Polio workers in Nigeria shot dead | World news | The Guardian Nigeria Polio workers in Nigeria shot dead At least nine health workers gunned down in northern city of Kano amid increasing hostility towards polio immunisation drive A schoolgirl in Kano, northern Nigeria, receives the oral polio vaccine during a nationwide immunisation campaign. Photograph: Chris Hondros/Getty Images Nigeria Polio workers in Nigeria shot dead At least nine health workers gunned down in northern city of Kano amid increasing hostility towards polio immunisation drive Friday 8 February 2013 12.55 EST First published on Friday 8 February 2013 12.55 EST Close This article is 3 years old At least nine women who were vaccinating children against polio have been shot dead in northern Nigeria by gunmen suspected of belonging to a radical Islamist sect. The killings drew comparisons with a series of incidents in Pakistan last December where five female polio vaccinators were gunned down, apparently by Islamist militants. It also signalled a fresh wave of hostility towards immunisation drives in Nigeria, where some clerics have claimed the vaccines are part of a western plot to sterilise young girls and eliminate the Muslim population.

The attacks took place in Kano, the biggest city in Nigeria's predominantly Muslim north, where families generally feel more comfortable allowing women inside their homes than men. On Friday morning gunmen arrived by motor tricycle and opened fire in the Hotoro Hayi neighbourhood, killing at least eight female vaccinators, witnesses told Associated Press. Four people were killed in a second attack, in the Unguwa Uku neighbourhood, according to witnesses. The final death toll remained unclear. A Kano police spokesman, Musa Magaji Majia, said the attacks killed nine people, all women, taking part in the vaccine drive and giving oral drops to children. A local hospital said it received only two bodies from the Unguwa Uku attack, with four others injured. While officers said there were no immediate suspects for the shootings, witnesses said the Islamist militant group Boko Haram was responsible. The sect has been blamed for the deaths of some 1,400 people in central and northern Nigeria since 2010, including an attack in Kano in January 2012 that killed at least 185.

Nigeria is one of three countries where polio, which can cause irreversible paralysis within hours, remains endemic; the others are Afghanistan and Pakistan. There were fears that Boko Haram is copying tactics used by militants in those countries who accuse health workers of spying for the US. Such rumours intensified after it emerged that a Pakistani doctor ran a fake vaccination programme to help the CIA track down and kill Osama bin Laden. At least 16 health workers taking part in polio vaccination drives were killed in attacks in Pakistan in December and January. Activist Shehu Sani, president of the Civil Rights Congress of Nigeria, said: "Boko Haram and the Taliban in Pakistan and Afghanistan share a common ideology and common strategy and also pose a common danger. If you observe their methods of operation, their targets are similar. Boko Haram have targeted police stations, politicians, religious clerics who speak out against them and people engaging in polio vaccination programmes." This was not the first strike against polio vaccinators in Kano. In October, police said two officers involved in guarding an immunisation drive there were shot and killed.

Earlier tThis week a Kano radio station told how one of its journalists had been attacked by local officials and had his equipment confiscated after speaking to a man who refused to allow his children to be vaccinated. A producer for the programme apparently spoke on air about fears people have about the vaccine, which then spread through the city. Kano state's police commissioner ordered his officers to arrest the producer, officials said. The suspicion surrounding polio vaccinations in Nigeria took hold in 2003, when a Kano physician heading the Supreme Council for Sharia in Nigeria said the medicine had been "corrupted and tainted by evildoers from America and their Western allies". The consequence was hundreds of new infections in children in the north. The outbreak of the virus eventually spread abroad, even causing infections in Indonesia. Sani added: "Polio vaccinations have been controversial. There are religious clerics who believe the specious argument that [the vaccination programme] is an attempt to reduce the number of Muslims in northern Nigeria through sterilisation.

There is a constituency of opinion that has been disseminated to the general population." According to the Global Polio Eradication Initiative, there were 121 new cases of polio in Nigeria last year, compared with 58 in Pakistan and 37 in Afghanistan. Oyewale Tomori, a campaigner for polio eradication in Nigeria, told Reuters: "This is certainly a setback for polio eradication in Nigeria, but not a stop. The best we can do is to work harder and see the end of polio ... so their loss will not end as a useless sacrifice." Kano's government banned motorbikes from carrying passengers last month after the state's emir, one of the country's most prominent leaders, was nearly killed when gunmen attacked his convoy, killing four of his aides. Residents said soldiers had cordoned off the areas attacked and movement was being restricted in the city. President Goodluck Jonathan has highlighted links between Boko Haram and Saharan Islamists and said that relationship justified his decision to join efforts by French and west African forces to fight militants in Mali last month.

Billionaire Microsoft chairman delivers Richard Dimbleby lecture and reveals his dedication to fighting the disease Published: 29 Jan 2013 Those attacking polio workers claim they are spies or that the vaccination will make Muslim children sterile [AP] By Arsla Jawaid Since July 2012, 31 people have been killed in Taliban-led attacks on anti-polio campaigners in Pakistan. Most recently, two policemen providing security to polio vaccinators in Swabi were killed when gunmen on a motorbike attacked them. In a separate incident, unidentified gunmen opened fire on polio workers in Peshawar, killing one. One and a half million children are at risk of polio in Pakistan, which along with Afghanistan and Nigeria are the only three countries in the world where the virus - which spreads from person to person - remains endemic. Gulnaz Nighat, the health official in charge of the anti-polio campaign in Karachi's Gulshan-e-Buner district, vividly remembers the day her sister-in-law, Fehmida; and niece, Madiha - both health volunteers - were killed.

On the morning of December 18, 2012, two men on a motorbike exchanged a quick "salaam aleikum" with the imam of a mosque in the area. Having brought their four-year-old cousin to get vaccinated, they asked for the polio workers. The imam pointed towards Fehmida and Madiha, who were administering oral polio vaccines to children at a house nearby before disappearing into the mosque. Ten minutes later, two shots were fired. The imam ran out to see Madiha fall to the ground as Fehmida ran inside the house. The two men chased her inside and gunned her down as well before escaping on their bike. Pakistani Taliban targets polio vaccination team in attack Gulnaz heard the shots but didn't make anything of it because she lived in an area where violence is rampant. A few minutes later, she heard police and ambulance sirens. "That is when I got worried. I called my niece's cell phone five times but there was no answer." Donning her abaya, she raced to the scene. "The moment I saw Fehmida and Madiha's bodies, I wanted to scream but not a sound would escape me.

I kept arguing that they must have fallen asleep. I couldn't grasp the reality of what had just happened." Many expected Gulnaz to abandon the programme out of fear, but instead the killing of her relatives only emboldened her. When asked whether she feels afraid, Gulnaz told Al Jazeera, "Allah has given me strength. We are doing this for the future of this country. We need to move towards light, not disappear into darkness." After pausing for a moment, she softly stated, "Whenever I go in the field, I feel that my niece and sister-in-law are walking right beside me. It makes me stronger to know that they didn't die in vain. It is my duty to finish what we started together." Security threats In 1994, Prime Minister Benazir Bhutto launched the Lady Health Workers Programme under the auspices of the Ministry of Health in an effort to introduce essential health care facilities to vulnerable communities. Today, Pakistan has approximately 110,000 Lady Health Workers in the field. There have been numerous killings and the girls are very scared. Volunteers have dropped out of the campaign and even the policemen are afraid.

- Ayesha Bibi, a health supervisor in Peshawar Despite running one of the largest community health-care programmes in the world, Pakistan's polio eradication efforts are troubled. Dr Elias Durry, the head of the World Health Organisation's Global Polio Eradication Initiative, told Al Jazeera that "security concerns and negotiated access are the two major problems facing polio elimination. The good news is that there have been no cases from [Pakistan's western province of] Baluchistan, and the polio epidemic is now confined to certain pockets. The bad news is the polio ban in certain areas, the killing of the workers and the lack of access that leads to missed children." This year, Pakistan has reported 75 cases of polio, with 52 cases occuring in its federally administered tribal areas. With security concerns high, polio vaccination teams lack access to the North and South Waziristan regons, meaning that close to 290,000 children have been prevented from receiving vaccinations. Nationwide, 90 percent of polio cases occur among ethnic Pashto families, many of whom live in Pakistan's northwest.

Ayesha Bibi, a Lady Health Supervisor in the northwestern city of Peshawar, argues that the level of security provided by the government is severely inadequate in the country's high-risk areas. "There have been numerous killings and the girls are very scared. Volunteers have dropped out of the campaign and even the policemen are afraid," she said. Ayesha told stories of changing cars and license plates to avoid Taliban monitoring but claims that she continues to receive death threats. "This issue is very politicised," said Saira Tarrar, minister of state for national health services, regulation and coordination. "We need two policemen per team, and that would mean about 3,600 policemen. Given our security constraints, that is impossible. I also monitor the prime minister's Polio Cell. We can only provide technical support and advise on security but cannot implement it. It is not our job." Refusing the vaccine According to information obtained from the WHO, Pakistan's National Immunisation Day in November aimed to vaccinate 34 million children. But some polio workers boycotted the initiative. They earn just $2.50 a day, yet many have not been paid for the past six months.

On top of that, they face tremendous risks in their day-to-day work. As a result of the boycott and the security risks, the National Immunisation Day was delayed in 70 districts across the country. Official statistics released by the WHO show that 2.34 million children were missed during this campaign - of whom 47,099 children were not immunised because their families refused the vaccine. Pakistan's polio fight faces new setback Apart from the inaccessibility of certain areas and the presence of polio "reservoirs" like Karachi, "security concerns and army operations also lead to a great movement of people. If we don't vaccinate children, they can quickly become the main carriers of the disease," said Durry. Some Pakistanis refuse to have their children vaccinated because they believe that it is "un-Islamic" or could be an American ploy to sterilise children. After news emerged that the US' Central Intelligence Agency employed a doctor to run a fake hepatitis B vaccination programme in an effort to find Osama bin Laden, conspiracy theories about health workers' activities have abounded - such as claims that vaccinators mark houses to be targeted by US drones.

Polio workers have been accused of being CIA operatives, and the campaign has suffered incalculable damage. However, according to Nasir Nawaz, a district health communication support officer in Sindh province, vaccines are most often refused by Pakistanis living in very poor areas, where basic needs for water, food and electricity are unmet. In such circumstances, polio workers who bring vaccines instead of food and clothing are promptly, and aggressively, turned away. Durry told Al Jazeera, "The real heroes of this campaign are the vaccinators who keep doing their jobs in high-risk areas without fear. They are not soldiers who are trained to battle. They are just there to do the right thing. If there is anyone who deserves to receive the Nobel Prize, it is the health workers." Health workers like Ayesha refuse to leave the campaign despite the threats and the lack of pay. "We play with our lives every day, but we do this for our country. What will happen to our children if we stop? We can't give into Taliban threats." Pausing for a moment, she says proudly: "I am a woman from FATA [Pakistan's federally administered tribal areas].

I am not one of those scared ones." Source: Al Jazeera An Honest Vaccine: The CIA in the War Against Polio - BORGEN You are at: Home » World News »An Honest Vaccine: The CIA in the War Against Polio An Honest Vaccine: The CIA in the War Against Polio World News ISLAMABAD, Pakistan — Pakistan has been engaged in a full-scale war against polio since eradication efforts started in 1993. However, recently, a new player joined the game, the CIA. For years, the CIA undercover fake vaccine operations put a strain on the eradication efforts, until recent news from the White House indicates such operations have stopped. Polio is not a concern in most places. The number of cases worldwide has dropped from 350,000 in 1998 to 416 in 2013. However, polio has never been successfully eradicated in Pakistan. The country remains one of three nations, along with Afghanistan and Nigeria, where the disease occurs and spreads naturally. Of these nations, Pakistan experiences the most cases.

So far in 2014, there have been 77 cases worldwide, 61 of which occurred in Pakistan. According to the World Health Organization (WHO,) one of every 200 of these cases leads to paralysis and a small fraction result in death, and for every case, there are 200 people carrying the disease. While polio has an effective vaccine that has made eradication possible, it is difficult to distribute vaccines in politically unstable or poverty-stricken areas. In addition, the presence of insurgents often hinders efforts to vaccinate children under 5, the target demographic for the disease. But it is rumors that are the most effective in stunting vaccination efforts. Such rumors started 10 years ago in Nigeria, when local religious leaders claimed the polio vaccine was a Western plot to sterilize their girls, and since then, this idea and other gossip has spread to more regions where polio is endemic. New rumors emerged in July of 2011, when The Guardian published a piece on the underground CIA vaccination operations. These operations were confirmed by then director of the CIA, Leon Panetta, in January of the following year.

The CIA employed Pakistani doctor Shakil Afridi to run a fake hepatitis B vaccination campaign which enabled the CIA to collect DNA and information in the compound where they suspected Osama bin Laden was hiding. The goal was to collect samples using residual blood obtained during a vaccination to compare the DNA to bin Laden’s deceased sister’s. This would prove that bin Laden’s children were living in the compound, thus increasing the likelihood that bin Laden himself was in the neighborhood. The vaccination operation ultimately failed to prove anything and Afridi was imprisoned for treason in May of 2012. The CIA operation in question administered hepatitis B vaccinations, which are given by a shot. Even though polio vaccines are distinguishable because they are given orally, the stigma against polio aid workers was already in place, and the CIA’s operation caused backlash against all vaccinators and proved to be a significant setback in the eradication of polio. The violation of trust caused by the CIA has endangered public health efforts and those working in the field. Rising distrust has sparked violence against legitimate vaccination workers. After nine public health workers were killed in December 2012, the United Nations withdrew its vaccination teams.

Since then, over 60 polio vaccinators have been killed in Pakistan alone. In addition, after the fake vaccination operations were uncovered, Taliban commanders banned polio vaccines in North and South Waziristan regions back in 2012. The ban is still in place today, and the majority of cases of polio in Pakistan come from the Waziristan region. Ultimately, the CIA’s operations worsened conditions for the fight against polio. It is predicted that the fake campaign could postpone eradication in Pakistan for another 20 years, leading to 100,000 more cases that could have been prevented. Polio has been spreading since the Taliban stopped vaccination efforts, and the country now sees a spike in cases. Pakistan reported 83 new cases of polio in 2013 alone. On top of this, the WHO declared polio a global health emergency on May 5. Polio has recently begun spreading from the three countries where it is endemic. In 2012, it existed only in Pakistan, Afghanistan and Nigeria, but new cases have since been found in Syria, Iraq, Cameroon, Guinea, Kenya, Ethiopia and Somalia. The U.N.

is recommending that Pakistan, Cameroon and Syria vaccinate all citizens before they leave the country, and the WHO is echoing the call for international travel restrictions coming from these countries. It has become apparent that any hindering of vaccination efforts will cause a global calamity. However, there is good news. In the face of this increase of polio, the White House has announced that the CIA will no longer use vaccination efforts in its information harvesting efforts. This information comes in response to a letter from the deans of 12 U.S. public health schools that was sent to U.S. President Barack Obama in January 2013, arguing that these operations are harming public health efforts and the “collateral damage” was too much. The White House responded in May, stating that operations of this type had stopped in August of 2013. The public announcement of the change in CIA operations will hopefully keep public health workers safer as they continue to vaccinate for polio. In addition, this knowledge will hopefully encourage Taliban commanders to lift the bans on vaccines, thus decreasing the number of cases of polio coming out of their regions.

With any luck, the vaccination teams will be able to return to vaccinating as many children as possible in Pakistan and the disease will cease to be so prevalent in the country and around the world. Pakistan grapples with polio fight - CNN.com Pakistan grapples with polio fight By Madison Park, CNN Updated 4:40 AM ET, Tue May 6, 2014 Chat with us in Facebook Messenger. Find out what's happening in the world as it unfolds. Photos: Fighting Polio in Pakistan Fighting Polio in Pakistan – Polio, once a worldwide scourge, is endemic in just three countries now - Afghanistan, Nigeria and Pakistan. Pictured here is Ameena, a Pakistani girl participating in an anti-polio campaign, showing her ink-marked finger after being vaccinated for polio in Rawalpindi, Pakistan, Monday, October 7, 2013. Hide Caption 1 of 9 Photos: Fighting Polio in Pakistan Fighting Polio in Pakistan – A Pakistani child receives an oral polio vaccine during an anti-polio campaign in Rawalpindi on October 1, 2013.

The Polio virus saw a huge surge in year 2011, with as many as 198 cases reported from different parts of the country, forcing the government to enhance the immunization in affected regions. Hide Caption 2 of 9 Photos: Fighting Polio in Pakistan Fighting Polio in Pakistan – Efforts to stamp out the crippling disease have been hampered by resistance from the Taliban, who have banned vaccination teams from some areas. A Pakistani policeman stands guard as a polio vaccination worker marks a child after immunization with anti-polio drops an infant in Lahore on December 21, 2012. Hide Caption 3 of 9 Photos: Fighting Polio in Pakistan Fighting Polio in Pakistan – People attend funeral prayers for victims of an explosion in Peshawar, Pakistan, Monday, October 7, 2013. A bomb exploded next to a van carrying Pakistani security guards tasked with protecting workers involved in an anti-polio drive in the country's northwest on Monday.

Hide Caption 4 of 9 Photos: Fighting Polio in Pakistan Fighting Polio in Pakistan – Pakistani polio vaccination workers carry placards during a protest against the killing of their colleagues in Lahore on December 21, 2012. Hide Caption 5 of 9 Photos: Fighting Polio in Pakistan Fighting Polio in Pakistan – Pakistani relatives mourn the killing of a female polio health worker at a hospital following an attack by gunmen in Peshawar on May 28, 2013. Hide Caption 6 of 9 Photos: Fighting Polio in Pakistan Fighting Polio in Pakistan – Pakistani polio vaccination workers shout slogans against the killing of their colleagues during a protest in Karachi on December 19, 2012. The violence prompted UNICEF and WHO to suspend work on a campaign opposed by the Taliban. Hide Caption 7 of 9 Photos: Fighting Polio in Pakistan Fighting Polio in Pakistan – A Pakistani health worker stands in front of a banner at a polio vaccination stall, set up at a bus station, in Rawalpindi on May 31, 2013.

The Pakistani Taliban in 2012 banned polio vaccinations in the tribal region of Waziristan, alleging the campaign was a cover for espionage. Hide Caption 8 of 9 Photos: Fighting Polio in Pakistan Fighting Polio in Pakistan – Former Pakistani cricket captain Shahid Afridi chats with a polio-afflicted child during a 'Make A Wish' event in Karachi 18 June, 2011. Hide Caption India celebrated its polio-free certification in late March Its neighbor Pakistan grapples with polio efforts with several cases reported in 2014 World Health Organization recommends emergency measures in Pakistan Pakistan has public health challenges including tribal areas, threats to health workers More than a month ago, the public health community celebrated the polio-free certification of Southeast Asia including India, viewed as a hopeful step toward global eradication. But the euphoria has waned as concerns grow the virus is making a comeback and re-appearing in countries that had previously eliminated the disease within their borders. Pakistan has seen major challenges in recent years, reporting 80% of polio cases this year. The country faces challenges within its health system including restricted access to its federally administered tribal areas and violence against polio campaign health workers.

Vaccine workers have been tortured, shot, bombed, and even have had their family members kidnapped. "You have disruption of health services, vaccination services are broken where areas are no-go because there is mistrust and health teams are not allowed within the conflict area," said Dr. Zulfiqar Bhutta, who is co-director of The Hospital for Sick Children in Canada and also works in Pakistan. "In that particular circumstance, to imagine that business would be as usual is naïve." While Pakistan faces hurdles, India's polio program has been lauded as a model for tackling polio. India's program "was largely internally funded, strongly managed," said Bhutta. Once considered the hardest place to end polio, India boosted disease surveillance and immunization efforts to vaccinate hard-to-reach communities. To counter rumors and misgivings about the vaccine, social mobilizers, religious leaders and parents were included to increase understanding about immunizations. JUST WATCHED MUST WATCH Polio rises from the grave 01:24 "In Pakistan, that political will in terms of making this a national priority hasn't existed," Bhutta said. "They haven't invested enough in routine immunizations, which are critical to eradicating polio.

You've got to get people aware of the importance of preventive strategies." In 2014, the World Health Organization confirmed 74 new cases of polio -- 59 of them were in Pakistan. Within Pakistan, 46 of these cases have been from its restive Federally Administered Tribal Areas, which is located along the Pakistan-Afghanistan border and retains internal autonomy. The country with the second highest number of polio cases is Afghanistan, which reported four cases. But all of these are related to viruses that originated from Pakistan, according to the WHO. Emergency measures recommended On Monday, the WHO recommended emergency measures for three of the countries deemed as the greatest risk for further exporting the virus -- Syria, Cameroon and Pakistan. The organization called for residents of these countries to get vaccinated and show proof of polio immunization before international travel. It also calls for the head of state to declare polio a national public health emergency. "If the situation as of today and April 2014 went unchecked, it could result in failure to eradicate globally one of the world's most serious vaccine preventable diseases," said Dr. Bruce Aylward, assistant director-general for polio, emergencies and country collaboration at the WHO.

Pakistan has been establishing vaccination booths at its land borders with Afghanistan, China, India and also Iran, according to the WHO. Bhutta said he wasn't surprised by the WHO's move, but worried the recommendation was a "Band-Aid measure" that's "not going get to the root of the problem." This may divert the vaccines and human resources from Pakistan communities that need them the most, to the huge number of travelers, Bhutta said. "I'm concerned that will take away from the main polio control program and that's the last thing anybody wanted." Pakistan is considered the only country that is "off track" in meeting its target to stop polio transmission, according to the WHO. Militants in Pakistan have targeted anti-polio campaigns since U.S. intelligence officials used a fake vaccination program to aid their hunt for Osama bin Laden in 2011. Since then, militant groups, with connections to the Pakistani Taliban, have been opposing polio vaccinations and accusing health workers of pursuing a political agenda. Dozens have been killed in acts of violence carried out against polio vaccine workers. Pakistan has tried to protect its health workers from violence.

In Peshawar, authorities banned the riding of motorcycles during vaccine campaigns to prevent attacks, said Aylward. Polio, which can cause permanent paralysis in hours, has been reported in 10 countries: Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, Nigeria, Pakistan, Cameroon and Syria. Polio Workers: Latest News, Photos, Videos on Polio Workers - NDTV.COM Polio Workers Pak Army Chief Confirms Death Sentence Of 10 Terrorists World News | Press Trust of India | Thursday October 13, 2016 Pakistan Army chief General Raheel Sharif today confirmed death sentence handed down to 10 terrorists by military courts for their involvement in killing civilians, polio workers and armed forces personnel. 7 Pakistani Policemen Killed During Anti-Polio Drive World News | Reuters | Wednesday April 20, 2016 Unidentified gunmen attacked policemen guarding medical workers administering polio vaccinations in Pakistan on Wednesday, killing seven of them, in the latest violence against efforts to eradicate the crippling childhood disease.

Pakistan Polio Drive Postponed Till Next Week World News | Indo-Asian News Service | Thursday October 29, 2015 A four-day drive against polio scheduled to be launched in Pakistan's Sindh province had to be postponed until November due to the refusal by police to provide security to polio workers, the media reported today. Nigeria Makes Final Push to Stamp Out Polio World News | Agence France-Presse | Monday June 8, 2015 Health workers move from door to door in the rural Sumaila district of Kano state, northern Nigeria, administering oral polio vaccines to children under five. Attack on Polio Team Kills One Policeman in North West Pakistan World News | Press Trust of India | Wednesday September 10, 2014 A policeman escorting a polio vaccination team in Pakistan's restive northwest was shot dead by unidentified gunmen today, the latest in a series of targeted attacks against medical workers campaigning to eradicate the crippling disease.

Kidnapped Pakistani polio workers released World News | Agence France-Presse | Tuesday November 26, 2013 Islamist militants on Tuesday released seven polio workers who were kidnapped last week in a northwestern Pakistani tribal district while carrying out a vaccination campaign, officials said. Pakistan militants kidnap 11 teachers in polio vaccination campaign World News | Reuters | Saturday November 23, 2013 Militants kidnapped 11 Pakistani teachers involved in a polio vaccination campaign for school children on Saturday, officials said, the latest in a string of attacks on health workers trying to eradicate the deadly disease. Gunmen kill two polio workers in Pakistan World News | Agence France-Presse | Sunday June 16, 2013 Gunmen on a motorbike shot dead two health workers during an anti-polio drive in northwest Pakistan on Sunday, police said, the latest in a series of deadly attacks on vaccination teams.

World Health Organisation cancels polio drive after gunmen kill two workers in Pakistan World News | Reuters | Tuesday May 28, 2013 The World Health Organisation (WHO) suspended its polio eradication campaign in Pakistan's Peshawar today after two young workers were shot as they administered drops, the latest attack aimed at the UN-backed operation. Pakistani Taliban deny anti-polio attacks World News | Agence France-Presse | Friday April 12, 2013 The Pakistani Taliban on Friday denied any involvement in attacks on polio workers, which have killed 21 people since December, but confirmed it opposed the vaccination as "un-Islamic." Gunmen kill Pakistani policeman during polio drive World News | Associated Press | Wednesday April 10, 2013 Gunmen shot to death a policeman protecting a team of female polio workers in northwestern Pakistan on Wednesday, the latest in a series of attacks on people working on the UN-backed vaccination campaign, police said.

Policeman escorting Pakistani polio team killed World News | Associated Press | Tuesday January 29, 2013 Gunmen riding on a motorcycle shot and killed a police officer escorting polio workers during a U.N.-backed vaccination campaign in north-western Pakistan on Tuesday, the police said. Pakistani polio workers get police protection World News | Associated Press | Friday December 21, 2012 Under police guard, thousands of health workers pressed on with a polio immunization program Thursday after nine were killed elsewhere in Pakistan by suspected militants who oppose the vaccination campaign. Fresh attacks on Pakistan polio workers World News | Agence France-Presse | Wednesday December 19, 2012 Gunmen opened fire on polio workers in three separate attacks in northwest Pakistan on Wednesday, seriously wounding one, officials said, following the killing of six workers. Gunmen kill four female polio workers in Pakistan World News | Associated Press | Tuesday December 18, 2012 A senior health official says gunmen have killed four women working on a government polio vaccination campaign in the Pakistan's largest city, Karachi.

The struggle for a Polio-free Pakistan The struggle for a Polio-free Pakistan What is behind the the sudden upsurge of violence towards polio vaccinators in Pakistan? Sign up to the Staggers Morning Call email * Print HTML On Sunday 16 June, gunmen on motorbikes shot dead two polio workers carrying out a vaccination drive in Peshawar, a crowded city in Pakistan’s north-west. One of the men who died was a schoolteacher, the other a paramedic. Both left behind grieving families. Their deaths bring the total tally of polio workers assassinated in Pakistan up to nearly 20 since last December. “People are scared,” says Muslim Raza, who heads the polio team in the Karim Poora area of Karachi. “Before this happened, many local people would come for a day’s training before joining the vaccination drives [which normally run for between three and five days each month]. Now nobody is volunteering to work.” The attempt to stamp out polio through oral immunising drops has been running in Pakistan since 1994. In recent years, huge strides have been made towards stamping out the disease, which used to affect tens of thousands of people every year.

In 2011, there were 198 new recorded cases of the polio virus in Pakistan; in 2012, just 58. Yet Pakistan is one of just three countries – including Nigeria and Afghanistan – where it remains endemic. While paralysis strikes just a small percentage of those carrying the virus, the effects are devastating. Unable to support themselves, many people disabled by polio beg at the side of the traffic-filled roads in Pakistan’s big cities. The attacks started on 18 December 2012, when five female health workers were killed within 20 minutes of each other, four in the southern port city of Karachi and one in Peshawar, in a brutal co-ordinated attack. News of the assassinations, shocking even by Pakistan’s blood-soaked standards, spread across the world. In the aftermath of those first attacks, the three-day vaccination drive, which would have immunised 5.2 million children in Karachi alone, was suspended. In the intervening months, the programme has resumed.

The chalk markings which denote that the polio team has been to visit can be seen on gates, doors, and walls outside houses across the country, from the upmarket areas of Islamabad, to slums, and remote villages. But despite high security in the problematic areas – the north-western province of Khyber-Pakhtunkhwa (KPK), parts of Karachi, and the Federally Administered Tribal Area – the death toll has risen. Many, though not all, of the victims have been women. As yet, no-one has claimed responsibility. The Tehreek-e-Taliban Pakistan has denied they are behind the attacks, although they have spoken out against vaccinations in the past and are certainly responsible for perpetrating misinformation. The attacks are clearly planned and co-ordinated, but there have been no arrests and no high profile investigation – merely a huge increase in the number of police escorts. The latest development is that the new provincial government in KPK is planning to give polio workers weapons licences to carry their own guns.

Meanwhile, teams of health workers – partly made up of civil servants drafted out to the polio campaign, and partly of local volunteers working for a fee of 200 rupees (£1.50) per day – are continuing to go out to immunise children. Who are these unsung heroes? And why has this senseless campaign of violence begun? Khoram Shehzad, 29, is a polio vaccinator from Karachi’s Kimari Town area. Like many vaccinators, he comes from the local community. Experts say that employing local volunteers is a crucial component of the programme as it means that the community feels a sense of ownership over the vaccination drive. “More than anything, more than police protecting you, the best protection is from those vaccinators coming from the community itself,” says Dr Elyas Durry, head of the World Health Organisation (WHO)’s polio team in Pakistan. Shehzad left a job as a computer engineer three years ago to join the polio campaign, and currently earns 250 rupees (£2) per day for each four day immunisation drive. “I didn’t start doing this for the money. I am doing this for the people of Pakistan.

These are the children, the future of the country,” he tells me when we speak on the phone. “We are all afraid because of the targeted killings. Some people don’t want to work in the field any more, but it is important for our country and our people.” The resistance to the vaccine is deep-rooted. Several rumours circulate. One – perpetrated and spread by extremist Islamic leaders – is that the vaccine is a CIA plot to sterilise Muslim children. Another is that it contains materials forbidden by Islam, such as alcohol and pig’s blood. “Some uneducated people don’t take the drops,” says Shehzad. “They say the medicine in the vaccine is haram [forbidden by Islam]. We tell them the government wouldn’t start this if it was bad for your children.” The misconceptions are worse among the Pashtun population, who come from the conservative north-west of Pakistan. The rumours and misinformation have been perpetrated through radio broadcasts and other propaganda channels of extremist organisations. Shehzad’s area in Karachi, where there is a high security risk, is 85 per cent Pashto-speaking.

“It is mainly illiterate and uneducated people that refuse the vaccine,” says Fahmeeda Malik, a polio worker from Rawalpindi. “We reason with them, saying, if the government wanted to give you family planning medicine, there are a lot of places they can do it for grown ups. Why children? If they think over it, they normally agree. But if they don’t, we are helpless.” Across the country, polio workers I speak to say that refusals make up just a tiny minority of the whole. Yet that small percentage is enough to jeopardise the goal of totally eliminating polio. The problem is compounded by the fact that Pakistan’s population is highly mobile, so the disease can easily spread outside the pockets where it is cornered as people are displaced or relocate in search of work. “Often we ask people, who told you this is against the preaching of Islam? Mostly they say it is the leaders of mosques, so we go to them and convince them,” says Dr Khaled Randhawa, district health officer of Rawalpindi. In May this year, a group of international religious scholars met in Islamabad and issued an edict saying that the polio vaccine did not contravene Islam.

“Depriving a child of polio drops is equal to committing a sin. Protecting your child from disease is a religious obligation,” said one of the scholars. This was a positive move, although it is too soon to say how much impact it will have. “I have been working with these misconceptions about the vaccine for my whole life – in Somalia, in Nigeria, elsewhere,” says Durry. “But I don’t understand – nobody does – how it became such a violent reaction here in Pakistan. I don’t know why it has escalated.” Many point to the CIA’s assassination of Osama Bin Laden. In the run up to the operation, the CIA ran a false hepatitis B vaccination drive so it could gather the DNA of local residents. It was a spectacularly irresponsible policy that leant credence to the conspiracy theories that were already widely circulated. The film Zero Dark Thirty depicted the fake drive as a polio campaign. Yet is this alone responsible for the sudden upsurge of violence? Many experts believe it goes deeper. “It’s another way of trying to control the population through fear,” says Mustafa Qadri, Pakistan researcher at Amnesty International.

“The aim is to terrorise, to make people scared, to make their conditions worse, and in that way to influence the society. Polio is not socially sensitive in the way that, for example, reproductive rights are: it is a very basic health requirement. When you’re attacking people’s access to these basic rights, you’re attacking their ability to live a normal life. And I think that is the overall objective: to control and to suppress the society.” In the areas of the country where the risk is highest, polio field workers and team coordinators feel under siege. “There is a big threat to these volunteers,” says Javed Marwat, the deputy commissioner of Peshawar, the provincial capital of KPK. “The situation is not good for anyone in the city. Every day there are bomb blasts, but the daily explosions get ignored. When a polio worker is killed, this news spreads to other countries, in the international media. The terrorists continue to kill polio workers because it has so much impact.

More people die in blasts, but nobody cares about that.” Indeed, against the violent context of today’s Pakistan, the daily news of small scale terror attacks no longer makes an impact; the constant news of death is simply the background music to life. Increasingly, it is violence against unexpected or soft targets – the schoolgirl activist Malala Yousafzai, or health workers delivering life-saving vaccines – that makes national and international headlines. At the District Health Office in Rawalpindi, I attended an evening meeting of polio workers. Here vaccination teams gathered in the evening to feed back on the day’s work. Most of them were women, clad in bright headscarves and face coverings, and drawn from the same conservative communities they are serving. They confidently talked through the day’s results, speaking over their male supervisor with details of refusals and the ways they had tackled them. “The woman in the house would not come out in front of a man, so I told my male colleague to leave,” says Saba, one of the vaccinators.

Another, Aisha, added: “Since the last drive, we spoke to local notables about the refusals, and they have told people they should take the vaccine.” Of the 1,700 vaccinations they had carried out between them over the course of the day, there had been just one refusal. It has been suggested that there is a gendered aspect to the violence. Not all polio workers are women, and some of those gunned down in recent months have been men. However, while the targeting of polio workers has suddenly escalated, there is a recent history of militant violence being directed against “lady health workers”, a body of more than 100,000 women who deliver door-to-door healthcare. The lady health worker programme was initiated by Benazir Bhutto in 1994, and for many women and girls in remote areas, they provide the only direct access to healthcare. A 2012 study published in the British Medical Journal looked at how the Taliban threatened and attacked female health workers in Swat during their brief period of control of the area.

It found that not only did community health suffer significantly, but that lady health workers were socially ostracised after public vilification by the Taliban. It also found that many others stopped working or left the area due to their threat to their lives. Against this context, the recent attacks on polio workers could be yet another demonstration of the deep discomfort among the conservative elements of Pakistani society about women in public space, and women taking ownership of their bodies. “By attacking these workers, the perpetrators of these attacks are cutting down people’s rights to services, particularly women and girls,” says Qadri. “When you target these people, you are effectively trying to destroy those parts of society that allow people to live with dignity.” In addition to this, he explains, the fact that the attacks have been sustained, despite extra security, compounds the desired effect of spreading terror. “Health workers are being targeted even when they have police escorts. They just feel very scared: even when the state is trying its best to protect people, they’re not safe. The impact for the community is profound.“ For the polio workers in the hotspots of Karachi and Peshawar, life goes on, for now.

“My heart is full of terror when I hear that more workers, more workers, more workers are being targeted,” says Sadia Zaidi, a vaccinator from Peshawar whose name has been changed for security reasons. “Sometimes we don’t like to stay in one place for too long to convince refusers to take the vaccine, because we are at such risk. But we carry on. Some of my colleagues don’t even take the money because they just want to work for the people. My family is afraid for my safety, but I am doing this so my children can live in a polio-free Pakistan.” Taliban attitudes changing amid renewed polio vaccine worker attacks - Humanosphere Taliban attitudes changing amid renewed polio vaccine worker attacks A Pakistani health worker, left gives a polio vaccine to a child, who was displaced with his family from Pakistan’s tribal areas due to fighting between the Taliban and the army. AP Photo/Muhammed Muheisen Consecutive days of attacks on polio vaccination workers in Pakistan renewed concerns about its eradication. At least ten people were killed during attacks on Tuesday and Wednesday, this week. Despite that, Changing public attitudes by Taliban leaders may indicate a coming decrease in attacks.

Gunmen on motorcycles opened fire on a vaccination team in the city of Karachi, killing three members and injuring two. The following day, a police van carrying guards for vaccine workers was bombed in the northwest. At least seven people were killed as a result, including one child, said local police. The police said that it will continue to provide security support for vaccine workers in the region. While neighboring India celebrated three years polio-free, Pakistan saw polio cases nearly double in 2013 to 91 cases. The northwest of Pakistan has struggled with reported cases of polio caused, in part, by the difficult circumstances facing vaccine campaigns. The Taliban have been a strong opponent to vaccines, citing fears of spying and harming children. UNICEF estimates that 32 polio health workers have been killed across Pakistan since the middle of 2012. While the Taliban has carried out may of the attacks over the past few years, attitudes are starting to change among some of its members and groups. Maulana Sami-ul-Haq, a Pakistani religious scholar considered to be the ‘Father of the Taliban,’ announced his support for vaccines, in October.

AFP obtained a document authored by Haq in which he argues that vaccines can save the lives of children. RELATED Clinton isn't going to jail, but in some countries it's a way to build power “Polio, measles, tetanus, tuberculosis…are fatal and dangerous diseases and the vaccines to save young children and pregnant women are effective and harmless. There is no reality in the doubts and suspicions being spread against these vaccines,” said Haq. One Taliban group distanced itself from the Wednesday attack and went as far as to say that it does not oppose polio vaccines. The change of attitude could be a breakthrough for the vaccination effort. “We have been holding detailed deliberations on the polio issue for some time and have been consulting trustworthy Muslim medical experts. Some of our doubts have been removed,” said senior Tehreek-i-Taliban Pakistan (TTP) member Ehsanullah Ehsan to DAWN . It is a departure from what Ehsan said the day before. In response to the attacks in Karachi, he cited concerns about the vaccines as reason to reject them. “We are against these polio vaccinations,” said Ehsan to the Wall Street Journal. “It is against Islam and our traditions.

These foreign nongovernmental organizations can easily use polio as cover for spying.” Politician and former cricket star Imran Khan traveled to the north-western Khyber-Pakhtunkhwa province in December to support a UN-backed polio vaccine campaign. He received a death threat for his remarks from a group linked to TTP. RELATED Conflict zones pose final threat to eradicating polio The change, as indicated by Ehsan, is a deliberate one. DAWN reports that it is among other shifts within the TTP. Other members agree that the issue is not the vaccines, rather the potential of spying. Their skepticism stems from the CIA-backed fake vaccine scheme that was used to try to catch Osama bin Laden. The doctor who carried out the scheme, Shakil Afridi, is cited as reason for continued concerns. The United States came under sharp criticism from global health experts and organizations after the details of the plot were revealed. The Pakistani government continues to support and carry out polio vaccine drives, despite attacks. Police units have been deployed for more than a year to provide protection after dozens of workers were killed in attacks between November 2012 and January 2013. Polio is on the brink of eradication.

It is endemic in only three countries: Pakistan, Afghanistan and Nigeria. The eradication effort suffered a difficult year in 2013 as cases were reported in Syria and along the border between Kenya and Somalia, in addition to cases in the three endemic countries. Vaccine coverage continues to be the most significant obstacle and is strongly linked to the persistence of polio in some parts of the world. Nigeria polio: Immunising the vaccine fears - BBC News BBC News Nigeria polio: Immunising the vaccine fears By Christine Otieno BBC News, Abuja 26 April 2013 Close share panel Two-year-old Abubarkar Al Hassan has the unfortunate tag of being Nigeria's first polio victim of 2013. "It's quite upsetting to see that my son cannot play with his friends when they come here," says his father Usman Al Hassan, who lives on the outskirts of Nigeria's capital, Abuja. "He cannot move unless someone carries him. This makes him cry." As Mr Al Hassan strokes his son's legs, some of his daughters sit around and one of his two wives prepares a meal in a tiny kitchen off the courtyard.

There are a lot of nomadic populations on the move… there is no fixed address where you can knock on their door during the campaign Melissa Corkum, Unicef "I have 14 children and 13 of them are vaccinated; it is very unfortunate that when the vaccinators came around this area they missed my house and my son was not vaccinated," he says, looking at his son who is sitting on his lap. In the long winding alleys of this community, houses are packed close together. Open gutters like streams run like central veins carrying household waste water from homes. Passers-by leap over them to avoid the dirty greyish sludge. Nigeria has been making some strides in the battle against the polio, which can cause lifelong paralysis, but the task has been slow and fraught with challenges. The West African nation is only one of three countries where polio is endemic - Afghanistan and Pakistan being the other two. Journalists arrested Last year, 122 cases of the virus were reported and the government is hoping to keep the numbers down this year.

Polio Polio is an infectious disease caused by a virus which invades the nervous system and may cause irreversible paralysis It can strike at any age but mainly affects children under five There is no cure for polio, it can only be prevented Polio vaccine, given multiple times, can protect a child for life. As long as a single child remains infected with polio, unvaccinated children in all countries are at risk "We still continue to miss too many children. In a campaign where you aim to reach 32 million children house-to-house there are number of challenges," says Melissa Corkum spokesperson for the UN children agency's polio campaign in Nigeria. "In Nigeria there are a lot of nomadic populations on the move… there is no fixed address where you can knock on their door during the campaign," she says. "This leads to many children being... missed." Together with the government of Nigeria, Unicef is running nationwide immunisation campaigns. Polio cases in Nigeria are mostly found in the mainly Muslim north of the country. In the past few months there have been violent attacks against health workers believed to be connected with polio vaccination drives.

The problem was caused by those who were preaching against it Alhaji Attahiru Ahmad, Emir of Anka In the most recent attack nine female health workers killed in Kano state. It is possible that these attacks were the result of religious and political leaders who have opposed the vaccine, saying it is a Western plot to sterilise Nigerian Muslims. Suspicions about vaccination programmes were fuelled in part by the Pfizer scandal in 1996 when the US drugs firm used an experimental drug during a meningitis outbreak in Kano. Eleven children died and dozens became disabled as a result. In 2003, these fears and conspiracy theories led to the suspension of vaccination campaigns in Kano, leading to a high number of children contracting the disease. Then earlier this year, a Muslim cleric and two journalists from Kano were arrested for broadcasting a report saying the vaccines were not safe. Not all religious leaders are of this school of thought and some regret the harm caused by their colleagues. "The problem was caused by those who were preaching against it," says Alhaji Attahiru Ahmad, the Emir of Anka in the northern-western state of Zamfara.

'Attitudes changing' He blames the slow response by the government to the statements. "They allowed them to have a field day before the intervention, and you know it's difficult to repair damage," the emir said. Media captionPolio cases in Nigeria are mostly found in north of the country He and other traditional rulers in the area have been trying to counter criticism of the vaccine. During the last polio campaign in this area, a father refused to have his child immunised. He was brought to the emir who convinced him to immunise his child. However the talk of polio remains a very sensitive subject and many in these communities shy away from talking about refusing immunisation. But the Nigerian government says they are making strides in reducing suspicion among vulnerable communities.

Countries with endemic polio Afghanistan: Cases in 2012 - 37 Nigeria: Cases in 2012 - 122 Pakistan: Cases in 2012 - 58 Source: Global Polio Eradication Initiative "People are becoming more aware and are realising that in fact the vaccine is safe, it's efficacious, and that other parts of the world have actually used it to eradicate this disease," says Dr Ali Pate, Nigeria's junior minister of health who also heads the presidential campaign against polio. "This [is a] collective effort. For the first time, you have the entire global community focusing on a single disease, after smallpox, to eradicate." Part of the government campaign has involved community mobilisation workers who talk to people about the benefits of the vaccine. 'No blame' In the case of Abubarkar, his contracting polio has had a positive effect on his neighbours. "People are aware, now they know that the disease is real," says Yakubu Yahaya, a social mobilisation officer.

Image caption Usman Al Hassan says he hopes his son's case will prompt others to immunise their children He has in the past had difficulties convincing the people in that community that polio as a disease was a reality. "They were saying it is either politics or religion or because they want to make their children infertile," he says. "So they are really now ready to comply with all the vaccinators." For Abubarkar and his father, the lesson learnt has been a harsh one. "I do not blame the vaccinators for missing my son, what has happened was God's will," says Mr Al Hassan. "At least because of him, others can now take this seriously and immunise their children." Those working on the government's drive against polio, will also be hoping that lessons can be learnt and they can indeed make strides towards eradicating the disease by 2014. Public health: Polio's moving target : Nature News & Comment Polio’s last stand Remote settlements in northern Nigeria remain a challenge for vaccine workers. Mohammed Abubakar's home is not on any map — at least not yet.

To reach his settlement in a desolate part of northern Nigeria, four health workers creep over deep-rutted roads in an old Peugeot for an hour, then ride motorcycles over narrow dirt trails for another 30 minutes — stopping only for the odd herd of cattle. Finally, they spot a cluster of mud-brick huts, known to the Fulani nomads who live there as a ruga. “As-salamu alaykum,” — peace be with you — says Ardo Babangida, a traditional leader accompanying the team. Children swarm around the visitors, and Daniel Santong, an easy-going veterinarian and leader of the group, asks to meet Abubakar, the head of the household. Meanwhile, a young colleague whips out a smart phone and uploads the settlement's Global Positioning System coordinates into a database. Abubakar arrives, clad in a lavender tunic and white skull cap, and Santong tells him that they are trying to eliminate polio in nomadic people. Abubakar clasps his guest's hands in appreciation. He says that he cannot remember the last time that health workers came to vaccinate his children.

It is a story that Santong and his colleagues are now accustomed to hearing, even though door-to-door immunization campaigns happen on a near-monthly basis in the region. These dusty paths are the front lines of polio eradication. A 25-year, US$10-billion global effort has taken the number of polio cases from hundreds of thousands per year to just hundreds, but it is now struggling to stamp the virus out of its final strongholds in Pakistan, Afghanistan and Nigeria, where transmission has never been interrupted. Of these, Nigeria was the only one to see an increase in cases from 2011 to 2012, and public-health experts worry that the virus's recalcitrance here will prevent global eradication, and eventually lead to a wider resurgence of the disease. Free podcast Ewen Callaway talks about the health workers who try to track down and give polio vaccinations to nomadic populations in Nigeria. You may need a more recent browser or to install the latest version of the Adobe Flash Plugin. The barriers to polio eradication in Nigeria are complex and numerous. The country does not have a working public health-care system, and some local government officials are less than committed to the cause.

In urban centres in the north, widespread distrust of the government leads many parents to refuse vaccination for their children. What is more, in February several polio workers were murdered — for unknown reasons — at health clinics in Kano, northern Nigeria's largest city. But epidemiologists have identified one barrier that might be overcome cheaply and safely: locating and counting remote populations, including the nomadic livestock herders who drift through the region with the changing seasons. Records of their numbers and movements are incomplete, but the population is thought to include hundreds of thousands of young children, many of whom have received none or only some of the multiple oral polio vaccine doses required to achieve full protection. Proponents of the programme say that nomads are a polio reservoir, spreading disease around the country during their migrations. So in June 2012, the National Stop Transmission of Polio (N-STOP) programme, organized through the Global Polio Eradication Initiative (GPEI) and supported by the Nigerian government, started a census of Fulani nomads and other hard-to-reach populations, as part of a global emergency action plan against polio. RUTH MCDOWALL Vaccinators reach a child in Bauchi, Nigeria.

“Until we solve the problem of these unvaccinated nomads, we're not going to fix polio,” says Frank Mahoney, a veteran field epidemiologist leading the project from Abuja. “We're not going to be able to eradicate it.” Roadblocks ahead On a scorching, cloudless December day, a procession of several hundred livestock has taken over a road running between the states of Bauchi and Kaduna in northern Nigeria. Men walk alongside their cows and sheep, while women and children creep along on motorcycles. It is the height of the dry season, the landscape is parched, and the group is heading south to graze its livestock. Lere, a local government area (LGA) in Kaduna is travelled by a sizeable population of Fulani pastoralists like these during their biannual migrations. It is also one of dozens of 'high-risk LGAs' on which N-STOP teams are focusing their efforts. No polio cases have yet been detected here, but Lere is not far from the borders of Kano and Bauchi, which both recorded cases in the past year. Mobile and remote populations are often strongholds for disease.

Somali nomads contained some of the final cases of smallpox, and the vaccination of herds in remote patches of east Africa was crucial to eradicating the cattle disease rinderpest, completed in 2011. In Nigeria, Fulani nomads receive little education or health care from the government. “Nobody looks after them, nobody takes primary health care to them, nobody remembers they exist,” says Endie Waziri, a member of one of the N-STOP teams. When polio vaccination workers do visit their remote settlements, she says, they tend to visit only the first ruga they see and not look for others in the vicinity. SOURCE: GLOBAL POLIO ERADICATION INITIATIVE Nigeria made significant headway against polio after starting an eradication programme in 1996. But those gains were erased in 2003, when Muslim clerics in the northern state of Kano called for a boycott of the polio vaccine over fears that the eradication campaign was a Western conspiracy to sterilize the population. Soon, Kano, Kaduna and other northern states had halted all polio vaccination campaigns.

The boycott ended a year later, but by then polio had exploded across northern Nigeria and started to seep into nearby countries, such as Cameroon and Côte d'Ivoire, that had previously vanquished the virus. Nigeria has since made lurching progress against the disease. Cases fell from more than 1,000 in 2006 to 21 in 2010, before rising again to 122 last year. Many more cases probably went undetected. Religious opposition to vaccines among settled populations has now given way to refusals driven by disenchantment. “People want things other than polio vaccination,” says David Heymann, chairman of the advisory board for Public Health England and the former head of the polio-eradication efforts for the World Health Organization (WHO). “They can't understand why people are coming once a month to give them vaccination when what they want are treatments for their children with fever or diarrhoea.” “If we hit these areas, we get a much bigger bang for the buck.” The nomads, however, rarely refuse polio vaccination for their children, and they are eager to receive other health and veterinary services.

“If we hit these areas, we get a much bigger bang for the buck,” says Chima Ohuabunwo, a Nigerian epidemiologist who took a sabbatical from his position at Morehouse School of Medicine in Atlanta, Georgia, to serve as the field coordinator of the nomads project. Still, the lack of a working public health-care system has been a problem, says Heymann, who points out that neighbouring countries with large nomadic populations such as Chad have successfully interrupted transmission. “Other countries with migrant populations have done the job,” he says. India, for instance, offered polio vaccinations at train stations to catch migrants, and Chad offers combined veterinary and polio vaccination services to encourage Fulani nomads — who depend on the health of their livestock — to take part. N-STOP's census programme was designed to support on-going vaccination efforts, uncovering areas of need and directing resources and local vaccination teams to them. In fact, so as not to interfere with local efforts, N-STOP teams didn't bring vaccine stocks with them until the federal government asked them to.

Since August, the N-STOP surveys have uncovered more than 32,000 settlements and identified more than 700,000 children — nearly 40,000 of whom had never been vaccinated against polio. RUTH MCDOWALL Many Fulani migrate twice a year, making it difficult for vaccination programmes to find them. Although little more than 3% of the 122 polio cases reported last year in Nigeria occurred in nomad children, the teams discovered more than 100 probable cases that went unreported, supporting the idea that nomads form an important link in the chain of transmission. When not on long migrations, Fulani nomads interact with other people at markets. More than one-third of confirmed polio cases in 2012 were among children who lived in close proximity to nomadic communities. And nomad migration routes are hotspots of low vaccination coverage, according to data from the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. The surveys are “really a strategy that's been missing in the tool box for a long time, and it needs to be urgently done”, says Mahoney.

But Mahoney also notes that the project is a work in progress. Emmanuel Musa, the WHO coordinator in Lere, is not sure that it will be feasible for his district's vaccination team to reach all the nomad communities that N-STOP teams are uncovering. “There are inadequate funds,” he says. At a catch-up in December, Fureratu Zakari, the WHO coordinator for Kaduna state, also questioned whether the mapping data will be enough to allow health workers to locate nomadic communities. “They should be showing teams where settlements are and not just writing it down,” she tells Olaniran Alabi, the programme's field coordinator for Kaduna. Zakari complains that the N-STOP programme isn't coordinating its day-to-day activities with local health authorities, which could result in confusion and duplicated efforts. The sheer scale of the GPEI initiative may explain some of the tensions. The public–private effort, which includes the WHO, CDC, the United Nations Children Fund (UNICEF), Rotary International and the Bill & Melinda Gates Foundation, has become the world's costliest public-health initiative, and one of the longest running.

Since it started in 1988, it has missed three deadlines for halting transmission — in 2000, 2005 and 2012 — and it now burns roughly $1 billion per year chasing the last remaining pockets of disease. Cause for optimism Organizers are optimistic about winning the war, however. India was long thought of as the Waterloo of the initiative because its high population density and poor sanitation provided ideal conditions for the virus to spread. But it celebrated its second year without a case of polio in January. And Pakistan and Afghanistan both saw significant reductions in cases between 2011 and 2012 (see 'Last holdouts' ), despite deep security challenges that limited the reach of vaccination campaigns. “Other countries with migrant populations have done the job.” Programme officials in Nigeria say that national and state governments are increasingly committed to eradication, but that complacency and corruption are still common among the officials in charge of local immunization campaigns. In October 2012, for instance, dozens of officials in Kano state were fired for treating the eradication programme as a “money-making venture”, in the words of the state's governor, Rabiu Musa Kwankwaso.

Counting and vaccinating nomads will not solve all Nigeria's polio troubles, but it is easier to achieve than tackling domestic terrorism, vaccine refusal and other challenges. When asked how N-STOP will measure the success of the nomad programme, Mahoney puts it simply: “Stopping polio transmission. That's the big indicator.” But he also points to the thousands of settlements and children that have been mapped and counted so far. As Nature went to press, Nigeria had recorded 11 cases of polio this year; it had 17 in the same period last year. President Goodluck Jonathan has vowed to bring that number to zero before his term ends in 2015. Michael Galway, senior programme officer at the Bill & Melinda Gates Foundation in Seattle, Washington, is optimistic that the push to reach remote populations is paying off. “The work of the nomads project has been extremely beneficial in opening the eyes of the [polio eradication] programme to this additional piece of the puzzle,” he says. The Nigerian project could hold lessons for future efforts to eradicate disease (measles is on some agendas), which are likely to hinge on reaching mobile and remote populations.

Targeting vaccination efforts on nomadic children is the right strategy, says Paul Rutter, a spokesman for the independent monitoring board set up to evaluate global efforts at polio eradication in 2010. But it will be the people behind it who ultimately dictate its success. “This kind of dogged determination to reach every last child will be what rids Nigeria of polio.” Journal name: Author details Ewen Callaway Ewen joined Nature in August 2010, after 2 years at New Scientist as Boston-based biomedical reporter. He attended the science-writing programme at the University of California, Santa Cruz, and earned a master’s degree in microbiology at the University of Washington. He spends his free time learning…

Question: Health workers in Nigeria and Pakistan were killed in 2012 and 2013 while carrying out vaccination programmes for what?
Answer: Poliomyelitis