Feb 4, 2020





The coronavirus outbreak in China has put the world in panic mode and the number of deaths and those with the virus continues to rise with each passing day.
The virus — known as 2019-nCoV — has now been diagnosed in people in several countries beyond China. The suspected source of the virus is bats.
But this is not the first time the world has been hit by a deadly disease.
Some of these diseases have been eradicated while others, such as tuberculosis and malaria, remain endemic in many parts of the world, and HIV/Aids continues to blight much of sub-Saharan Africa.
Here are some of the worst epidemics throughout the ages.
Smallpox 
Smallpox dates back to Egyptian civilisation times. The risk of death from contracting the disease was about 30 per cent, with higher rates among babies. Those who survived had extensive scarring of their skin.
In Europe, the disease is estimated to have killed 60 million people in the 18th century alone. Smallpox is estimated to have killed up to 300 million people across the world in the 20th century.
Smallpox was declared eradicated in 1980 following a global immunisation campaign led by WHO. The last known natural case was in Somalia in 1977. Since then, the only known cases were caused by a laboratory accident in 1978 in Birmingham, England, which killed one person and caused a small outbreak.
One of the greatest effects of the 1882-84 epidemic in Kenya was that it nearly wiped out the Rendille tribe. Although population estimates pre-smallpox are unavailable, the epidemic hit them hard, nearly exterminating the entire population of the tribe in less than two years.
Tuberculosis
Tuberculosis (TB) is a serious infectious disease that mainly affects the lungs. The bacteria that causes tuberculosis is spread from one person to another through tiny droplets released into the air via coughs and sneezes.
TB has also been around for a long time — with evidence of the disease found in some Egyptian mummies dated between 3,000BC to 2,400BC.
During the 19th and early 20th centuries, TB killed more people than any other disease, according to the Harvard University Library.
By the late 19th century, between 70 per cent and 90 per cent of the urban populations of Europe and North America were infected with the TB bacillus, and about 80 per cent of those individuals who developed active tuberculosis died of it.
According to WHO, TB is rare in wealthier countries, but is second only to HIV/Aids as the greatest killer worldwide. In 2012, some 8.6 million people fell ill with TB and 1.3 million died from it.
HIV/Aids
HIV patients have a much higher risk of falling ill with TB because of their weak immune systems, thus making TB common in countries with high numbers of HIV/Aids.
HIV, the virus that causes Aids (acquired immunodeficiency syndrome) continues to be a major global public health issue. Around 75 million people across the world have contracted HIV while 32 million have lost their lives.
Sub-Saharan Africa remains the most severely affected, with nearly one in every 20 adults living with HIV, according to WHO.
According to the Healthy Nation 2018, some 1,493,382 Kenyans were living with HIV.
Malaria
Malaria is still a major problem in developing countries, particularly in sub-Saharan Africa, where around 90 per cent of all deaths from the disease occur. WHO estimates that in 2018, there were around 228 million malaria cases across the world, resulting in 405,000 deaths.
Malaria was once endemic in Europe but was eradicated during the 20th century. However, cases have reappeared in Greece since 2009.
In Kenya, 2,783,846 cases were confirmed in public health facilities in 2017 while the number of deaths increased from 2016 to 2017.
The disease is caused by parasites that are transmitted to people through the bites of infected mosquitoes.
Cholera
Cholera is an acute infection picked up from contaminated food or water. It first hit Europe and North America between 1831 and 1832 but originated centuries before in India. Symptoms include violent cramps, vomiting and diarrhoea.
Epidemics trickled out towards the end of the 19th century in Europe and the US, but continue to hit poorer countries. WHO estimates there are still three to five million cholera cases a year.
Here in Kenya, there was an outbreak in 2019 where 12 counties were affected.
More than 4,731 cases were reported, 222 confirmed through lab tests and 37 deaths were recorded.
Since 1971, cholera epidemics seem to erupt somewhere in Kenya almost annually. Outbreaks before 1989 had a fatality rate of about 3.57 per cent, but by 2007, the rate had risen to about 5.6 per cent.
The worst of them all started in 1997 in Nyanza Province and spread across Western Kenya. In 2009, an outbreak hit Kodiaga prison, killing over 30 people in less than a week. Some 274 people died that year out of 11,769 reported cases countrywide.
Polio
Polio or paralytic poliomyelitis is a viral disease that affects the nervous system and can lead to paralysis and death.
The disease reached pandemic proportions in the 1940s and 1950s across Europe, North America, Australia and New Zealand.
At the disease’s height in 1952, some 3,145 Americans died from it and 21,269 were left paralysed.
The first outbreaks in Europe and the US were not reported until the 19th century.
Vaccines are now available against polio and there are hopes the virus will be eradicated within the next decade.
In May 2018, the Ministry of Health rolled out oral polio vaccination across the country for over 800,000 children under the age of five.
This is after the Kenya Medical Research Institute laboratory notified the MoH of poliovirus in the sewage in Kamukunji sub-county in Nairobi.
Kenya has been free of any wild poliovirus (WPV) circulation since 2014.
The ministry has reduced the number of children suffering from paralysis caused by polio from 350,000 per year in 1988 to 22 in 2017.
Influenza
Influenza, commonly known as “the flu”, is an infectious disease caused by an influenza virus.
Between 1918 and 1920 a disturbingly deadly outbreak of influenza tore across the globe. One third of the world’s population was afflicted, with more than 500 million people losing their lives.
The Hong Kong flu of 1968 managed to take out at least a million people.
In the 20th century, three influenza pandemics occurred: the Spanish influenza in 1918 (40-50 million deaths); the Asian influenza in 1957 (two million deaths); and the Hong Kong influenza in 1968 (one million deaths).
This story was first published on the Sunday Nation

Fathema Ismail: A Crusader Against Polio | #IndianWomenInHistory







It has been seven years since India declared herself to be polio free in 2011. However, this remarkable feat could not have been achieved without the firm and resolute will of Fathema Ismail, the woman who led the battle against polio and the rehabilitation of the physically handicapped. She was nominated to the Rajya Sabha in 1978 and served until 1984. She was also awarded the Padma Shri in 1958 for her phenomenal groundwork in building a polio free society as early as in the 1940s.
Fathema Ismail

Early Life And Education

Fathema was born in 1903, the sister of Umar Sobhani, a Congress supporter. Given the time she was born in and the social relations around, she was molded by ideas of social justice and emancipation. Along with Kulsum Sayani, she established the All India Village Industries Association and also served as the Secretary of All India Women’s Conferencein 1936.
An active participant in national politics, she is known to have hidden freedom fighters like J.P. Narayan and Aruna Asaf Aliat her Bombay residence (now Mumbai). In 1920, Fathema went to Vienna to study medicine, until 1923 when financial crisis in the family cost her untimely departure back to the country. 

The Birth Of Her Daughter

In the 1940s, when the Quit India Movement had set the nationalistic aspirations on a high note, a daughter was born to Fathema who was fondly named Usha, after the Goddess of Dawn. Usha’s birth was also a turning point in Fathema’s life when she realised her daughter was suffering from poliomylitis. 
Motivated by her ailing daughter’s condition, Fathema set on a mission to secure the best treatment for her. Her search for a doctor led her to Madras where Fathema was initially turned down for providing any medical treatment. However, she did not resign and after relentless solicitation the doctor agreed to give his services. Her eight months long stay with her daughter during her treatment exposed her to the crippling medical condition of polio-stricken patients. The callous attitude of the medical community made her realise that something had to be done. 
Fathema now headed towards Pune where she learned about rehabilitative services being given to injured soldiers. Her three years of study were put to use when she insisted on learning the rehabilitative techniques and eventually imbibing them. 

Career And Social Work

After gaining considerable experience, Fathema was determined to provide medical facilities to the disabled polio-stricken persons at large but she was low on resources. The departure of the British posed an imminent crisis on the availability of medical equipment and a premise to operate. Eventually, in 1946, she established the Physiotherapy and Rehabilitation Centre for Infantile Paralysis. Despite her efforts, the hospital was not ready to share its equipments.
Fatema Ismail checking on a child who was undergoing rehabilitation
Fortunately, help came from a surgeon who offered his clinic while the equipments were sourced in from the hospital by two Indian assistants who were convinced by Fathema into the nobility of the task. The word spread soon and patients started trickling in often leading to a long waitlist. 
Fathema did not limit herself to provide medical facilities but also envisioned supplemental organisations like the Fellowship of the Physically Handicapped and the Children’s Orthopaedic Hospital which exists even today. A true visionary, she was aware of the impediments that lie in the path of differently-abled children in accessing educational and recreational facilities. 
Around 1947, her persistent efforts gained momentum and were widely noted by the medical fraternity at home as well as the international organisations. She visited the United States and Europe to attend conferences and spread her vision of rehabilitative care for polio patients. In the same year, Fathema established the Society for the Rehabilitation of Disabled and Crippled Children. Her work was not one that could be easily overlooked which ultimately resulted in a grant from the government. 
Fathema had for long desired a full-fledged hospital for polio patients and approached Pt. Nehru to grant land in the prominent race-course area, which was frequented by affluent people. The reason behind this was to make a large part of the society aware and responsive to the polio patients. Thus, in 1952, a children’s orthopaedic hospital was built dedicated exclusively for children suffering from polio.
Fathema Ismail and Jawaharlal Nehru at the opening of her clinic in the military barrack at Marine Drive in 1947
Fathema Ismail and Jawaharlal Nehru at the opening of her clinic in the military barrack at Marine Drive in 1947
In 1958, Fathema also started a school which provided educational services to polio-stricken students (including her daughter) from underprivileged backgrounds. The schools expanded and continue to run even today in Mumbai. 

Appreciation 

Fathema Ismail has been compared to the Australian nurse, Sister Elizabeth Kenny for her rehabilitative work for polio patients, by MV Kamath, a veteran journalist. Fathema’s resolve and dedication to fulfill her noble ambitions can be clearly expressed in her words, “My country is the extension of my home, and I do for other children what I have so courageously done for my own children.”
On February 4, 1987 Fathema Ismail passed away leaving behind a legacy of care and cure not only for her daughter but countless other children whose lives were uplifted with strength restored. She can be rightly called the pioneer in polio eradication in India for her unparalleled work in launching a movement to wipe out polio. 

Post Polio Litaff, Association A.C _APPLAC Mexico

Feb 2, 2020

What are vaccines, how do they work and why are people sceptical?



Index image
Vaccines have saved tens of millions of lives in the past century, yet in many countries health experts have identified a trend towards “vaccine hesitancy” – an increasing refusal to use vaccination.
The World Health Organization (WHO) is so concerned that it has listed this trend as one of the 10 threats to global health in 2019.
Graphic: Chart showing how vaccines work

How was vaccination discovered?

Before vaccines existed, the world was a far more dangerous place, with millions dying each year to now preventable illnesses.
The Chinese were the first to discover an  of vaccination in the 10th Century.
Eight centuries later, British doctor Edward Jenner noticed how milkmaids caught mild cowpox, but rarely went on to contract the deadly .
In 1796 Jenner carried out an experiment on eight-year-old James Phipps.
The doctor inserted pus from a cowpox wound into the boy, who soon developed symptoms.
Once Phipps had recovered, Jenner inserted smallpox into the boy but he remained healthy. The cowpox had made him immune.
In 1798, the results were published and the word vaccine - from the Latin 'vacca' for cow - was coined.

What have been the successes?

Vaccines have helped drastically reduce the damage done by many diseases in the past century.
About 2.6m people were dying from  every year before the first vaccination for the disease was introduced in the 1960s. Vaccination resulted in an 80% drop in measles deaths between 2000 and 2017 worldwide, according to the WHO.
Graphic: Chart on cases of mumps, measles and Rubella
Only a few decades ago, paralysis or death was a very real concern as millions fell victim to . Now polio has almost disappeared. 
Graphic: Chart on the number of cases of polio since 1980

Why do some people refuse vaccination?

Suspicion of vaccines has been around almost as long as modern vaccines themselves.
In the past people were sceptical for religious reasons, because they thought vaccination was unclean, or because they felt it infringed on their freedom of choice.
In the 1800s so-called  popped up across Britain, pushing for alternative measures to fight disease, such as isolating patients. 
In the 1870s, the first anti-vaccination group in the US started after a visit by a British anti-vaccination activist, .
One of the key figures in the recent history of the anti-vaccination movement is Andrew Wakefield.
In 1998, the London-based doctor published a report falsely linking autism and bowel disease to the  vaccine.
Even though his paper was discredited and Wakefield was struck from the medical register in the UK, there was a  in the number of children vaccinated after his claims.
The issue of vaccines is being increasingly politicised too.
Italy’s interior minister Matteo Salvini has allied himself with anti-vaccination groups.
US President Donald Trump, without evidence, appeared to link vaccinations to autism, but has recently urged parents to get their children vaccinated.
The biggest  of attitudes to immunisation, conducted by the Wellcome Trust in 2019, suggested that distrust of vaccines was highest in Europe, with France the most sceptical. 

What are the risks?

When a high proportion of the population is vaccinated it helps prevent the spread of disease which in turn provides protection for those who have not developed immunity or who cannot be vaccinated. 
This is called  and when it breaks down there is a risk to the wider population.
Last year in an ultra-Orthodox Jewish community in Brooklyn, USA, fliers were distributed wrongly claiming links between vaccines and autism.
That same community has been at the centre of one of the  of measles in the US in decades.
Graphic: Chart on the number of measles cases since 2011
England’s most senior doctor warned last year that too many people were being fooled by misleading information about vaccines on social media, and US researchers found that  were being used to sow discord online by posting false information about vaccines.
The proportion of the world’s children who receive recommended vaccines has remained unchanged at 85% for the past few years, according to the World Health Organization.
The WHO says vaccines continue to prevent between two and three million deaths worldwide every year.
The biggest challenges to vaccination, and the lowest rates of immunisation, are in countries with a recent history of conflict and extremely poor healthcare systems, including Afghanistan, Angola and the Democratic Republic of Congo.
But the WHO has also identified complacency as a key issue in developed countries; put simply people have forgotten the harm a disease can do.


Post Polio Litaff, Association A.C _APPLAC Mexico

Top vaccine concerns and why we shouldn’t worry about them








Marketplace sifted through mountains of studies and arguments, examined anti-vaccination documentaries and even attended an anti-vaxx rally in Washington, D.C., to get a deep sense of the information being distributed.
We also spoke with more than a dozen vaccine-hesitant and anti-vaxx Canadians, and heard from many more via email.
Many arguments and scientific studies seemed reasonable, so we ran them by specialists in that particular type of science or medicine.
We consulted with toxicologists, vaccinologists, microbiologists, psychologists and academics throughout this investigation, all of whom confirmed the safety and efficacy of vaccines.
Here are some of the most pervasive concerns Canadians brought to Marketplace, and why experts say we shouldn't worry about them:

Vaccine ingredients
It’s true that vaccines contain chemicals that would be considered toxic at very high doses. But so does pretty much everything humans interact with daily. Even water is toxic to humans in high enough quantities.
Although the idea of a "chemical" may sound harmful, everything we eat can be broken down into its chemical makeup. For example, here is a list of all the chemicals that make up an all-natural banana:
The vaccine ingredients that most people are concerned about — mercury, formaldehyde and aluminum — exist only in very small, non-toxic quantities.
Mercury was previously used as a preservative in some vaccines in the form of thimerosal. It was one of the first ingredients that parents took issue with, and there was so much public concern that it was removed from almost all vaccines, despite the fact that it never existed in quantities that would be considered problematic.
Vaccines only ever contained 50 micrograms of thimerosal (equal to 25 milligrams of mercury) per 0.5 millilitre dose. For comparison, that's about the same amount of elemental mercury in a three-ounce can of tuna.  Nowadays, mercury only exists in certain types of flu shots.
Formaldehyde is another ingredient often of concern. There is only between 0.1 mg and 0.003 mg of formaldehyde in a single dose, depending on the vaccine. Compare that to a 200-gram pear, which contains 12 mg of formaldehyde, or 120 times as much. Formaldehyde is actually a chemical that your body creates itself as part of the metabolic process.
Aluminum is another ingredient people are concerned about. It is also found in very low quantities in vaccines for diseases like HPV and hepatitis. Aluminum is one of the most common metals found in nature and is present in air, food and water and breast milk. The reason it is added to vaccines is because it helps create the immune response needed to develop immunity.
Vaccines work by injecting a dead, weakened or partial version of the virus into the body so the immune system can learn what it looks like and how to fight it the next time it is encountered — before it gets deep within the body and causes physical harm.
Adjuvants, like aluminum, make that dead virus look more threatening than it is in order to activate an immune response, prompting the body to learn how to fight the disease instead of immediately flushing it out.

It is important to note that all traces of aluminum (and the rest of the ingredients in the vaccine) would still be flushed completely out of the body within a day or two, leaving behind only the lessons learned by your immune cells. The ingredients don't build up in the body, therefore, receiving many vaccines will not stack up the levels of aluminum or other ingredients.
Learn more about aluminum and other adjuvants here.

Vaccines and autism
The claim that links vaccines and autism originates from a now-discredited 1998 study published in the prestigious Lancet medical journal by former gastroenterologist Andrew Wakefield an, titled "Ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children."

There were 13 authors listed on the study, with Wakefield being the lead author. But in 2004, 10 authors retracted the interpretation of the study after "serious allegations of research misconduct" were brought to the attention of The Lancet, including allegations of biased selection of patients and unethical, invasive procedures.
The journal also found Wakefield had unreported conflicts of interest, namely that some of the research was funded by lawyers who were acting on behalf of parents suing vaccine manufacturers. Two authors did not retract the interpretation (including Wakefield) and one could not be contacted. As a result, Wakefield lost his medical licence.
Many studies have since been done to test his hypothesis, but all scientifically reputable studies found no link. A 900-page analysis by the American Institute of Medicine (IOM) looked at all relevant studies and meta-analysis, finding that "the mechanistic evidence regarding an association between MMR vaccine and autism is lacking."
This may sound like the science is simply insufficient, however we checked the language with experts like microbiologist Jocelyn Sringly, who explains that the phrase "lacking" in science is the category below "weak," meaning they found zero evidence.
The biggest and most recent study looking for a correlation between vaccines and autism followed 657,461 children born in Denmark from 1999 through 2013. This study compared MMR-vaccinated with unvaccinated children and found "no increased risk for autism." This study even looked at sub-factors, like sibling history of autism, autism risk factors or other childhood vaccinations to see if those factors could combine with a vaccine to create a higher risk. But again, it found no increased risk.

Big pharma and money
Big Pharma is a wealthy industry that has behaved unethically in the past — and particularly has come under fire in recent years due to the opioid crisis.
But vaccines are not big money-makers compared to other drugs.
Only two to three per cent of the global pharmaceutical profits come from vaccines, despite the fact that most people on earth are vaccinated. In fact, most childhood vaccines have expired patents, and it's estimated that once a generic drug enters the market after a patent expiration, name-brand sales drop by 80 per cent
Physician offices often lose money on the administration of vaccines and some governments have to incentivise drug companies to keep making them because of the fact that the profit margins are so low.

Vaccines take lots of time and money to develop because the regulatory standards are higher than other drugs since they are being injected into healthy people. They may make some money in the first few years, but they also have to carry the burden of cost for all the years of research and development.
Vaccines prevent millions of people from getting seriously sick every year. If you're worried about motives, keep in mind that Big Pharma makes a lot more money off people that are sick than people that vaccines have kept healthy.
Prevalence and danger of vaccine preventable disease
Even though we don't see much of some diseases anymore, like pertussis and polio, they are only kept at bay because of the vast majority of the population being vaccinated.
If you talk to older generations, they'll tell you stories of their friends who became deaf, blind, disabled or died from many of the diseases that vaccines have eliminated in North America.
In areas where vaccination rates drop past a certain threshold, we can see resurgence of these diseases, which can be picked up and brought back to countries that have "eliminated" status.
For example, Samoa had a significant drop in vaccination rates over the past few years due in part to anti-vaccination campaigns, and an MMR scare after a nurse accidentally mixed up two shots with an expired anesthetic, resulting in two deaths. When measles made it into the community, it quickly infected thousands of people; 81 of those infected died, and almost all of them were babies and young children.

Authorities arrested an anti-vaxxer for spreading misinformation during the epidemic while the government was frantically trying to get everyone vaccinated.
The only disease that has been entirely eradicated worldwide is smallpox. This was due to a very effective mass-vaccination initiative in the 1960s which managed to drive the disease into complete extinction. Polio is a hopeful candidate for eradication, with only three endemic countries left.
Until complete eradication is reached, vaccination is still necessary for highly contagious and dangerous diseases. Measles can live for two hours in airspace, which means if an unvaccinated person entered a room where someone with measles coughed an hour earlier, they would still be likely to catch the virus.
More information
Here is a link to the largest, most comprehensive and most recent study discrediting any notion that there is a link between vaccines and autism https://annals.org/aim/fullarticle/2727726/measles-mumps-rubella-vaccination-autism-nationwide-cohort-study
Here is the full report by the institute of medicine (IOM) Adverse effects of Vaccines: Evidence and Causality: https://vaccine-safety-training.org/tl_files/vs/pdf/13164.pdf
Here is a list of some additional reliable, scientific sources curated by Natasha Crowcroft, Director of the Centre for Vaccine Preventable Diseases; Professor at the Dalla Lana School of Public Health and Laboratory Medicine and Pathobiology; and Adjunct Scientist ICES and Senior Fellow Massey College at the University of Toronto.
On ingredients:

We don't agree Polio vaccine dosent give Autism.

Post Polio Litaff, Association A.C _APPLAC Mexico

Polio cases jump in Pakistan as clerics declare vaccination an American plot






The parents of 24,000 children in northern Pakistan refused to allow health workers to administer polio vaccinations last month, mostly due to rumours that the harmless vaccine was an American plot to sterilise innocent Muslim children.
The disinformation - spread by extremist clerics using mosque loudspeakers and illegal radio stations, and by word of mouth - has caused a sharp jump in polio cases in Pakistan and hit global efforts to eradicate the debilitating disease.
The World Health Organisation (WHO) recorded 39 cases of polio in Pakistan in 2006, up from 28 in 2005. The disease is concentrated in North-West Frontier Province, where 60% of the refusals were attributed to "religious reasons".
"It was very striking. There was a lot of anti-American propaganda as well as some misconceptions about sterilisation," said Dr Sarfaraz Afridi, a campaign manager with the WHO in Peshawar.
The scaremongering and appeals to Islam echoed a similar campaign in the Nigerian state of Kano in 2003, where the disease then spread to 12 polio-free countries over the following 18 months. Pakistan is one of just four countries where polio remains endemic. The others are Nigeria, India and Afghanistan.
The North-West Frontier Province government made strenuous efforts to counter talk of an "infidel vaccine". Health workers fanning across the province last month were equipped with copies of a fatwa, or religious order, endorsing the vaccinations and signed by Maulana Fazlur Rehman and Qazi Hussain Ahmed, the leaders of Pakistan's most powerful religious parties.
The move reassured many doubters. More than 5.7 million children were vaccinated in January, with another 3 million targeted in a second round due to start next Tuesday. "The elephant is over. We are left with just the tail," said Dr Afridi.
But the tail has a deadly sting. Even though only 24,000 children missed the vaccine, the WHO officials said failure to vaccinate in small pockets of the country gave the virus a fresh toehold to spread.
The vaccination struggle is entangled with the confrontation between the government and powerful militants in the tribal areas. Refusals were highest in areas where conservative clerics and self-styled "Pakistani Taliban" fighters hold sway, flouting government authority and making their own strict laws.
Almost 2,000 children were not vaccinated in Bajaur, a tribal agency on the Afghan border where US warplanes bombed a house last year in the hope of killing al-Qaida's No2, Ayman al-Zawahiri. The jets missed their target but inflamed extremist sentiment. Recently militants ordered Bajaur's barbers to stop shaving beards on the grounds that it was "un-Islamic". The barbers complied.
In nearby Swat Valley, a young firebrand cleric, Maulana Fazlullah, denounced the polio campaign through a local FM radio station. His brother was killed in a Pakistani army attack on a madrasa, or Islamic school, late last year. Almost 4,000 children were not vaccinated in Swat.
Imran Khan, of the Human Rights Commission of Pakistan, said: "Some people feel they are under attack here ... That is clouding their attitudes."
Demands for "assistance" from local officials and elders was the other major factor behind the refusals. In the Mohmand tribal agency, policemen demanded their salaries before allowing vaccination to proceed. Other villagers asked for money or the release of criminals from jail.
"Demand" refusals accounted for about one-third of cases, the WHO said.
But some brave women were uncowed by the extortion or demagoguery. Up to 200 babies a day are vaccinated at the Khyber teaching hospital in Peshawar, where burka-clad women arrive with children in their arms. Some arrive in secret, slipping into the clinic in defiance of male relatives who oppose vaccination. "One woman told me, 'My husband is illiterate. He has no idea how important this vaccine is,'" said Muhammad Islam, a male nurse.
Aid workers fear they are being pushed into the frontline of the struggle between the government and tribal militants, some linked to the Taliban and al-Qaida. Last weekend a grenade was lobbed into a Red Crescent compound in Peshawar, damaging vehicles but killing nobody.
Some linked the attack to a fatwa issued in Dara Adam Khel, a lawless town famous for its gunsmiths, just before Christmas. A cleric named Mufti Khalid Shah declared a fatwa on employees of the UN, WHO and all other foreign organisations. "Killing their employees is in line with the teachings of jihad in Islam," said a notice.
"We are very worried," said Mr Khan, of the Human Rights Commission. "You have to be very careful about admitting to working for an NGO these days."
Recently aid workers in Bannu, near North Waziristan, were sent a letter and a 500 rupee (£4.50) note, he said. "The letter said they had a choice. They could either stop work or buy their own coffin."
Backstory
Poliomyelitis is an acute viral infection of the nervous system. Worldwide more than half of infections are in children under five. One in two hundred infections leads to permanent paralysis, usually in the legs. In 5-10% of these cases the victims die when the breathing muscles are paralysed.
Since the launch of the Global Polio Eradication Initiative in 1988 the number of reported cases worldwide has fallen from 350,000 to 1,968 - a decrease of over 99%. Today it remains endemic in four countries: Nigeria, India, Afghanistan and Pakistan. In 1988 affected countries numbered 125. While there remains no cure for polio the progress towards its eradication is due to widespread use of polio vaccines. By 2002 the WHO had certified 124 countries polio-free.
More than 2 billion children have been immunised against the disease since 1988. The WHO estimates that because of the initiative five million fewer people have been paralysed by the disease.
Source: WHO

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