The polio virus is almost completely wiped off the face of the earth, thanks to a global effort to exterminate the crippling disease. In 1988, when the Polio Eradication campaign was launched, 350,000 children were paralyzed by polio across 125 countries. Last year, there were only 37 cases reported in three countries: Afghanistan, Pakistan and Nigeria. Most were in Pakistan.
Sadia Alam’s team is amongst the 14,000 polio vaccination teams deployed across neighborhoods in Peshawar, Pakistan that are vulnerable to a polio outbreak. Polio-wallahs can be recognized by the eponymous blue box of vaccines they carry from door to door.
In a conservative society, only female vaccinators are allowed to enter the house, where they will give two drops of the oral polio vaccines to all children under five years of age. Sadia Alam earns around $10 per day, and will visit 103 households in this campaign.
This overcrowded neighborhood in Peshawar, with summer temperatures over 100 degrees and poor sanitation infrastructure, is the perfect environment for the polio virus to flourish.”
Male members of polio teams chalk vaccination data across the front door of each house visited: how many children under five, how many vaccinated and how many missed. This data is key to ensuring campaign coverage, but can also raise suspicion by making communities feel like they are being monitored by the government.
This grandfather has turned away vaccinators, because he does not trust the government, which sends polio workers to his home twice a month but does not clean up the mounds of garbage choking the streets of his neighborhood.
In 2011, the CIA commissioned a vaccination campaign to collect blood samples from the house of Osama Bin Laden. Many communities have since become wary that door-to-door vaccination campaigns are a front for spying.
The Taliban retaliated by banning polio vaccination in regions under their control. The first polio worker to be targeted in Peshawar was killed in Hasan Garhi, a neighborhood which now faces a shortage of female vaccinators.
Misinformation about polio vaccination circulates in communities with low levels of literacy, and leads to vaccination refusals. Some families believe that the polio vaccine causes infertility, and is part of a western conspiracy to limit the Muslim population.
Some parents who refuse polio vaccination believe that the vaccine causes children to become sexually mature at a young age. In a country where young women are lawfully killed by their families for sex before marriage, these rumors stoke deep parental fears.
After a child receives the vaccine, their pinkies are colored with blue marker. 86% of children here must be vaccinated in order to prevent the virus from circulating in the community, but achieving high rates of vaccination can be challenging.