Another day on Pakistan’s polio vaccination drive. Another series of deadly attacks on health workers.

As the gut-wrenching pictures of dead and injured Pakistani health workers come rolling in, we’re likely to hear a number of explanations for this abysmal state of affairs. Let’s set the record straight on some of them.



The stakes could not be higher. As I write this, the UN has suspended its anti-polio campaign in Pakistan. Back in the day, we used to be able to eradicate terrible diseases like smallpox.

But in 2012, we apparently can’t. Pakistan is going to continue to be a polio endemic nation in 2013 and probably beyond – along with just two other countries in the world: Afghanistan and Nigeria.

Some of the countries neighboring Pakistan, Afghanistan and Nigeria that have not had polio cases last year could well sprout a case or two since, breaking news: diseases spread.

We can kiss those UN-WHO polio eradication deadlines goodbye. So, we’d better take note.

Until and unless some militant group claims these latest attacks, much air time and column space will be spent on the old whodunit. Correspondents will report no claims, the history of X group claiming attacks and why they haven’t done it this time, how credible is a claim if it happens – the old shebang.

It really doesn’t matter. I’ll tell you why, just hold on a bit.

Pushing the CIA blame-game to its logical conclusion

We’re also likely to see the re-emergence of those espionage suspicions. Locals in and around Pakistan’s tribal areas, we’re told, suspect health workers of being spies.

This apparently only got worse after it emerged that the CIA had used a fake vaccination campaign to try to gather information about Osama bin Laden before he was found and killed in a house right under the Pakistani military’s noses in 2011.

Here’s the Guardian’s health editor: “If polio eradication comes unstuck, the CIA will be held by many to blame. The disastrous decision to use a child immunisation programme as cover for a Pakistani doctor working for the US to spy on the house of Osama bin Laden cemented the suspicions lurking in the minds of certain Islamic clerics.”



The CIA blame-game is so old in the Pakistani context, we may as well conflate every existing CIA grouse – drone strikes, high-handedness, whatever – and accuse the CIA of actively infecting Pakistani children with polio.

I mean, why not? Let’s just take this thing to its logical conclusion. Who knows, in a country like Pakistan, it just might work if you tell folks the CIA is infecting Muslim children with polio. That could bump up the moribund anti-polio campaign’s anti-Western/anti-US cred and win the campaign some much needed militant Islamist backing.

But let’s get back to that CIA-assisting Pakistani doctor, Shakil Afridi. Last year, he was sentenced to 33 years, NOT it must be said, for involvement in the bin Laden case, but for links to the militant group, Lashkar e-Islam. 

All sorts of Lashkar e-Islam leaders are still at large, some reports say the group changed its name to Jaish e-Islam, but no matter. There’s a roster of Lashkar/Jaish e-Islam militants roaming around, but they got Dr. Afridi.

Whatever the veracity of the charges against him, the lessons in the Dr. Afridi case is clear to every Pakistani, from the rich landlord in Sindh to the unskilled laborer in Khyber-Pakhtunkhwa: He’s a traitor.



This is a man who helped track a terror chief in a country that has received $25 billion in US military and economic assistance since 9/11- including F18 fighters, Cobra attack helicopters, TOW anti-tank missiles, and all sorts of surface-to-air and air-to-air missiles.

If Dr. Afridi is viewed as a traitor after all those official Pakistani declarations of counter-terror assistance (remember old Pervez Musharraf, our favorite post-9/11 ally?) it means there’s a serious message mismatch filtering from the authorities to ordinary Pakistanis.

‘Mullah Radio’ has a Jewish-Christian conspiracy theory

It’s easy to view the latest attacks on polio vaccination workers in Pakistan through the “CIA doctor” rubric. But polio vaccinations were being targeted by militant Islamists long before the CIA sniffed out bin Laden in 2011.

Back in 2007, Pakistani health officials failed to immunize a target 160,000 children against polio because parents in northern Pakistan believed the vaccines were a tool to cut fertility and reduce the Muslim population.

How did they get this idea? Many ways – including a certain “Mullah Radio” as he’s popularly known.

It was Mullah Fazlullah who used his illegal FM station, probably based in the Swat district, to spread the message that the vaccination drive was “a conspiracy of the Jews and Christians to stunt the population growth of Muslims”.

Can we learn lessons from Nigeria and India?

It’s the same conspiracy theory that has gripped Muslim-dominated northern Nigeria – the other polio endemic country on the other continent.

In an excellent report titled, “Diplomacy and the Polio Immunization Boycott in Northern Nigeria,” US experts Judith Kaufmann and Harley Feldbaum detailed the political roots of the northern Nigerian vaccination boycott and the ingenious use of diplomatic tools to try to overcome it. It’s a long report, but should you want to read it, here’s the link.

To be fair, the Pakistani authorities have attempted to launch vigorous vaccination efforts.

President Asif Zardari’s daughter, Aseefa Bhutto Zardari, has been made Pakistan’s goodwill ambassador for eradicating polio. With the help of international donors, including the Bill and Melinda Gates Foundation, the government has launched a massive vaccination campaign aimed at up to 35 million children.



There’s no doubt the embattled Pakistani government would love to have a public health success story on its record and is embracing previously unheard of ways to eradicate the disease.

In May, a high-level Pakistani delegation visited India to understand the neighboring country’s anti-polio strategies.

India was officially removed from polio-endemic countries only in February and Indian public health teams have been working in a number of countries – including Afghanistan, Bangladesh, Nepal and Nigeria.

It’s a good way to challenge the “Western” smear that bedevils polio vaccination campaigns in some countries. But what about that particularly fraught, thorny relationship between India and Pakistan?

If the two countries can pitch their collective wills to tackle the problem, it would be awesome. After all, with shared borders and migratory populations this issue potentially affects both countries.

But I must confess that when I first heard of India and Pakistan sharing polio-eradication experiences, my initial reaction was, oh boy, I hope Mullah Radio doesn’t hear of this. If Pakistan’s polio fight gets tainted with both, the evil US AND the evil Indian brushes, we’re never going to eradicate this disease on the subcontinent.

Alas, I’m falling victim to the politicized and cowardly old discourse that has gripped this region for more than 60 years - which leads me to the crux of the matter. Pakistani authorities cannot, will not be able to tackle this public health challenge unless they manage their extremist problem. One arm of the establishment will not be able to fight polio while the other arm just can’t seem to break away from the nefarious Islamism ushered in during Gen. Zia ul-Haq’s reign in the 1980s.

When one arm works at odds with the other arm

It’s the old solution to an old problem. Many of us thought 9/11 would have hammered home that lesson. But nothing, it seems, penetrates those thick Pakistani military-intelligence skulls.

Now they’ve locked up Dr. Afridi instead of handing him to Washington. They’ve channeled the ire of Pakistan’s chattering classes against the US – so the silenced liberals in Lahore can find common cause with Mullah Radio’s friends in Bajaur. They’re back in business playing king-player with the other Taliban in Afghanistan (the “Good Taliban” - not the bad, Pakistani Taliban, since some lessons will never be learned). And finally, they have not managed to administer huge tracts of their tribal areas.

You cannot effectively implement disease eradication programs when there’s little or no security on the ground - ask any public health official.

It doesn’t matter if the Pakistani Taliban did it or the Afghan Taliban or some new fangled militant group with ever-changing Islamist names. Let’s stop wasting our time on this.

After two days of attacks, eight health workers killed and many more injured, some local Pakistani officials have vowed to carry on with the polio vaccination.

As I write this, local authorities in Khyber Pakhtunkhwa province have said they will plough ahead, regardless of the UN/WHO pullback. Bless them, these brave local officials, and let’s salute their indomitable spirit.

But there are reports that Pakistani health workers are incensed by the lack of security for a drive that, let’s admit it, everyone knew would face some trouble.

In the end, there’s just so much high security can do. How many Pakistani security officials, health workers and vulnerable children must we lose to this insanity?

The solutions are in bold print in public health reports: community alliances, building bridges with tribal and religious leaders, that sort of thing. And in Pakistan’s case, not allowing one arm of the state to undo what the other arm is attempting to do.