(30 Jul 2019) Administering the polio vaccine is a simple enough procedure. But in parts of Pakistan, a scene like this stirs controversy.
Health workers are fighting not just naturally wary parents, but also Islamic militants who claim the polio vaccine is a secret sterilisation ploy.
The memory of a fake CIA hepatitis vaccination campaign that was used as a ruse in Pakistan to find Osama bin Laden lingers.
Here in Karachi, these two children are being inoculated with the approval of their grandfather, Javed Ahmed.
"Islam tells us to take the necessary precautions for health. If, in doing that, we require medicines and vaccines, then we should use them. We should spare no efforts and vaccination is ideal. As for the rest, we leave all to God," he says.
Vaccinating Pakistan's millions of children is also a logistical challenge.
Here at the Cantt railway station in Karachi, more than a dozen officers are administering the oral vaccine.
For 21-year-old Farheen Younus, it's a relief to be able to do this without police protection.
"My younger brother had polio and died very young. That's the main reason my mother became a polio worker. My mother left the job after she witnessed an incident in which two young polio workers were killed. But she didn't stop me from working as a polio worker. Instead, she told me that vaccination drives should continue. Because those households where a child is afflicted with polio experience life and death on a daily basis," she says.
According to Emergency Polio Centre Pakistan, 70 people associated with the polio programme have been killed in the country in the past seven years. In April, three polio workers were killed in the span of one week, resulting in the suspension of a nationwide drive.
Paediatrician Professor Dr Iqbal Memon says movements between Pakistan and Afghanistan, both countries where polio is endemic, make vaccination difficult.
"The research data tells us that in an environment of developing countries like Pakistan, where enteric infections - that is GI tract infections, gastro infections - are more common, where sanitation is a problem, where clean water is a problem. And of course hygiene process is limited, and hand-washing and all. In those environments with frequent infections, about 15 time doses is what is considered adequate," he says.
He says there have been reports of 45 confirmed polio cases in Pakistan already this year, up from eight last year.
"Till the environmental samples are telling us that there is a poliovirus around, that's a danger sign. That is a red light. And it can only be circumvented when we are giving polio drops to everybody around, maximum number of children, who then transfer these vaccine polio viruses into the sewage and sanitation. And then, there is the survival of the fittest (between the poliovirus and vaccine)," he says.
For now, polio remains ever present in Pakistan, with sewage samples testing positive for the virus in 12 cities.
For some, it's already too late, like 10-year-old Aleena Ahmed.
Health workers hope cases like hers will become rarer as this vaccination programme expands.
But it's a tall order: earlier this year, authorities said they needed to immunise 39.2 million children across the country.
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