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The global effort to eradicate polio has been going on for more than two decades at a cost of over $10 billion. In the 1950s, polio paralyzed 350,000 people a year. This year, there have been just over 100 cases recorded. Health officials say they're on the verge of wiping out polio entirely, except in one country, Pakistan. The effort to eradicate polio there is being derailed by the Pakistani Taliban. NPR's Jason Beaubien reports.
JASON BEAUBIEN, BYLINE: In a small house, down a small alley in Karachi, Salma Jaffar still waits for a phone call that's never going to come - a call from Anita Zafar, her friend and fellow vaccinator. Months after the two of them were shot, Salma still struggles to accept that Anita is dead.
SALMA JAFFAR: (Foreign language spoken).
UNIDENTIFIED TRANSLATOR: She says that I still believe that she will call one day and will say she was busy and was not able to call her. She said she can't die. So she is unable to believe this.
BEAUBIEN: On January 21 of this year, Salma and Anita were going door to door in Karachi as a part of a mass polio immunization drive. They were in a crowded slum in this crowded city of 2 million people on the Arabian Sea. Small, blue ice chests were slung across their shoulders. The vaccine coolers with the words, end polio now, on the front, have become emblems of the polio eradication campaign. Suddenly, two men on a motorcycle screeched to a halt in front of them. The man on the back pulled out a gun.
JAFFAR: (Through translator) Even when they took out the pistol, I couldn't understand why he's taking out a gun. But when he opened the fire that was the moment I thought that it is the end of the life.
And the first thing which came to her mind was that I will not be able to see my children again.
BEAUBIEN: Salma's friend, Anita, and two other vaccinators were killed in the attack. Salma herself was shot four times - twice in the chest and twice in her arm. She spent the next three weeks in an intensive care unit. Now she's still recovering from her injuries at home. In Pakistan, the fight against polio is no longer a medical issue or just a public health campaign. The battle against polio in Pakistan has become embroiled in an armed conflict between Islamic extremists, the Pakistani government and the West. It's a clash that's leaving children paralyzed and vaccinators dead in the streets. Salma Jaffar, however, says she won't be cowed by armed extremists. And she plans to rejoin the door-to-door vaccination campaigns as soon as she's healthy.
JAFFAR: (Through translator) I'm not afraid at all because God has given me this life. And he will say look apart from this incident. I'm alive so I'm not afraid of death.
BEAUBIEN: The three vaccinators killed in the January attack, on Salma's team, are among more than 60 polio workers who've been gunned down in Pakistan since 2012. That's when the Taliban put out a ban on polio vaccination. The edict was in response to the CIA setting up a fake hepatitis vaccination campaign in 2011, to gather intelligence on Osama bin Laden. The militants threatened to kill not only vaccinators, but also parents who got their kids immunized. This had a chilling effect on anti-polio efforts nationwide and halted vaccination drives completely in some areas. Mufti Muneeb Ur Rehman is a prominent, moderate cleric in Pakistan. He runs a madrasa on the northern outskirts of Karachi. Mufti Muneeb says he personally accepts the polio vaccine and encourages people at his mosque to get vaccinated.
MUFTI MUNEEB UR REHMAN: But there are some certain areas in Pakistan where the people resist because the CIA used the polio campaign for intelligence purpose.
BEAUBIEN: I tried to point out that this is technically not correct and that in the CIA operation against bin Laden, it was actually a hepatitis B campaign.
REHMAN: The one who can use hepatitis for intelligence - they can use polio for intelligence.
BEAUBIEN: And he says the CIA using a humanitarian medical campaign as cover for espionage was unacceptable. He says it was an insult to Pakistan.
Is it solely because of the CIA that this has become so controversial?
REHMAN: Yeah, when I consult with those people who are in those areas, according to them, this is the main cause.
BEAUBIEN: Now, because of that insult, more children are being paralyzed by polio in the Taliban-controlled swath of the Pakistan-Afghan border than anywhere else in the world.
ELIAS DURRY: Almost three-fourths of cases, globally, this year, is coming out of Pakistan.
BEAUBIEN: Elias Durry is the World Health Organization's point man on polio in Pakistan. He says before the ban, Pakistan was on the verge of eliminating the disease. In 2012, the country only recorded 58 cases.
DURRY: The whole thing just then got reversed or got in trouble, where vaccinators started to be targeted and killed.
BEAUBIEN: Pakistan is currently in the low season for polio. Yet, the country has already recorded more than 88 cases this year. And almost all of those cases are in the Taliban stronghold. Pakistan is doing what it can to keep the outbreak from spilling out into the rest of the country. In Northwest Pakistan, police have set up a polio roadblock along the main highway entering the Punjab province. This is the historic Grand Trunk Road that traverses the subcontinent from Calcutta to Kabul. The motorway cuts through the rest of federally-administered tribal areas, where the Pakistani military, along with the help of U.S. drone strikes, is battling Taliban militants. Polio vaccinators move through the stream of Toyota vans and large Daewoo buses, searching for children to immunize.
MUBBASHIR SARDAR: We are going to prevent it - to come into the Punjab.
BEAUBIEN: One of the vaccinators, Mubbashir Sardar, says because vaccinators can't get into the Taliban-controlled areas, west of here, the goal is to vaccinate children as they come out.
SARDAR: Because if the people will travel, automatically the virus will come with them from there.
BEAUBIEN: And right now, this is the strategy against polio in Pakistan - repeatedly vaccinate all the kids you can in government-controlled areas through mass immunization drive. When you can't get inside an area to reach kids, try to vaccinate around the edges. In addition to polio vaccination posts on major roadways, immunizers ply the bus and railway stations across the country, vaccinating any child that appears to be under the age of five. But all this isn't enough to wipe out the disease. Elias Durry at the World Health Organization acknowledges that as long as the Taliban block vaccination in territory they control, the virus can't be defeated - either in Pakistan or the world.
DURRY: Yes, we will do all of this supplementary activity and maintain to keep the immunity level of the majority of the country. But I think to really win the war, we have to be able to access children who are currently not available for vaccination.
BEAUBIEN: And there's no indication when the armed conflict between the Taliban and the government will end or when the Taliban will allow vaccinators access to all the children of Pakistan. Jason Beaubien, NPR News.
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