shots are jeopardizing humanity's battle to eradicate polio, and they don't
include syringes or vaccines. Rather, they're the gunshots of Islamist terrorists.*
fight to eliminate polio is now imperiled, according to the World Health
Organization (WHO), by "insecurity, targeted attacks
on health workers and/or a ban by local authorities on polio immunization," and
violence in the Middle East. In a March 2014 report, the organization warned
that the virus, which existed in only three countries at the dawn of 2012, is
now returning to places from which it had been eradicated, and "risk of further
international spread remains high, particularly in central Africa (especially
from Cameroon), the Middle East, and the Horn of Africa."
forces of global health are watching their efforts backtrack, thanks to warfare
and to the growing belief within Islamist circles that the polio-eradication
effort is a secret CIA plot, designed to harm or contaminate Muslim children.
Amid assassinations and bombings of vaccination sites, chiefly in Pakistan and
Nigeria, the death toll for healthcare workers now exceeds the number of
children dying of polio, and could soon surpass the tally of new virus-paralyzed
was once a triumphant example of humanity and solidarity has transformed into
something deeply dangerous.
1988, Rotary Club International combined forces with UNICEF in an effort to eradicate polio
from the planet by the year 2000. In just 12 years the global effort reduced the
estimated number of polio cases from 400,000 in 1980 to just over 7,000 cases
in 1999. As the clock ticked toward the millennium, the then-new Bill &
Melinda Gates Foundation threw considerable financial weight behind the effort,
which has now immunized 2.5 billion children and youth in 200 countries,
corralling a force of more than 200 million volunteers, at a combined cost of
2000 came and went with polio still in circulation in several countries,
chiefly Pakistan, Nigeria, Afghanistan, and India. In 2003 -- when just 784
polio cases were reported worldwide -- a handful of imams in Nigeria's northern
Kano state, which is overwhelmingly Muslim-populated, concluded that the
vaccine contained American-made sterilizing agents that would render their
daughters incapable of bearing children. Some were also convinced that the HIV
virus was deliberately added into the vaccine.
the imams were well-read scholars who drew their conclusions after perusing websites
similar to those former South African President Thabo Mbeki used back in the
day. Mbeki concluded that AIDS did not exist and that Western pharmaceutical
companies invented false HIV claims in order to compel drug sales across
Africa. A Harvard study found that the former president's AIDS denialism and
refusal to allow treatment for his people cost more than
300,000 South African lives.
polio-is-a-CIA-plot idea spawned in northern Nigeria spread to Afghanistan and
Pakistan, where some Taliban members added vaccination to their list of
complaints against American military forces. By 2006, the polio caseload had
risen to more than 2,020 children.
2007, a chief surgeon and head of
polio eradication in northern Pakistan, Abdul Ghani Khan, was
assassinated in a Taliban bombing
attack. His murder followed a fatwa issued by Mullah Fazlullah, the leader of the Taliban in Swat, declaring war on all who vaccinated
children against polio. Since 2003, public health leaders and Muslim
scholars have struggled in northern
Nigeria, Pakistan, and
Afghanistan to convince the public that their local imams and Islamist leaders are wrong, the vaccine is safe, and the alternative of
widespread child paralysis is unconscionable.
In 2008, the polio effort took on a more
tightly targeted approach under a new WHO-led Global
Polio Eradication Initiative (GPEI), which struggled to maintain
international momentum and funding, to design sophisticated vaccination methods,
and to counter mistaken beliefs about immunization safety. At that time, only
four countries -- Nigeria, India, Pakistan, and Afghanistan
-- had endemic polio, meaning the wild virus was still circulating in
contaminated water supplies and between infected children. Fifteen other
countries in 2008 had isolated polio cases, typically imported from those big four
remaining endemic nations, or resulting from the very rare vaccine-induced
disease. The eradication effort focused on the wild polio virus.
two main types of polio vaccines. One type, a descendant of that originally
invented by Jonas Salk in the 1950s, is made from killed viruses and is
injected. The other, more commonly used today, is an oral vaccine that contains
live viruses that have been crippled so that they cannot cause illness. Invented
in the late 1950s by Albert Sabin, the oral vaccine takes care of two failures
of the Salk approach. First, it doesn't require needles, therefore poses no
risk of needle-born contamination and sterilization problems. And second,
unlike the Salk vaccine, which prevents viruses from causing disease in the
individual, the Sabin product eliminates polio from the gastrointestinal tracts
of children, thereby stopping fecal passage of the virus into sewage and water
supplies. The problem, however, is that in rare cases some of the live viruses
are not properly crippled, and may cause polio in the vaccinated child.
Death is rarely the result of a polio infection -- less than one out of 3,000 infected children will suffocate as their capacity to breathe is paralyzed. But crippling, permanent paralysis occurs in about one out of 200 cases. As the overall numbers of polio-stricken kids have fallen, so have the horrors of paralysis and death.
Polio eradication witnessed astounding successes in previously desperate places: northern India, Southeast Asia, Ethiopia, and West Africa. In recent months, both India and all of Southeast Asia have been declared polio-free, having gone without wild polio cases for more than three years.
In 2013, for the first time in years, there were more polio cases outside the endemic countries than inside Pakistan, Afghanistan,
and Nigeria: 240 versus 160 cases. The surge outside of the endemic areas was due to warfare that
interrupted child vaccination in Somalia and Syria -- and in both cases,
genetic analysis revealed the new outbreaks were caused by strains of the virus identical to those circulating in Pakistan. It is not known precisely how the Pakistani virus
reached Somalia and Syria. However, there is a possible link: The militaries
that were present in both countries trained inside Pakistan.
of March 26, a total of 47 polio cases have been reported in 2014 -- all but six
of them in the endemic countries, mostly Pakistan.
far more polio vaccinators are dying than the toll of children killed or
permanently paralyzed by the virus. At
least 59 vaccinators and their security team members have been murdered over the
past 20 months, primarily in Pakistan. GPEI has identified Pakistan's Peshawar valley and
abutting North Waziristan as the world's "main ‘engine' of poliovirus
transmission." Not coincidentally, these are strongholds
of Taliban-aligned Islamists and the locations of most violent assaults on
The attacks and murders have targeted
unarmed, usually female polio volunteers and health workers, or more recently
their police or private security protectors.
In January 2014, three female
polio workers were gunned down outside Karachi, prompting a mass walk-out by immunization employees locally, and then nationally. Shortly after,
six polio security team members were felled in a bombing outside Charsadda, Pakistan. On
February 11, a police officer was killed amid a hail of gunshots aimed at polio
volunteers in northwest Pakistan. On March 2, a mass funeral was held in Khyber
District, mourning 11 vaccinators, a police officer, and a child killed in a
coordinated set of two bomb assaults. Salma Ghani,
a 32-year-old female health worker, was kidnapped from her Peshawar home on
March 24 by five unidentified men; her bullet-riddled body was found dumped on
a roadside the following day. On March 27, in Balochistan,
assailants opened fire on vaccinators from a speeding motorcycle, killing a
police officer. It was perhaps coordinated with another, nearly simultaneous motorcycle
attack in Larkana,
which killed a police officer and a vaccination volunteer. A female polio worker in Bannu was killed on March 31, when gunmen opened fire
as she left her home to start work with an anti-polio team.
The distinct escalation in assaults and
killings of polio vaccinators can be traced directly to the May 2011 U.S.
Special Forces assault on the Abbottabad compound inhabited by Osama bin Laden,
his family, and al Qaeda elite. Three months after the raid, in which bin Laden
was killed, the Guardian revealed that the CIA used
a Pakistani doctor, Shakil Afridi, to carry out a fake hepatitis B vaccine
effort in hopes of gaining DNA samples from the children living in the
mysterious compound by injecting them and retaining the syringes. Afridi, who
is now imprisoned in
Pakistan as a traitor, never managed to gain entry to the compound.
Shortly after the CIA ploy was
disclosed, Orin Levine of the Gates Foundation and I warned in the Washington Post that any use of
vaccination by intelligence operatives risked worsening conditions in the fight
against polio. And David Ignatius wrote, "Afridi and his handlers should reckon with the
moral consequences of what they did."
As predicted, in 2012 several
Taliban leaders and mullahs issued decrees, linking polio vaccination to U.S.
military use of drones and accusing vaccinators of being CIA spies. They called
for a jihad against immunizers. Maulvi
Ibrahim Chisti of the Muzaffargarh district declared the anti-polio campaign "un-Islamic" and parents started refusing vaccines. By the end of the summer of 2012, hundreds of thousands of children across Pakistan were going without
immunizations, not only for polio, but all of the key childhood diseases.
Matters worsened in early 2013 after DVDs of
the movie Zero Dark Thirty turned up
in the Pakistani black market. The Kathryn Bigelow film mistakenly
depicted an Afridi character as a polio vaccinator.
As the pools of unvaccinated
children grew, so, too, did the courage of the men and women carrying out polio
work. It is hard not to describe these unarmed, poorly-paid, or volunteer
workers -- who, while dripping Sabin's fluid into the mouths of babies, are
well aware that they are being watched, their names noted, their addresses
logged -- as saints.
the Pakistani polio strain has surfaced in Syria's battlefields and, from there,
has spread across the Middle East -- from refugee camps to Palestinian outposts
to the sewers of Israel. In its recent report the WHO said:
The major risks to eradication are: the bans on
immunization campaigns in the North Waziristan agency in Pakistan and parts of
southern and central Somalia; the continued targeting of vaccinators in Khyber
Pakhtunkhwa province and Karachi in Pakistan; ongoing military operations in
Khyber Agency (within the Federally Administered Tribal Areas) of Pakistan;
insecurity in Eastern Region, Afghanistan, and Borno state, Nigeria; active
conflict in the Syrian Arab Republic; and gaps in programme performance in Kano
state, Nigeria, and in the outbreak response performance in Cameroon. These
risks are compounded by gaps in polio surveillance and the continued threat of
new international spread of wild poliovirus.
tone of alarm in the WHO's statement reflects the recent discovery of a six-month-old
baby in Baghdad
suffering from polio paralysis. It has been 14 years since polio has been seen
in Iraq, and the Iraqi family had not traveled in known polio-hit areas. The
child's strain matched the one circulating in Syria.
still unconfirmed, there is a possible polio case in a Syrian refugee baby
residing in Lebanon, and this
has increased concern throughout the Middle East. More than 400,000 refugees and
internally displaced people have fled Iraq's Anbar Province,
where conflict has rendered immunization especially dangerous. Fewer than 48
percent of the area's children were vaccinated over the last two years,
according to UNICEF. Better than 90 percent coverage is essential to creating "herd immunity," bringing human-to-human spread of polio to a halt. The Iraqi
government now talks about creating an immunization firewall across its
northern border, blocking further spread of polio from Syria.
vocabulary of warfare has been injected into the Middle East polio struggle. Because
much of Syria is inaccessible to humanitarian workers, the exact extent of
polio in the country is not known: 37 paralysis cases have been reported since
the Syrian outbreak began
sometime in October 2013.
mass vaccination in 2013, environmental sampling in Israel, the West Bank, and
Gaza continues to test positive for polio -- the sources are unknown. A large
population of Palestinians has been trapped inside Syria throughout the war,
only receiving vaccines in February 2014,
and it's possible that refugees from this enclave have carried polio to nearby
Global Polio Eradication Initiative has set new targets,
new strategies, and new funding goals struggling to stay ahead of the virus -- and
Islamist zealots. It has done so before, of course, managing to conquer challenges but often twarted by political reality. In the end, polio will be eradicated when counterterrorism no longer includes fakery, and Islamists cease believing in jihad against health workers.
*Correction, April 19, 2014: This article originally misstated the source of the gunshots. They were fired by Islamist terrorists, not Islamic terrorists. (Return to reading.)
Photo: RIZWAN TABASSUM/AFP/Getty Images; Chart: Global Polio Eradication Initiative