A 3-year-old named Sakhina last week became the first case of polio in Kabul, Afghanistan, in thirteen years. She will be paralyzed for life.
In response to Sakhina’s diagnosis, the Afghan government has launched an immediate vaccination campaign in the capital city to halt the spread, showcasing the determination that has caused Afghanistan’s polio rate to drop to only 14 new cases in 2013, including Sakhina whose paralysis was only announced last Tuesday, compared to 80 in 2011.
But Sakhina’s case is just one example of a trend taking place in the Middle East, South Asia, and sub-Saharan Africa. Polio, once one of the top killers of children globally, has become a mere shadow of its former self, due to protracted efforts to vaccinate communities globally. But now those efforts are at risk, thanks to distrust of the workers that provide them from armed groups and governments alike. Only three countries are left in the world where polio is still endemic: Nigeria, Afghanistan, and Pakistan. In all three, however, violence against aid workers and their campaigns are hampering that progress.
Sakhina’s infection can be seen as the result of factors beyond her control, with their source across Afghanistan’s eastern border. Pakistan has been the epicenter of attacks on vaccination programs, following the revelation that the CIA in 2010 used a fake vaccination campaign to hide their intelligence gathering efforts to locate Osama bin Laden. Since then, the Pakistani Taliban have now come to see all health workers as suspect and prime for targeting. The result is a country where 91 cases of polio were identified in 2013, up from 58 the year before, and at least 31 polio vaccinations workers have been killed throughout the country since 2012. Just this last Sunday, militants planted a bomb near a vaccination station in the city Peshawar, where the explosion killed a police officer and wounded another.
It’s the ripple effect of the attacks in Pakistan that are keeping Afghanistan among the ranks of those struggling with polio. While most of the country is polio-free, thanks to a concerted effort from international NGOs and the Afghan government, the disease still has a foothold, particularly in provinces that still have a heavy Afghan Taliban presence. Though the former leaders of the country have vacillated back and forth between condemning the efforts of the Afghan government to wipe out the disease and offering full-throated support to the campaign, the social and political instability has made it difficult for workers from the World Health Organization and UNICEF to make the rounds necessary to provide full immunization for an area.
And while the Afghan Taliban has been amenable to such efforts, their Pakistani counterparts have been far less inviting. In areas of eastern Afghanistan where their influence is strong, members of the Pakistani Taliban have managed to block most aid workers from entering for the better part of two years as part of their campaign to have all health workers driven out. “The result is a pocket of unvaccinated children and a reservoir for the virus—one that threatens to spread to the entire region if unchecked,” Mathieu Aikens wrote last November.
A similar situation to that in Pakistan can be seen halfway around the globe in Nigeria, where aid workers are also under fire from terrorist assailants. The West African country is home to the most polio outbreaks in the world, and with the rise of the group Boko Haram, it may be years before that number begins to drop appreciably. Last February, the Islamist group was implicated as the attackers who gunned down at least nine vaccine workers. Borno state, where the militant group is particularly strong, accounted for 14 of the 53 polio cases recorded in Nigeria in 2013, according to the Global Polio Eradication Initiative.
The efforts to wipe out polio in Nigeria are further complicated through the militants accusing the vaccines of being a Western plot to sterilize young girls and causing AIDS, neither of which is remotely true. “Propaganda that the West is keen to reduce the population of Muslim communities through covert sterilisation campaigns disguised as immunisation outreaches also helps Boko Haram stir up feelings against polio vaccination workers,” a team of polio researchers wrote in PLOS Medicine last October. This in turn builds on misguided beliefs about the efforts of groups such as the Bill and Melinda Gates Foundation to provide contraception, the researchers continue, which some in the country view as a way to depopulate the country.
And conflict and violence don’t only effect areas where polio already has a safe haven. As the Syrian civil war rages into its fourth year, the results of the fighting’s toll on public health are now beginning to be borne out in a country that had previously put polio behind it. Last year, the World Health Organization reported an outbreak of 27 cases in the wartorn country, whose vaccination rate has plummeted from nearly 100 percent to just 45 percent. While the Syrian government has pledged to vaccinate all children under five, the clashes between the government and opposition fighters — as well as the jihadi groups who are fighting against both — make it increasingly impossible for aid workers to reach their charges. On top of the actual shooting which makes it dangerous for aid workers to travel throughout Syria, Damascus has blockaded whole cities against food and medical treatment as punishment for showing support to the rebels.
The result of this violence can be seen clearly mapped out in a recent Council on Foreign Relations interactive graphic, which shows the epidemic of outbreaks in these four countries in recent years. Each of them has taken a different response to the violence, but none of them seems close to eliminating the factors that has allowed polio to thrive. All told, it will be years at least before these countries are able to join — or rejoin in the case of Syria — India in completely wiping out the disease.