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Role of Fundamental Islamic Groups in the Eradication

of Polio in Pakistan

Madeline Halpern

The International Maze of Guerrilla Warfare & Terrorism

Doctor Jonathan Fine

January 10, 2014


Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Polio as a Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Vaccination and Eradication . . . . . . . . . . . . . . . . . . . . 3

Terrorism in Pakistan . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Polio in Pakistan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11


As of 2013, small pox remains the only disease to ever be intentionally eradicated by humans

(Shah). The public health industry hopes that polio may soon follow small pox by existing

solely within labs, saving thousands of lives and resulting in the decrease of childhood paral-

ysis (Shah). Unfortunately, three countries continue to act as reservoirs for polio, risking

the surrounding countries for future outbreaks. These three remaining countries Pakistan,

Afghanistan, and Nigeria are predominately Muslim countries and that house many radical

Islamic groups (Khowaja). This paper will explore the connection between such demograph-

ics and the polio eradication efforts within Pakistan while Pakistan is certainly not the

only country that this relationship may apply to, it serves as an effective lens through which

to analyze the relationship.

Polio as a Disease

Poliomyelitis, commonly known as polio, is a waterborne virus that affects the nervous

system (Khowaja). Symptoms, when present, are typically mild and similar to influenza.

However, 1 in 200 cases 0.50% inflict paralysis. In some cases, paralysis becomes severe

enough that the infected person can not breathe on their own, requiring the assistance of

machines to conduct such a basic activity required for life. Polio is extremely similar to

Hepatitis in that there are several serotypes or families, of the disease, and in that infection

from one of the three serotypes renders the subject immune to all future mutations and

strains from that serotypes.

At present, no cures or treatments exist for polio infections, which makes it imperative

that the disease is treated in a preventative manner (Shah). To this end, the Global Polio

Eradication Initiative was founded in 1988, focused on ensuring the vaccination of children

worldwide (Shah). Such efforts proved extremely effective in countries that emphasize ex-

tensive vaccination campaigns, including the United States and China, rendering the disease

extinct in such countries (Khowaja). Even politically tumultuous countries, such as Somalia

and the Democratic Republic of Congo in Africa, have successfully eradicated the disease

(Khowaja). Since 2012 only type 1 polio still exists outside of laboratories; type 3 was last

seen in 2012 while type 2 was last seen in 1999 (Shah).

Vaccination and Eradication

During the 1950s, two polio vaccines were developed by separate American scientists, each

using a different method (Shah). The first and most well-known vaccine was developed by

Jonas Salk, using deactivated viruses from each of the three serotypes (Shah). At the time,

live virus vaccines were considered dangerous and often resulted in infection instead of the

desired result of immunity. As a result, Salks inactivated vaccine was widely adopted within

the United States and Western Europe, leading to the recognition that Salk holds in modern

popular culture (Shah).

Concurrently with Salk, Albert Sabin developed a live polio vaccine (Shah). While live,

inactive vaccines were considered the gold standard at the time, Sabin was convinced that a

live vaccine would be more effective against polio than a inactivated one (Shah). Despite the

preconceptions that his vaccine would be less effective and even dangerous, Sabins vaccine

was tested within the Soviet Union and found it to be effective (Shah). Starting in 1961,

many countries in the developing world began using Sabins vaccine due its lower cost.

In addition to differing with respect to the state of the viral contents, the two vaccines

differ significantly the process of administration. The deactivated virus is administered via

an injection, whereas the live virus is administered orally in drops (Shah). While both

vaccines are available at present, many organizations are fighting the use of the oral vaccine,

citing it as an origin point for incidences of polio. Given that an effective, presumably safer

alternative exists, such organizations view the oral vaccine as a needless risk, that could not

possibly be mitigated by the reduced cost of the oral, live vaccine. Additionally, when funds

exist, the ideal course would be the injection followed by several doses of the oral vaccine.

Since polio primarily infects those under the age of five, children must be inoculated at an

early age to reduce the risk of infection (Shah). In many countries, infants are vaccinated at

the ages of two, four and six months, then receive a booster inoculation at the age of four.

Less developed countries often fail to adhere this schedule, aw well as, in areas with limited

access to healthcare for the general public (Shah). Unfortunately for those living in such

areas, no other way exists to prevent infections of polio even boiling water and utilizing

iodine drops to purify water will not kill the virus, and it is impossible to detect without

specialized laboratory equipment (Shah).

Global eradication of polio poses a great challenge, given the globalized economy and ease

of international travel (Bhutta). Some countries which previously erridicated polio have

observed a resurgence of the disease following extended periods without proper sanitation

or with slipping vaccination rates (Bhutta). Israel, a country which has been without polio

since the early 1990, periodically discovered evidence of polio within waste water in 2013

(Beaubien). Researchers are still unsure of how the virus entered the country. Fortunately,

Israel requires all children to be vaccinated against polio, which led to a total of zero diag-

nosed cases (Beaubien). On the other hand, Syria let vaccination rates and overall sanitation

slip significantly during 2013 (Bhutta). Unlike Israel, Syrias infrastructure has crumbled

during their recent years of civil war, and healthcare workers have struggled to reach those

in need of assistance or inoculation. Should the overall situation in Syria not improve, the

country may be on the fast-track to become a hotbed for polio.

While some organizations like Doctors Without Borders and the United Nations Chil-

drens Fund may make an effort towards improving the vaccination rates of these countries,

merely setting up clinics and encouraging vaccinations is not enough to halt the polio epi-

demic (Nishtar). A correlation exists within countries between the prevalence of polio and

government-level corruption, which inhibits the trust of the public in government-backed

campaigns (Nishtar). Some countries such as India and China have observed positive re-

sults from programs called vaccination days (Bhutta). The Democratic Republic of Congo

had similar results from days of tranquility where a country wide cease fire held until all

children were vaccinated (Bhutta). In countries like Pakistan, these may actually serve as a

deterrent against vaccination (Nishtar). For this reason, Pakistan had not held a vaccina-

tion day since 2001 (Shah). Specifically, within Pakistan, there are widespread rumors that

all vaccines are designed to make Muslim boys sterile, and that such vaccines may spread

HIV/AIDS (Rockett). Additional rumors address the workers administering the vaccines

themselves, claiming workers are foreign spies (Rockett).

Rumors are not the only factor parents take into account prior to deciding on if they will

vaccinate their children. In interviews with Pakistani parents, one third believed that the

polio vaccine is ineffective (Khowaja). Many parents also felt that multiple doses were

unneeded and did not continue with the regime (Khowaja). Additionally, many people are

of the belief that vaccines are created with non-halal, or un-Islamic, ingredients (Khowaja).

Some even resent the government putting emphasis on polio as opposed to issues more

pressing in their area (Khowaja)

Further complicating the vaccination effort, not all areas of developing countries such as

the ones affected significantly by polio have access to stable electricity (Nishtar). Despite

the inactive virus in the injection-administered polio vaccine, both vaccines must be kept

refrigerated in order to maintain maximal effectiveness (Nishtar). Without reliable electricity,

it is extremely difficult to ensure the delivery of a viable and effective vaccine to residents of

remote areas. However, this is only a concern when such areas can even be reached often,

paved roads do not even exist outside of cities in these countries, and mountainous terrain

can render a large portion of land unreachable to those who might be able to administer

vaccines (Nishtar).

Unfortunately, the government is not the only organization that suffers from serve corruption.

Reports exist stating that vaccine workers attempt to charge for vaccine card which are meant

to be free (Nishtar). These cards allow future workers to know if a child needs additional

doses and which vaccines the child has received (Nishtar). Also, workers sometimes sell

vaccines and syringes to private hospitals for a hefty profit (Nishtar). When workers are

thieves or corrupt it makes all of the industry look bad even if only a minority takes part in

these activities.

Terrorism in Pakistan

Radical Islamic groups perpetuate terror throughout the Middle East, Africa, and Southeast

Asias Muslim populations. These groups, such as the Muslim Brotherhood, the Taliban, and

Al-Qaeda, are responsible for more than just suicide bombings they focus on propagandistic

teachings that render their constituents convinced that such terrible actions are the only way

to attain justice or equality in the world. Communities within which these groups operate

are taught to follow specific interpretations of the Quran that emphasize these teachings

(Murphy). While one might expect the general public to recognize this manipulation, poor

education, corrupt governance, and a myriad of other factors force residents to flock to these

groups, under the guise of providing hope for a better future (Murphy).

During the reign of General Muhammad Zia ul-Huq, the number of Islamic seminaries

Madaris rose drastically (Murphy). Over his eleven years in power, the number of Madaris

jumped from 900 to 8, 000 (Murphy). While these counts only include legally registered

Madaris, there are an additional estimated 25, 000 unregistered Madaris (Murphy). Within

these seminaries, students without any financial means received an education, food, and

housing at no cost (Murphy). Pakistan has historically housed many peaceful, co-existant

sects of Islam, despite their potentially contradictory views (Murphy). Contrary to this

history Madaris taught an extremely narrow view of Islam that focused on the earliest fun-

damental sources of Islamic teaching (Murphy). Some seminaries went so far as to train

students to become fighters for a holy war jihad (Murphy).

In addition to the radicalization of schools, the reign of General ul-Huq saw the incorporation

of Islamic teachings into the curriculum of Pakistans armed forces (Murphy). Whereas the

proportion was significantly lower before, estimates claim between 25 and 30% of Pakistani

armed forces members identify as having fundamentalist views with regard to Islam (Mur-

phy). The invasion of the Soviet Union in Afghanistan led to widespread hatred of Western

society among these radicals (Murphy). During the ensuing war, the Taliban rose to promi-

nence as fervent fighters for the good of Islam (Murphy). This group won the support of both

Afghanistan and Pakistans governments (Murphy). While the Taliban may have originally

harbored good intentions, they ultimately became the face of radical fundamentalist groups

the shared border between Afghanistan and Pakistan, combined with widespread support

between both countries, led to the organization having effectively free reign over the region


Following the attacks on the United States on September 11th , 2001, Pakistan observed a

spike in terror attacks within the country. These attack, which rose from 2 incidences in 2002

to 335 in 2010, led to a schism within the countrys government (Sultana). While some parts

of the government continued to believe that the Taliban represented Islam appropriately,

others believed that fighting such attacks was imperative to maintaining the safety of the

general public of Pakistan (Murphy). Those members of government who sided with the

Taliban cited their actions as part of a cleansing jihad, and maintain that it was essential

to the continuing existence of the religion (Murphy). This schism rendered it impossible to

make a country-level decision between accepting foreign aid from the West, including the

United States, and leaning on the Taliban (Murphy).

As a result of the September 11th attacks, Osama bin Laden, a well-known terrorist linked

to these attacks, was assassinated in 2011 (Mazzetti). In order to ascertain his location, a

covert operation was designed where a doctor, under the guise of providing vaccinations, took

DNA samples from those they presumably inoculated (Mazzetti). These DNA samples were

utilized to find links to bin Laden (Mazzetti). Eventually, Osama bin Ladens whereabouts

were uncovered, and a team of Navy SEALs successfully assassinated him. (Mazzetti)

While their mission was successful in that bin Laden, a known terrorist responsible for

the loss of thousands of lives, was successfully terminated, a slew of unintended negative

consequences occurred as a result. Whereas the region was already distrustful of vaccinations,

the circumstances of this operation led to increased distrust and skepticism of all vaccines

(Bhutta). Even following the imprisonment of the doctor responsible for the false campaign,

this sentiment is prevalent (Stone). As an extension of this, healthcare workers in the region

are regularly attacked, sometimes fatally, as retribution for the campaign (Watson). Over

a two-day period in December 2012, no fewer than eight aid workers distributing vaccines

were shot and killed in Peshawar within Pakistan. Soldiers and police officers escorting

such workers are also regularly fired upon (Watson). As a result of such violence, many

organizations have suspended their inoculation campaigns until the safety of their workers

in Pakistan can be guaranteed (Watson). At the time of such suspension, it is estimated

that 280, 000 children in northwest Pakistan alone are in need of vaccinations (Watson).

Polio in Pakistan

Pakistans tumultuous history, widespread poverty and terrain have all greatly aided the

growth of radical Islamic groups. Such groups have expressed disapproval of vaccination

workers, as evidenced by the violence against such humanitarian workers (Bhutta). Whether

this disapproval is fueled by retribution for the killing of bin Laden, or by propagandistic

beliefs such as a presumed intent of castration, the net effect is the same: it is increasingly

difficult to provide inoculations to the general, unsuspecting public of Pakistan (Bhutta).

Additionally, without the support of Madaris the general public chooses to abstain from

vaccines (Bhutta).

As a result of this, polio has run rampant in Pakistan. In 1997 1155 were report. Following

years of aggressive vaccination a mere 28 cases were reported in 2005 the lowest year on

record (Nishtar). Given the widespread support that the Taliban has, and given that this

organization appears to believe that it is imperative to stop vaccinations, it should come

as no surprise that Pakistan, and by extension Afghanistan, is one of only three countries

experiencing widespread polio.

Beginning in 1994, Pakistan started a polio immunization program (Shah). The World

Health Organization and Pakistani government jointly funded this program with high hopes.

Each year the country has received 5.8 million vaccines meant for Pakistani children (Shah).

At around 6, 000 permeant clinics around the country there are 10, 000 vaccinators, as well

as, 6, 000 women health workers (Shah). Additionally, there are close to 1 million mobile

clinic workers who also vaccinate (Shah). Combined these workers are responsible for nearly

30 million childrens health each year (Shah).


The combination of many factors has stalled the eradication of polio. Among the countries

still harboring the virus, there is rampant poverty, illiteracy, poor sanitation, lack of infras-

tructure and radical Islamic groups. It is hard to quantify the influence of each factor but

it remains clear that even on their own each could prevent countries from eradicating the

disease. Hopefully with better education and support of community leaders will dispel myths

and lead to higher vaccination rates.

Works Cited

Bhutta, Zulfiqar A. Conflict and Polio Journal of the American Medical Association

310.9(2013).905 6. Print

Beaubien. To Keep Polio At Bay, Israel Revaccinates a Million Kids. National Public

Radio 2 September 2013. Online

Khowaja, Asif Raza; Sher Ali Khan; Nizam Naveeda Nizam; Saad Bin Omer; Anita Zaidi.

Parental perceptions surrounding polio and self-reported non-participation in po-

lio supplementary immunization activities in Karachi, Pakistan: a mixed methods

study Bulletin of the World Health Organization 90.11(2012) : 822 30. Print.

Mazzetti, Mark; Helene Cooper. Detective Work on Courier Led to Breakthrough on Bin

Laden. New York Times 2 May 2011. Online.

Murphy, Eamon; Ahmad Rashid Malik. Pakistan Jihad: The Making of Religious Terror-

ism Islamabad Policy Research Institute Journal 2.(2009)17 31. Print.

Nishtar, Sania. Pakistan, Politics, and Polio Bulletin of the World Health Organization

88.2(2010). Print

Rockett, Karen. Islamic militants kill polio vaccination worker in Pakistan in latest Muslim

sterilisation plot attack Mirror 28 December 2013. Online.

Shah, Masaud; Muhammad Kazim Khan; Saleha Shakeel; Faiza Mahmood; Zunaira Sher;

Muhammad Bilal Sarwar; Aleena Sumrin. Resistance of polio to its eradication in

Pakistan Virology Journal 8.(2011). Online.

Stone, Andrea. Shakil Afridi, Pakistani Doctor Who Helped Catch Osama Bin Laden,

Faces Prison As Payback. The Huffington Post 29 June 2012. Online

Sultana, Saeeda; Syed Khawaja Alqama. Pakistan: The Critical Battlefield of the War of

Terror Pakistan Journal of Social Sciences 32.1(2012) : 49 63. Print.

Watson, Leon. Taliban Shoot Dead Three More Polio Aid Workers in Revenge Campaign

for Fake Vaccination Ruse That Helped Capture Osama bin Laden Daily Mail 19

December 2012. Online