ABHYANKAR AND BESHAR: Pink needles and misplaced fears

On a quiet December morning, two teenaged women walked the streets of the Pakistani city, Peshawar. They posed no threat, carrying only clipboards with lists of local schoolchildren and boxes of refrigerated polio vaccines. Yet along with seven other U.N.-backed health workers, they were stalked and gunned down by men on motorbikes, killed instantly in billowing gunfire of hate and violence.

Within hours, UNICEF, Rotary International, the Bill and Melinda Gates Foundation and the World Health Organization ordered their 225,000 polio vaccinators off the streets, thereby ending the three-day mission that aimed to administer nearly 5.2 million drops of the vaccine. Although no specific group has claimed responsibility for the attacks, polio officials suspect Pakistan Taliban groups based in the Pashtun region at the Afghanistan border. These militant groups have long issued threats against the U.N.’s anti-polio efforts, citing the use of health workers as U.S. spies and the inefficacy of the vaccine.

Eradication campaigns, often backed by the U.N., have proven effective in the majority of the world. In 1988, over 200 countries and 20 million volunteers joined together to start the Global Polio Eradication Initiative. Since then, 2.5 billion children have been immunized, with only 214 reported cases of polio worldwide in 2012. The WHO classifies Pakistan as one of three “polio-endemic countries,” along with Afghanistan and Nigeria. Worldwide eradication of polio remains elusive: annual cases can fluctuate in the thousands depending on the year. As one of only three nations with a high incidence of the disease, these eradication campaigns in Pakistan are crucial.

Given the pressing nature of these efforts, where lies the opposition? Cultural distrust, medical misunderstanding and politicized relationships account for this gap. Historically, “polio rumors” have poisoned the vaccination process. Recipients of the vaccine — many of whom are isolated in rural villages — believe that the vaccine contains pork, that it hosts the HIV virus or that traces of estrogen may be responsible for female sterilization. These suspicions explain the resistance to polio vaccinations in Afghanistan — where the Taliban targeted eradicators until Mullah Mohammed Omar’s fatwa in 2007 — or in Nigeria, where Islamic extremist group Boko Haram continues to attack police officers accompanying WHO teams.

However, more recently, vaccination efforts have been hampered by political conflict — confrontations far more damaging. In May 2011, the CIA admitted to using Pakistani doctor Shakil Afridi to run a vaccination scheme as a ruse to enter bin Laden’s compound in Abbottabad. Even though the cover failed, the global reaction was explosive, damaging the credibility of the polio campaign and putting lives of vaccination doctors, nurses and volunteers in danger. In the months following the discovery of this ploy, public outcry and attacks against health workers became all too common.

Just a few months after the bin Laden raid, angry villagers chased out health workers in the Khyber-Pakhtunkhwa province of Pakistan. Since this incident, the Taliban commanders have banned vaccination teams from entering North and South Waziristan, justifying the prohibition with the same suspicion. A follow-up study quantifying global “vaccine confidence indexes” revealed plummeting trust in the polio campaign. The recent attacks on the health workers — all Pakistani natives — serves as a cry for a serious reform of where to draw the line between medicine and political conflict.

The recent attacks only highlight the impact of Afridi’s vaccination ploy and the bin Laden raid. A trajectory of intense suspicion has been established, thereby hampering further discourse in eradicating the disease. Most concerning, the attacks were extensively coordinated and well-planned, indicating a symbolism far beyond simple medical misunderstanding.

By using vaccination efforts as covers for our military ventures, we link public health with our politicized efforts abroad. Political conflict has crossed the line too far, compromising the well-being of millions of impoverished individuals as well as the safety of those who are eager to help combat the wrongs of such illness. But we should not and cannot introduce health campaigns into this equation. It encourages reactions like those in Khyber-Pakhtunkhwa province, where commanders will not allow polio vaccinators into their villages until U.S. drone strikes are stopped. It turns the health of children into a weapon. It justifies acts of violence against innocent aid workers.

If we are to truly achieve 100 percent eradication, we need to eliminate global conflict and political disagreement from these health conversations. This latest attack should serve as a tipping point in the grand scheme of eradicating the disease. The line between health and politics cannot be blurred.

Rima Abhyankar is a junior in Branford College and Isabel Beshar is a junior in Saybrook College. They are co-coordinators of the Public Health Coalition. Contact them at rima.abhyankar@yale.edu and isabel.beshar@yale.edu .

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