 55, told IRIN. “I know because my own sister was disabled by polio over 45 years ago.”

Under the new strategy, the high-profile ‘National Immunization Days’ planned across the country have been dropped, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA) and sources in the health ministry. The recent vaccination program, organized over three days from 18 to 20 November in Khyber Pakhtunkhwa (KP) province, was conducted with far less publicity than before.

It means an end to the kind of campaigns seen in the past, often headed by high-profile national celebrities such as cricketer Shahid Afridi. They could attract the television cameras to major anti-polio rallies featuring important political figures who kicked off anti-polio drives with a celebration. The “new look” vaccination campaigns will be far more low-key.

“This new, quiet method allows women, like myself, to decide, rather than leaving it in the hands of men,” Bibi said.

“Following the attacks on polio workers in December 2012 and government recommendations, the polio campaigns shifted from high profile, to low profile. This is our approach,” Azmat Abbas, Communications Officer for the UN Children’s Fund (UNICEF), told IRIN.

“The decision for campaign visibility now rests with the district governments, who are responsible for the security of the polio vaccinators. At the national level, polio campaign dates are not publicly announced and the focus is now on creating awareness of vaccine-preventable disease. The federal government has asked all the districts to ensure the security of the polio workers, which continues to remain a major concern.”

Pakistan made strong vaccination efforts in the late 1980s and early 1990s, leading to significant strides in the battle against the disease, according to local monitoring organizations. In 1997 Pakistan reported 1,147 cases of polio, compared to 58 cases in 2012 and 72 so far in 2013 (up to 4 December), but it remains one of only three countries where polio is endemic.

The change of direction in anti-polio campaigns is not only about security – some health officials were also concerned that the national drives were losing their impact. “People are tired of repeated polio vaccination campaigns,” said Dr Qasim Khan, the District Health Officer for Mardan district in southwestern KP province. “We need to alter strategy and create awareness among parents.”

During the November anti-polio drive in KP, 5,694 parents in Mardan had refused to allow their children to be vaccinated, the highest rate of “refusals” recorded in a provincial district. But this figure was “an improvement on those in the past”, he said. In total, there were 22,175 refusals across KP during the most recent campaign, according to official data.

Less publicity has also meant, in some cases, less acrimony within households over whether or not to allow children to be vaccinated, residents told IRIN. Without the clamor usually associated with national polio drives, there is less resistance by men in the household, who often react by forbidding their wives and children to take part.

“This time the polio team just came to our house one day and gave the drops to my two children, aged under five years,” said Qudsia Bibi, from a village on the outskirts of Peshawar, the provincial capital. She said this prevented “arguments over polio drops” within families, such as those that had broken out in the past after vaccination campaigns were announced.

Photo: Kamila Hyatt/IRIN

Glossy anti-polio campaigns are a thing of the past

In many cases, Qudsia said, there were claims that polio drops caused sterility. This misperception is widespread, though Muslim scholars have been attempting to dispel the idea.

“This new, quiet method allows women, like myself, to decide, rather than leaving it in the hands of men,” Qudsia said.

But there is nostalgia for the previous national drives. “I miss the excitement and color of past campaigns, when we would go out together, paste up posters and hear the national anti-polio day announcements made over radio and television,” said Sajjida Bibi. “But given all that has happened, visiting homes quietly, talking to parents and just giving the children the drops without too much fanfare may be the best approach.”

Her opinion is shared by Islamic scholar Mulana Ismail Uddin, who leads prayers in the Jamia Masjid (Congregational Mosque) in Peshawar. “There is nothing in our religion against these vaccines. But given the environment that has been created, I just think it would be more sensible to avoid making such a big deal over them and agitating extremists who can harm health workers or others,” he told IRIN. “It makes more sense to keep the matter quieter and just go about it in a matter of fact way.”

(IRIN is a service of the UN Office for the Coordination of Humanitarian Affairs)