ISLAMABAD -- Five-year-old Mohammad Ashar Aziz will never be able to walk without orthopedic leg braces.
The youngest of three brothers from a village near Islamabad, he is one of just 17 children in the world -- all of them in Pakistan or Afghanistan -- who developed paralysis during 2017 from a wild polio-virus infection.
His father, 41-year-old day laborer Hamid Aziz, is disconsolate because he repeatedly had the chance to immunize Mohammad Ashar for free during the past five years.
Instead, Hamid Aziz says he listened to the advice of a cleric in his village, who announced over loudspeakers of the madrasah, a local Islamic religious school, that the vaccine was “not good” for children’s health, and prevented it from being administered to any of his sons.
Whenever teams of government and international aid workers came to his village as part of a massive polio-eradication campaign, Aziz and his illiterate wife, Huma, hid Mohammad Ashar and his siblings and told the vaccination teams there were no children in their home.
“Why didn’t I give the vaccine to my son?” says Aziz, who quit school at the age of 14 and knew nothing about the polio vaccine.
“We believed what our cleric told us, but now I realize that we’ve not done the right thing for our son,” Aziz tells RFE/RL. “We realize how important it was and that we should have let him get the vaccine.”
Perceptions And Misinformation
Public health studies in Pakistan have shown that maternal illiteracy and low parental knowledge about vaccines -- together with poverty and rural residency -- are factors that most commonly influence whether children are vaccinated against the polio virus.
Nooran Afridi, a pediatrician at a private clinic in Pakistan’s Khyber tribal region, says one of the biggest obstacles to eradicating polio in Pakistan has been “refusals” stemming from “antipolio propaganda” spread by conservative Islamic clerics in “backward areas.”
One common fallacy in parts of Pakistan and Afghanistan with low literacy rates is that the vaccine sterilizes young boys.
Antipolio propaganda also has been fueled by distrust in Western governments who fund vaccine programs -- particularly after the CIA staged a fake hepatitis vaccination campaign in 2011 to confirm the location of Al-Qaeda leader Osama bin Laden in Abbottabad, Pakistan.
Since then, some clerics have even issued fatwas saying that children who become paralyzed or die from polio are “martyrs” because they refused to be tricked by a Western conspiracy.
Taliban militants in both Afghanistan and Pakistan also have propagandized that Western-made vaccines contain pig fat or alcohol, which are both forbidden in Islam.
Pakistan’s Tehrik-i Taliban has used that false claim to justify its killing of more than 80 polio vaccination team workers in Pakistan since a massive polio-eradication effort was launched in 2012.
Massive Eradication Effort
Pakistani health workers, together with the World Health Organization (WHO) and other international aid organizations, have immunized millions of children across the country since 2012 with more than 100 rounds of the vaccination drive.
More than 38 million children under the age of 5, the most susceptible age group for contracting the contagious disease, were vaccinated in Pakistan during 2017 alone.
The effort has brought Pakistan’s paralytic polio rate to its lowest level since the early 1990s.
Six of the world’s 17 paralytic cases in 2017 were reported in Pakistan, compared to 20 in 2016 and a peak of 198 cases in 2011.
In Afghanistan, there were 11 paralytic polio cases in 2017, down slightly from 13 the year before.
The WHO, which treats Afghanistan and Pakistan as a single epidemiological block, has warned that the risk of the spread of polio remains high along the countries' 1,500-kilometer shared border -- particularly among nomadic tribes that travel within both countries and across the frontier.
But the WHO also has been encouraged by Pakistan’s eradication efforts in its tribal regions along the border, where no new paralytic cases were reported during 2017.
Completely eradicating polio from Pakistan “will depend on reaching all children who have not been vaccinated,” it said in a late November report.
Both countries demonstrated “strong progress, with independent technical advisory groups underscoring the feasibility of rapidly interrupting transmission of the remaining polio virus strains,” according to the WHO, which also praised closely coordinated Afghan-Pakistani initiatives to identify children missed by vaccination programs and to understand why they were missed.
Almost Gone
Pakistan had hoped to be removed from the list of polio-endemic countries by the end of 2017 by achieving its goal of no new paralytic cases for a year -- a result achieved by Nigeria in October.
Rana Safdar, coordinator for Pakistan’s national Emergency Operations Center for Polio Eradication, announced in April that Pakistan was “about to defeat polio” because of a continued political commitment from Islamabad and support from international and Pakistani partners in the eradication programs.
The next round of mass vaccinations in Pakistan is scheduled for the end of December.
WATCH: Pakistan Launches New Polio Vaccination Drive (from July 2017)
Mezhar Nisar, a member of Pakistani Prime Minister Shahid Khaqan Abbasi’s polio eradication task force, says he is confident the disease “is on the way to being rooted out from Pakistan.”
“We have addressed all the refusal issues in our overall social-mobilization strategy,” Nisar told RFE/RL. “We have involved religious scholars from the Ulema councils and community-based women health workers. This has brought the number of vaccination refusals to the minimal level. The program is fully on track.”
The Independent Monitoring Board of the Global Polio Eradication Initiative (GPEI) on December 8 praised the prime minister’s “hands-on approach” with Pakistani provincial leaders.
Meanwhile, in Cairo, the Islamic Advisory Group for Polio Eradication has issued a new training manual for madrasah students that supports polio eradication efforts with practical guidance about engaging with local communities in support of vaccination.
Endpolio Pakistan, which brings nongovernmental and government experts in Pakistan together with international health organizations, says declarations by Muslim scholars in Ulema councils were critical to eliminating new paralytic polio cases during 2017 from Pakistan’s tribal areas along the Afghan border.
In the town of Akora Khattak in Khyber-Pakhtunkhwa Province, Jamiat Ulema-e-Islam party chief Maulana Samiul Haq declared a fatwa in late 2013 at the Darul Uloom Haqqania religious seminary, stating that “there is nothing forbidden” in the polio vaccine.
Haq, who had close ties with the late Taliban leader Mullah Mohammed Omar, said it is “the responsibility” of the religious scholars in the Ulema councils "to remove misconceptions about the use of vaccines to protect children from the crippling disease.”
He also publicly declared that Islamic Shari'a law “has made it clear that there is no harm in it. Rather, the treatment is an obligation.”
Other clerics have issued appeals for ordinary citizens, religious scholars, and tribal elders to fully support the polio vaccination initiative across Pakistan so that every child is vaccinated -- insisting that the vaccine's ingredients are, beyond any doubt, permissible under traditional Islamic law.
Hamid Aziz says he wishes he would have had that kind of Islamic instruction when his son was born in 2012.
Instead, Aziz is now struggling on his intermittent wages of about $7 per day to come up with the funds needed to buy the leg braces that his youngest son will need to use for the rest of his life in order to walk.
“Now I am asking other parents to allow the medical workers to administer the polio vaccine to their children,” Aziz told RFE/RL. “It is good for your children.”
