It was October. I had just returned from an interview on a local television focusing on a mother's responsibility in protecting her children from polio. I was very energetic and optimistic about eradicating this crippling disease when I received calls from the remote areas of the province asking questions and showing their commitment for vaccinating their children. This can be done, I thought!!!

I received a call from one of the COMNet field staff. "A polio vaccinator has been shot in eastern by pass - we heard the gun shots they have taken him to the hospital, we are worried he might die," said one of the communication officers. I couldn’t grasp the situation - got a second call from a journalist asking for details, and it went on.

The vaccinator shot was Imran, an 18-year-old boy who had volunteered with the Government of Balochistan for the polio eradication. A hepatitis B patient himself, he was a brother of two deaf and dumb siblings. His father did some labor work in Sindh, and he volunteered thinking he will earn 2 dollars a day to buy his medicine. The thousands of polio volunteers in Pakistan earn only less than 2 dollars per day; they go house to house to deliver polio vaccine. Most of them do it because they are very poor and this small amount may help them in paying for food or clothes.

During field visits - working on forming methods to motivate these female volunteers - I often asked them: why do you volunteer? I remember this girl telling me: "I have to buy my school uniform".  Some would say "it helps us buy food people throw stones at us, call us bad names but no one will put food on our table". To keep the volunteers motivated so that they join as a polio team member and carry out their work properly is one of the major challenges for polio eradication program in Pakistan.

I was shaken, it was horrible... But it didn't stop us from carrying out our work for PEI [the Polio Eradication Initiative]. These were the days when the Taliban's opposition to polio vaccination had been announced and was quite visible amongst other religious groups in form of anti-vaccination wall chalking, mosque announcements and distribution of flyers. But to our worst fears this was only the beginning. In December similar multiple coordinated attacks all over the country took more than 10 lives, in Karachi city and KPK [Khyber Pakhtunkhwa] province. Then this chain of incidents continued in the form of threats (incidents including killings of aid workers involved in campaigns and attacks on security protecting the teams) in Nigeria where 9 innocent vaccinators were killed.

In my experience interacting with the field staff and with the communities, polio vaccination was always seen as an "Imposed" initiative. In a country where regions as Balochistan has the worst Infant and Child mortality indicators, where more than 50% of the children are malnourished,  where children die of preventable diseases as diarrhea and pneumonia and lastly where people see children dying in bomb blasts every day - a crippling disease is not really a priority. 

The top-down approach of forming strategies at global level, trial and error methodology, and negligence of the local realities and context has led the polio eradication program to where it is today: 20 years back. Issues such as ownership, accountability and oversight by Governments have been highlighted on paper but completely ignored on ground by the donor agencies - funds will keep coming no matter how the country has performed or how much corruption is seen.

It's about time polio eradicators realize that Polio eradication as we knew it had died and washed away with the blood of all those brave volunteers who died in the line of duty. What has worked in India will not work in Pakistan, strategy documents made in Geneva will not help, and unconditional donation to the countries will only damage the program further. Accountability mechanisms need to be reviewed at grass root level by the Government and also the Agencies supporting the program. We have enough evidence that proves that more than 80% of the children who are missed for immunization are directly linked with the supply side of the program, which can be corrected; the better we run the program, the more commitment we show - we earn trust in the community. The better we address their other health concerns in the form of polio, the closer we can get to them.

In the end those were just young girls, trying to earn some money for their books, medicine or food and we have to ensure that those lives were not lost in vain.

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