The world has expressed shock and sadness following the wave of killings of health workers in Pakistan tasked with delivering polio vaccines in areas where polio still persists. Those murdered were mostly women and teenage girls, dedicating their time to provide infants and children with the most basic of health services.
Frontline health workers have been the backbone of the polio eradication campaign for more than 20 years. Their tireless work has brought the Global Polio Eradication Initiative breathtakingly close to achieving the goal of wiping the disease from the planet.
Since 1988, billions of children have been vaccinated, sparing them the devastating effects of polio. The accomplishments of the polio eradication campaign have been tremendous and just this week, India celebrated its two year milestone of being polio-free. Only three polio-endemic countries remain: Afghanistan, Nigeria and Pakistan.
Many public health endeavors with similar results would be deemed a runaway success, but a single polio outbreak threatens re-establishment of the virus even in areas previously declared free of the disease.
The virus is spread by person-to-person contact and contaminated food or water. Most infected individuals are symptomless and only one in 200 cases ever result in irreversible paralysis.
The virus can lie in wait, circulating in communities, infecting an increasing number of people without any sign, until someone, most often a child, develops paralysis. If these biological complexities were not enough, there are other factors that complicate the eradication campaign. Public mistrust of vaccines, unsanitary living conditions, overcrowding, logistical challenges with vaccine delivery, and limited political involvement all hamper the effort.
To address these barriers, the global polio eradication campaign has rallied a vast number of institutions, organizations and individuals. Central to the eradication effort are frontline health workers—those putting their lives on the line to help others access this care.
Violence against vaccinators in Pakistan has been a tragic setback, yet public health workers have battled rumor and resistance to vaccine campaigns for years.
Rumors that polio vaccines were a ruse to sterilize children have long circulated in some Muslim communities, and others perpetuate the myth that polio vaccine is contaminated with HIV. In places where illiteracy is high and access to information is limited, these myths are hard to debunk.
Although completely unrelated to polio vaccine efforts, the 2011 attempt to confirm the location of Osama bin Laden with the use of a hepatitis B vaccine program eroded trust in all immunization programs—trust that local and global public health communities legitimately earned through decades of dedication and achievement.
Undeterred by the killings, vaccination efforts in Pakistan have been re-instated in the most high-risk polio areas, and include paramilitary and police support to protect vaccinators. The Pakistani government’s strong commitment to ensure the country is taking the right steps to achieve eradication is a positive response in the midst of these tragedies.
As Pakistan takes its own measures to protect the health and safety of its citizens and health workers, the global community must continue to support them in doing so.
The United States and all governments around the world must ensure that health issues are never again entangled in intelligence operations or held hostage to politics and power.
In a world without borders, where people and the germs they carry travel freely, we must remain committed to the fight against polio, and speak out against deeply misplaced tactics that jeopardize the goal of eradication and the vaccines that will achieve that goal. Our lives depend on it.
Kate O’Brien is acting executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health in Baltimore. Anita Zaidi is professor and chair, Department of Pediatrics and Child Health, Aga Khan University in Karachi, Pakistan.