The recent selection of Jenny McCarthy for a spot on The View has angered vaccinators and people who support childhood vaccination. Her opposition to vaccination, however, puts her in company with the most notorious anti-vaxxers of modern times -- the Taliban.
The coordinated murders of community health care workers in Pakistan, most of them women, in May has once again put into jeopardy the global polio eradication initiative. While the movement initially experienced exponential progress, it now finds itself trapped in an increasingly bloody battle with Islamic fundamentalists. When a female health worker wakes up in the morning, puts on her shalwar kameez, covering her head and most of her face in a dupatta, she is getting in gear to step out on to the front lines of one of the most important and dangerous wars of our time.
The global battle against polio lends itself well to the grisly metaphors of war. In many ways, the world-wide campaign to eradicate the disease has mirrored the fight against terrorism. The number of polio cases hit its lowest mark in 2001 with 483 cases reported. Since then, however, the world has been struggling to go the final inch. With India finally having eradicated polio in 2011, the only thing standing in the way are Islamic fundamentalists in Afghanistan, Nigeria, and Pakistan -- the only countries where polio remains endemic. These fundamentalists have been instrumental in obstructing polio vaccination in all three of these countries. In the Nigerian province of Kano in 2003, Islamic leaders declared polio vaccination to be a conspiracy to sterilize Muslim populations, resulting in a large epidemic that spread polio to several other African countries where polio had previously been eradicated.
The Af-Pak front has been even more problematic. With children on both sides of the restive border between Afghanistan and Pakistan remaining outside the reach of vaccinators, polio continues to proliferate in these areas. Polio vaccinators, at times the only visible footprint of the Pakistani government in these areas, have remained under continuous threat and are frequently attacked.
In the summer of 2011, another noxious ingredient was added to the swirling milieu of conspiracy over vaccinations. Shortly after the killing of Osama bin Laden, it was revealed that the CIA had been running a fake vaccination campaign to acquire genetic material from members of the Bin Laden compound. This news was supposed vindication to the years of propaganda aired by Islamic fundamentalists and the worst nightmare of public health officials who had been struggling to push vaccination on the staunchest of skeptics. "The credibility of health care workers involved in polio eradication seems to have taken a hit due to this episode" said Saad Bin Omer, an associate professor at Emory University with expertise in vaccine refusals both in Pakistan and the United States. The systematic countrywide massacre of hapless vaccinators morbidly underscores his point.
These attacks have once again put the brave women of Pakistan at the forefront of Pakistan's war within itself. The "lady health workers" project was founded by late Benazir Bhutto and is one of her lasting legacies. By making women the centerpiece of community health, building on the access and trust they have with their communities, the thinking was that large-scale public health interventions for infants, mothers, children, and adults could be delivered cost-effectively to the populations that needed it the most. Population-based research has demonstrated their role in everything from delivering psychotherapy to women with perinatal depression to identifying infants with serious infections. Extremists' attacks against Pakistan's women, however, are an example of the terrorists' increasing cowardice and the emptiness of their purported ideals.
Finding it more difficult to launch the sort of high-profile attacks they carried out in past years, the Taliban have started to opt for softer targets. The women of Pakistan are far from collateral damage in this war. Whether it is the spirit of Benazir Bhutto, which continues to power the left in Pakistan, the formless strength of Malala Yousafzai, or the endurance of the women roaming their villages and towns with droppers full of attenuated polio organisms, the women of Pakistan have shown up where many of their men never dare trespass.
However, they cannot carry the mess created by some of Pakistan's men on their own shoulders alone. Nor can Pakistan's weak civilian government. Pakistan's army only became involved in protecting vaccinators after the killings. While moderate religious experts have come out in favor of vaccination, large religious parties and leaders have shied away from supporting it. According to Saad bin Omer, while there are no "silver bullets," having religious leaders endorse vaccination, setting up vaccination sites at key transit points, and increasing community worker compensation and protection are some interventions that should have downstream benefits.
The challenge to vaccination in the United States is an entirely different one, and much of it has the effectiveness of vaccination itself to blame. Historically, as a disease is eradicated, the populace forgets the devastating effects of the disappearing disease. While it was not long ago that a sitting United States president -- Franklin Roosevelt -- was crippled from polio, the last indigenous transmission of the polio virus in the United States occurred during the 70s. The unfortunate resurgence of vaccine-preventable diseases, such as whooping cough, that has resulted from vaccine refusals here may, however, reverse that narrative. Similar to Pakistan though, women, in their role as mothers and advocates, are the key to battling anti-vaccination propaganda, such as the link to autism that has been fully debunked. In many ways, the war on polio and other vaccine-preventable diseases is likely to be just as consequential as the fight against global terror.
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