PESHAWAR, Pakistan — It is early morning in the month of Ramadan, and Peshawar’s Lady Reading Hospital in Pakistan is packed with patients. Rainaz has come back here with her mother-in-law and 1.5-year-old son Muhammad Ali, who she believes is still suffering from adverse effects of a polio vaccine he received weeks ago.
“As soon as he was vaccinated, the diarrhea started,” said the mother of three, who withheld her full name for safety reasons.
Muhammad Ali was one of the over 25,000 children brought into hospitals all over the conservative province of Khyber Pakhtunkhwa on April 22, as mass panic spread following rumors on local news channels that children had fallen ill after receiving polio drops. Like the other children, he was sent home because the condition wasn’t serious and couldn’t be linked to the vaccine.
But on the same day, a health clinic in a Peshawar suburb was torched by an angry mob. Later, two policemen accompanying polio teams in the province and a female polio worker in Balochistan province were shot dead. As the rumors spread, newspapers reported that refusal rates soared to 85% in Khyber Pakhtunkhwa. Eventually, the government was forced to halt the campaign nationwide.
The panic has now ceded, but there are fears that permanent damage has been done to efforts to finally eradicate polio from Pakistan, which along with Afghanistan and Nigeria are the only three countries where the disease is still endemic.
“The media played the greatest role in fueling the panic by reporting incorrect information, and the rumors spread even faster on social media.”— Dr. Abdirahman Mahamud, team lead, Polio Eradication Initiative, WHO Pakistan
Despite recent progress, vaccination campaigns have been viewed with suspicion, especially in militancy-hit areas of Pakistan. The challenge before officials now is to counter both long-held fears and newly instilled skepticism driven by fake news.
The spread of misinformation
The panic started when photos and videos first shared on social media began to be reported by local news channels. In one video, which has since been removed, children were shown to fall ill right after receiving polio drops. Soon, another video emerged — a man could clearly be seen instructing children to lie down on hospital beds and pretend to have fallen unconscious after polio vaccination. Like many others, Rainaz had rushed to the hospital with her son after watching the news.
“It was like a massacre,” said Muhammad Asif, the hospital’s spokesperson, describing the influx of children and their worried parents.
Over the course of the day, the number of children brought in exceeded 7,000, making it impossible for hospital staff to manage the situation. The army had to be called in.
“People came in … and we were just trying to counsel them. No kid was ill due to the polio vaccine,” Asif said. Some of the parents became aggressive with hospital staff. “They said, ‘you poisoned our children,’” he recalled.
“Maybe one or two were having nausea or vomiting … maybe due to the weather — the weather was very hot,” Dr. Amir Muhammad, a pediatrician at Lady Reading Hospital who was on duty on the day of the panic, told Devex.
According to Muhammad, some parents had been told their children would die within 24 hours of receiving the vaccine. Some heard this from mosque loudspeakers in their village, while others saw the fake video on social media or TV.
According to an official investigation, the video was a “preplanned conspiracy” against the polio eradication campaign. The provincial health minister blamed the Taliban. The suspects have been arrested.
Onus on local media
Dr. Abdirahman Mahamud of World Health Organization Pakistan, one of the partners in the government-led polio campaign, believes different influencers contributed to the spread of rumors, but the majority of the blame should be put on local media.
“The media played the greatest role in fueling the panic by reporting incorrect information, and the rumors spread even faster on social media,” he said.
Following WHO, he emphasized the importance of strengthening community awareness.
“While not the only solution, it is important to help parents understand the safety and benefits of polio vaccines as well as the seriousness of polio disease that they prevent,” Mahamud said. “There are comprehensive communication strategies in place including engagement of media, social media and community influencers to address any refusals.
In addition, the government and its partners have launched a perception management campaign to combat misinformation. This, according to Mahamud, includes working with Google, Facebook, YouTube, and Twitter, among others, to remove anti-vaccine content from social media.
Removal of the content had already been sought by the prime minister’s focal person for polio eradication, Babar Bin Atta, prior to the incident, but it was only on May 9 that Facebook and other platforms started to block it.
Many believe the damage has been done and that bouncing back will take a long time. Pakistan had made impressive progress in its fight against polio, bringing the number of cases down from more than 300 in 2014 to just nine in 2018. This year, however, the number is already at least 17.
Weeks after the incident, polio workers in Peshawar still fear for their lives. They sit huddled together at a health clinic with nothing to do since the campaign has been halted.
“Armed people came to threaten us and asked why we are doing this,” Nazia, who was vaccinating children in schools on the day the panic started, told Devex. All health workers Devex spoke to preferred to withhold their full name for safety reasons.
The new five-year strategy aims to build on what has worked, but also plans to adopt new tools and approaches in the hopes of finally eradicating polio from the world.
“People came to my house. They banged on my door and said I made their children get sick,” Fatima, another polio worker, said. Scared, she locked her door and hid inside. This was the first time she had faced such issues in her area.
The workers say people believe they are working for Western NGOs, when in fact they are employed by the Pakistani government.
“There is a misconception among the people that polio vaccine may cause physical issues among children and that it is against Islam. They even say it is a conspiracy by the West to stop population growth [in Muslim countries],” said Shakeela, another vaccinator.
These perceptions have been fueled by militants and radical clerics, especially since the Osama bin Laden raid in the Pakistani town of Abbottabad in 2011. The United States’ CIA had reportedly staged a fake vaccination campaign in the area to gather DNA samples to confirm bin Laden’s presence.
Such instances coupled with general distrust of Western governments and NGOs provide fertile ground for rumors and fake news to spread, particularly in remote, conservative areas where literacy levels are low.
Using religious leaders for education
One of the methods to tackle misinformation is to employ religious leaders in an awareness campaign, experts say.
“Our government should use [religious leaders] because they are very approachable [and] forceful. They can convince the people,” said Muhammad from Lady Reading Hospital.
In 2013 for example, a well-known religious scholar, Maulana Samiul Haq, also known as the father of the Taliban, issued a fatwa, a religious decree, in favor of vaccination. Haq was killed in Rawalpindi late last year. But despite getting religious leaders on board to speak in favor of vaccination campaigns, many believe they still continue to spread propaganda.
The reason for suspicion is that the vaccines come from western countries, Lady Reading’s Asif explained. “Because you [western] people don’t have polio patients but we have. So they think [polio] is from the West,” he continued.
Engaging local communities and religious leaders in the fight against polio is a long-term process.
In Afghanistan, where vaccination teams also battle rumors, so-called mobile mullahs have been recruited to visit families who refuse vaccines. Their job is to convince the parents that Islam is not against vaccination, and many have changed their minds as a result, according to the United Nations.
Now, the Pakistani government is considering different options on how to respond to the aftermath of the panic. These include increasing advocacy programs, reducing the frequency of vaccination campaigns, and adopting a lower-profile approach in order to avoid renewed suspicions.
WHO acknowledges more work needs to be done in Pakistan.
“We are identifying gaps and working to address them,” Mahamud said. “It always takes months to recover from these types of attacks.”
Asif believes it will take much longer to repair the damage, but admits he is no longer sure what to believe and how to convince people to vaccinate their children.
“Even I am confused a little bit.”