Despite longstanding efforts to eradicate polio, the crippling disease has reemerged as an international health emergency following a dramatic spike in the number of cases over the past year.
The majority of new cases have been detected in Pakistan
, which the World Health Organization (WHO) has called "a powder keg that could ignite widespread polio transmission." There have been 74 confirmed polio cases worldwide, compared to just 24 at the same time last year. Fifty-nine of the new cases are in Pakistan.
There are several reasons why polio has thrived in the volatile, deeply conservative country.
In Pakistan, militants have kidnapped, beaten, and assassinated dozens of vaccinators in a bid to stop local antipolio campaigns.
Vaccinators have met the fiercest resistance in the restive province of Khyber-Pakhtunkhwa in northwest Pakistan, where the presence of militant groups such as the Pakistani Taliban (Tehrik-e Taliban Pakistan, or TTP) is strongest.
Militant groups such as the TTP have opposed immunization partly because they see it as cover for foreign spying. Such beliefs gained credence following a Pakistani investigation that alleged that the CIA used a Pakistani doctor, Shakil Afridi, to uncover Osama bin Laden's hideout. Afridi was accused of confirming bin Laden's presence through DNA samples taken from his family under the guise of a hepatitis vaccination program. The Al-Qaeda leader was killed in May 2011 in the Pakistani garrison town of Abbottabad.
Pakistani Health Minister Saira Afzal Tarar blames the surge of polio cases in Pakistan mainly on "a reaction to the Afridi case."
Widespread public fears that the polio vaccine leads to infertility have contributed to the crippling and deadly disease's resurgence in Pakistan.
Religious hard-liners have called vaccinations a Western plot to sterilize Muslim populations. Some Islamic clerics have even issued fatwas saying that any person who became paralyzed or died from polio would earn "martyr" status for refusing to be duped by a Western conspiracy.
Pakistan recorded 91 cases of polio in 2013, according to WHO, up from 58 in 2012. Polio is a highly contagious disease that mainly affects children under five years of age. It cannot be cured, but it can be prevented with vaccination. One in 200 infections results in paralysis and between 5 and 10 percent of paralyzed patients die.
Religious hard-liners and militants have claimed that polio vaccinations are "un-Islamic" and an attempt to thwart the will of God.
Polio vaccines used in Pakistan are made in laboratories worldwide, including in the United States, making them a source of resentment. Militants and some religious clerics claim the vaccinations are made out of pig fat or have traces of alcohol, both of which are banned under Islam.
Government health officials have met with religious leaders and clerics across the country in a bid to dispel misconceptions surrounding vaccinations. Some clerics have publicly declared that the immunization drive is acceptable under Islam and that it is, in fact, the militants' deadly campaign against polio workers that is "un-Islamic." But the word of hard-line clerics and militants continues to hold sway.
In Pakistan, the majority of confirmed polio cases has been detected in the country's restive northwest. The city of Peshawar, the capital of Khyber-Pakhtunkhwa Province, and the Federally Administered Tribal Areas (FATA) along the border with Afghanistan are particularly vulnerable. Pakistan's largest city, Karachi, located in the southeastern Sindh Province, is also a polio hotbed.
The impoverished, volatile northwest has borne the brunt of an insurgency. It is host to millions of Afghan refugees, creating the conditions for the disease to spread. And there is also poor sanitation and weak health infrastructure in the region.
Health officials have called on the government to increase expenditures on public health care, to improve infrastructure, and to provide added security for polio vaccinators working in insecure areas.
Dr. Zubair Mufti, the WHO polio department head
for Pakistan, says the government needs to do more to gain access to high-risk areas.
"The key to success in Pakistan is to obtain access to the nearly 250,000 children in North and South Waziristan tribal agencies [eds. in FATA]. Then you need to maintain consistent vaccination activities in the cities of Karachi and Peshawar. These are the three areas where Pakistan remains struck."