World Polio Day: Why Pakistan is failing to eradicate the disease

In Pakistan's Balochistan province,  health workers consider it a productive workday when they are able to vaccinate enough children with polio shots -  supported by their parents - as they pass from house to house in the provincial capital city of Quetta.

Once a vaccine is administered, the health workers mark the child's house to record it, while police and security officers keep a watchful eye.

But while things here are going smoothly, in the wider battle against the deadly polio virus - which remains stubbornly entrenched in parts of Pakistan and neighbouring Afghanistan - the country is struggling.

In a statement issued on 3 October 2019, the World Health Organisation said it was "gravely concerned" by an increase in polio cases in Pakistan.

Rashid Razaq, the Co-ordinator of the Polio Emergency Operation Centre in Baluchistan, says the situation is worrying.

"This year so far in Pakistan we have reported about 76 cases, and our contribution from Baluchistan has been seven, unfortunately. The seven cases have been reported from four different districts, which include Killa Abdullah - we have three - Jaffarabad - two - and Quetta - one. And now recently one in Harnai," he says.

That recent rise contrasts with a trend in recent years of gradual improvement.

This year there have been at least 72 cases of polio in Pakistan after only eight in 2018.

Pakistani officials say, the rise this year might be partly due to continuous traffic across the border between Pakistan and Afghanistan.

Scepticism from families is also part of the picture, they say, while attacks on health workers have been a concern.

In April a health worker and two policemen escorting vaccination teams were killed in separate attacks.

According to conservative estimates, at least 70 officials associated with the polio programme have been killed in Pakistan in the last seven years.

"(There is) suspicion about the vaccine service efficacy as well. So there are various reasons for that, whereas the lack of co-operation from the community, well as well as the quality of the complaints are so that we could not administer two drops to a child. All of these aspects needs to be improved," concedes Razaq.

Here in the village of Chaman, close to the border between Pakistan and Afghanistan, 11-year-old Hassan Khan is living with polio.

His father, Nisar, urges other parents to get their children vaccinated.

But in part of Pakistan, parental suspicion runs deep.

Some doubt the vaccine's efficacy; others listen to the words of militants who falsely claim the polio vaccine is a western conspiracy.

The Government is doing what it can to dispel such concerns, working with religious leaders to try to send a different message.

Hassan's father Nisar's plea is straightforward.

"My son is affected with polio. Everyone should try to arrange polio drops for their children, so they can keep their children safe from polio. And my message to all (is) please, give the polio vaccine to your children," he says.

In Rawalpindi, Farzana Bibi knows about life with polio all too well.

She's a polio survivor, and her experience is driving her to work with the vaccination campaign as a supervisor.

"I was operated on nine times and the last time the doctors told me, "your treatment is not possible now, even if you go abroad". I was hopeful in the beginning, (but) later I knew that there is no treatment for polio-affected parts of body. But I have decided I have to save lives of children by serving as a polio vaccinator," she says.

In the city of Rawalpindi, this local dispensary is having a busy day.

Later, local official Muhammad Nadeem and a colleague will go out on the streets with a cooler containing the vaccines.

Nadeem says the suspicion about the vaccination programme takes a toll on health workers.

"Sometimes the behaviour of parents is insulting (to) the polio vaccinating team, even the staff become disheartened and quit later. We, as staff, face many difficulties, but are not discouraged. Working with lots of passion, we are ready to eradicate polio," he says.

Pakistan is just one of three countries in the world - the others are Afghanistan and Nigeria - where polio is endemic.

Recently, parents in conservative places and rural areas in Pakistan have been using fake "pinky marks", a marker for polio workers to know that a child has been recently vaccinated, to refuse vaccination.

Environmental challenges also pose a threat to the polio eradication drive, with sewage samples testing positive for the virus in 12 cities.

In October, the World Health Organisation said of Pakistan that "the increasing refusal by individuals and communities to accept vaccination is a serious setback to eradication".

But, while the WHO said it was "very concerned about the current status of the management of the polio program in Pakistan", it also noted that "steps are being taken to get the program back on track".