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American parents may have the luxury of being able to buy into odd ideas about vaccines — their children are protected by others' immunity. But elsewhere, the results are tragic.
KARACHI, Pakistan — When health workers approached Zulfikar Quaid about inoculating his three children against polio, Quaid picked up an old cricket bat inside his home and waved it at them. "Get out of my house," he yelled. "My children are Muslim and we don't need your dirty Hindu drugs."
The health workers he was yelling at were stunned — though they'd become accustomed to hearing some Karachi residents' resistance to vaccines, they'd never heard it linked to a Hindu conspiracy before.
Zarmina, the lead health worker, asked Quaid's wife, who was standing beside her husband, why they were refusing the drugs. "The Hindus are lacing it with pig's blood to send us all to hell," she explained. Quaid was still holding the bat and waving it menacingly, and Zarmina, by now familiar with anti-vaccine fervor, decided that a quick retreat was the safest option for her. She motioned to her partner that they should leave immediately. In the past 18 months, 34 health workers had been killed for attempting to administer the polio vaccine.
Since 1978, when the World Health Organization’s Expanded Program for Immunization was launched in Pakistan, conspiracy theories about polio have been rampant. While the supposed conspirators change frequently, the myth is usually the same and involves someone attempting to rid the world of Muslims — Zarmina and her fellow health workers have heard that the polio vaccine is part of a Western (or US or Jewish) conspiracy to sterilize all Muslims, or that Mossad or the CIA is orchestrating the campaign to kill Muslims outright.
“When the polio vaccination program was initially launched, international organizations didn’t take into account that there was very little engagement with the local government,” said a senior World Health Organization official, speaking on the condition of anonymity. “Because the drugs and information was all coming from another country, people became very suspicious of vaccine programs.”
The immunization effort in Pakistan took a major hit when in 2007, Maulana Fazlullah, the current chief of the Pakistani Taliban, announced a ban on polio vaccinations in Swat. After news broke that a CIA had launched a fake hepatitis B vaccination program to obtain information about Osama Bin Laden, the theories gained even more prominence in Pakistan. Since then, militants and religious leaders alike have warned people against the polio vaccine and targeted health workers like Zarmina for participating in the immunization campaign.
The problem isn’t confined to Pakistan. In Nigeria, Ibrahim Datti Ahmed, a physician and the president of Nigeria’s Supreme Council for Sharia Law accused Americans of lacing the vaccination with an anti-fertility agent that sterilized children. It took years for international organizations to combat the rumor and Polio is still endemic to Nigeria. India, too, battled conspiracy theories about sterilization and poisoning, however unlike Pakistan, India has a stronger local government program, which has aided the World Health Organization’s efforts to eradicate the disease.
“In Pakistan, conspiracy theories are almost an Olympic sport,” explained C. Christine Fair, a Pakistan scholar and assistant professor at Georgetown University. While Fair is quick to clarify that conspiracy theories aren't unique to Pakistan, "the effects of [conspiracy theories] are more pernicious in Pakistan than they might be elsewhere because the stakes are so high."
It’s not just vaccination campaigns that inspire bizarre rumors. Many people believe that the CIA planted the Taliban to weaken the Pakistani state and that Malala Yusufzai was a CIA agent. Four days after Osama bin Laden’s death was announced, a YouGov/University of Cambridge poll found that 66 percent of Pakistanis did not believe he had really been killed.
The Pakistani media often magnifies disinformation rather than debunking it. In 2010, The Washington Post chronicled the frustration of the US embassy in the country, confronted, for example, with reports in the media that all Pakistanis are stripped naked at American airports.
Fair isn’t one to mince words: "Part of the problem is that in Pakistan, lies are built into the very fabric of the educational system," she said, referring to reports that state textbooks often have factual inaccuracies about Pakistan’s national history, along with a great deal of anti-minority and anti-Western language.
However, unlike other popular conspiracy theories, the polio conspiracy theories are easily rejected by educated people in Pakistan. “Since their children were born they’ve known that you give them shots for MMR [Measles Mumps and Rubella] and DPT [Diptheria, Pertussis, and Tetanus],” said one WHO official of the more privileged and educated parents. “They’ve heard about the Expanded Program on Immunization, they’ve seen countries where polio isn’t really a problem anymore.”
Acceptance of the benefits of vaccination tend to go hand in hand with general knowledge about the scientific benefits of medicine, he added.
“These are the same people that will go to a licensed doctor instead of a faith healer when problems first arise,” he said. “However, if you don’t know all of this, if your child isn’t even getting a first tetanus shot, much less a booster, you’re not really going to know that the polio vaccine isn’t an evil western import.”
In fact, many of the falsities about polio are spread by religious leaders, who often don’t have a formal education, but can disseminate information to a large number of people in their local language. Pakistan’s educational system is vastly unregulated — ghost schools pepper the official records, even lower-income children prefer to study at cheaper private institutions than public schools, and madrassas, religious schools run out of a local mosque, are free alternatives adopted by many families.
Though in past decades the religious clergy in Pakistan would have studied Islam along with other sciences and subjects, now they’ve usually only graduated from the local madrassas with little to no time in a secular school.
Religious leaders in Pakistan are highly influential, and micropolitics incentivize the spreading of anti-polio vaccine rumors. “They’re competing for congregations,” Fair said. “As the clerics are tied to [religious political parties], even if they know what they’re saying is a dangerous pack of lies, they have no incentive to say it.”
Earlier this month, Maulana Sami-ul-Haq, a religious scholar and leader of a faction of the conservative political party Jamiat Ulema-e-Islam, came out in support of the polio vaccine, issuing a fatwa against polio. Though not many local-clerics followed suit, his announcement was viewed as a major victory in the fight against polio.
But the rumors are so pervasive, and the suspicion of officials so great, that in some Karachi neighborhoods, residents aren’t swayed even by the fatwa urging them to vaccinate their children.
“Why is the government giving me polio drops for free?” asked one resident of Orangi town, who wondered why this would be an initiative the government would take when education, basic healthcare, and access to water wasn’t something that they provided for her.
A Pakistani volunteer prepares to transport a body of a polio vaccination worker, from a hospital following an attack by gunmen in Karachi on December 18, 2012.(Rizwan Tabassum/AFP/Getty Images)
Though community-based health workers like Zarmina say that they’ve tried to engage people in conversations about the misconceptions surrounding polio, she and international aid workers are too frightened to openly talk about the vaccine. In July 2012, a WHO doctor, Constant Dedo, was shot during a visit to Gadap Town, Karachi. Last year, a Rotary International volunteer who headed a polio center in the SITE area was shot dead.
For Zarmina the battle is personal. She became a community health worker — part of the WHO funded Lady Health Worker program — in 2002 after her eldest daughter died after contracting measles.
“Until my daughter was lying dead in the hospital, I didn’t even know that there was a disease called measles, or that I could have gotten all of my children vaccinated,” Zarmina said. “The lady who talked to me told me about the Lady Health Worker program and after she helped vaccinate my other children, I went to see if I could work with her.”
After six months of intensive training she began acting as a liaison between the ministry of health and her community. She prides herself on convincing reluctant parents to vaccinate their children.
Quaid’s particular conspiracy theory was new to Zarmina, so she was especially taken aback by the claims. She was working in a neighborhood on the outskirts of Karachi. Usually Zarmina works in the same neighborhood that she lives in, and has worked to foster connections with the community there. But on National Immunization Days, Lady Health Workers are deployed to go door to door and vaccinate children in areas where they may have little experience. She said that she’d never been to this area of the city before, and that’s why she was especially hesitant to engage Quaid in further debate.
A few hours later, she heard that shots had been fired elsewhere in the city and that three people had died administering the vaccine. She’s not sure that she’ll participate in the next drive. She’s not the only one. Polio workers are terrified that if they participate in another vaccination drive, they won’t come home. The consequences have ripple effects across the globe. Last year Pakistan saw an uptick in confirmed cases of polio — the two other countries where polio is endemic, Afghanistan and Nigeria, managed to reduce their number of cases.
Late last year, a polio outbreak in Syria was linked to a strain from Peshawar. With both Nigeria and Afghanistan reducing the number of polio cases in 2013, health experts warn that Pakistan may become the only exporter of the polio virus in the world.
“I used to think that by talking individually with the families in my neighborhood, I could help stop this crippling disease,” Zarmina said. “Now, I’m not so sure.”