By: IRIN

Huma Shazif had just vaccinated five children against polio in Pakistan’s northwestern city of Peshawar when gunmen attacked. They sped off on a motorbike as her colleague lay dying on the ground after being shot in the abdomen, while she was hit three times in the leg.

“It was painful,” she told IRIN. “I had never even thought that militants could attack us just for administering polio drops to children.”

The attack in February last year has not deterred Shazif. She is back at work vaccinating children in Pakistan, which along with Afghanistan remains one of only two countries left in the world where polio is endemic.

Over the past few years, half a billion doses of vaccine have been given each year to Afghan and Pakistani children, and the World Health Organization says it is now in the final stretches of the global battle against polio.

“The polio virus cannot survive under this pressure, and it’s a done deal now – the virus will be interrupted both in Pakistan and Afghanistan by the end of this year,” Dr. Michel Thieren, the WHO representative in Pakistan, told IRIN.

The poliovirus is often transmitted from person to person through fecal matter. People living in areas with limited access to running water or flush toilets often get the virus from drinking water contaminated by human waste that contains the virus. Even if it is wiped out by the end of 2016, the world will have to wait until the end of 2019 before eradication can be declared as there have to be no new cases for three years. The only human disease ever to have been eradicated was smallpox, in 1980.

Dangerous missions

The main reason the disease persists is that militants often attack health workers and block them from going to areas under their control. As late as April, the Taliban shot down seven vaccination workers in Pakistan. According to the World Health Organization, shootings of immunization workers in Pakistan, Afghanistan and Nigeria have killed more people than the disease has. In Afghanistan, insecurity prevented health workers from carrying out vaccinations of 385,000 children this year and 15 vaccinators were abducted, according to a report published last week by the UN.

In Pakistan, 91 health workers and security personnel guarding vaccination teams have been killed since 2012, according to Rana Muhammad Safdar, a coordinator at the National Emergency Operation Centre for Polio in the capital, Islamabad. Polio has killed 15 to 30 across the world.

“The frontline workers are our real heroes in fight against polio,” he said.

Despite risks to health workers, the vaccination campaign has been successful, as illustrated by the rapid decrease in reported cases over the past few years. So far this year, Pakistan has found 13 cases of polio, compared to 54 last year and 306 in 2014, according to data collected by the NEOCP.

Afghanistan has reported only six cases this year, all of them contracted by children living in areas “under the influence” of militant groups, the UN report said.

Thieren said that if polio is eliminated from Pakistan by the end of this year, Afghanistan will also become a polio-free country as the virus won’t be able to survive in its scattered population. 

Conspiracy theories

Attacks, threats, and intimidation from militant groups aren’t the only reasons the vaccination process has been slow in Pakistan. Despite the risk that their children could die or become paralyzed by polio, many parents refused to vaccinate them as rumors spread that vaccination campaigns were ploys by Western intelligence agencies to spy on or even to sterilise people.

The conspiracy theories gained credence in 2011. That’s when Pakistan arrested a doctor on charges that he worked with the CIA to organize a fake vaccination campaign as part of an attempt to obtain DNA from family members of Osama bin Laden, in order to confirm his presence in Abbottabad.

“In Pakistan and Afghanistan, the immunization was initially perceived as a Western-imposed intervention, but this notion has been overcome now with [the] help of imams and community leaders,” said Thieren.

The government convened a National Islamic Advisory Group that has worked with the Islamic Advisory Group for Polio Eradication, an international organization, to dispel rumors and encourage people to get vaccinated.

These efforts have seen parents’ refusal rates for vaccinations drop from 3 percent in 2014 to 0.05 percent in 2016, according to Safdar of the NEOCP.

Final frontiers

Until last year, vaccination teams had no access to parts of the Federally Administered Tribal Areas, which border Afghanistan, said Safdar.

The military has now finished operations that pushed militant groups out of FATA or broken their control over some regions.

Safdar said the number of children inaccessible to vaccination teams has fallen from more than 600,000 to 2,500 in parts of Khyber Agency and North Waziristan.

One of those now working to vaccinate children in Khyber Agency is Shazif, who has recovered from the February 2014 attack that killed her colleague.

“It’s a dangerous job to administer polio drops to children, but I’m doing it for the sake of my nation,” she said.

IRIN is an international news agency specializing in reporting on humanitarian and social issues