The subject of whether children should be vaccinated is controversial in Australia and around the world, but in Pakistan health workers are being killed for carrying out immunisations.
Karachi - One of the most overcrowded cities in the world. I've arrived as the country faces a crisis. After nearly eradicating polio three years ago, the disease is once again crippling Pakistan's children.
As people travel around Pakistan, so does the polio virus, so it becomes really important to try to
manage it here. In response, the government has set up thousands of emergency polio teams.
Polio teams have had to adapt, and now they’re based at train stations and coach stops around Karachi.
These teams are fighting more than just the virus. In 2012, the Pakistani Taliban issued a threat against anyone working in polio vaccination, calling it a Western conspiracy. To date, 80 people working to fight polio have been killed in targeted attacks. The team must move quickly. Their goal is to vaccinate every child on this train before it departs. They have 15 minutes.
REPORTER: It's a thankless job, this.
VACCINATOR (Translation): How old is he?
MOTHER (Translation): He is five.
VACCINATOR (Translation): Let them both have it. Open your mouth.
Pakistan has the largest reservoir of the polio virus in the world. Polio thrives in the dirty water, and open sewers, that flow throughout Karachi. There are kids that walk up and down this open sewer. It's just dripping over there, and it only takes one drop - it only takes a small amount - for a child to get polio.
The disease is highly contagious, and there's no cure. Prevention is essential. Two of Abdullah Bakar's grandsons contracted polio five months ago.
ABDULLAH BAKAR, OMER’S GRANDFATHER(Translation): Slowly, do not use too much force, slowly, slowly.
This morning, Abdullah and their mum Yasmin are stretching Omer's limbs to stop them from seizing up.
ABDULLAH BAKAR (Translation): Hold him from the knee.
Pakistan, Afghanistan and Nigeria are the only three countries where polio remains endemic. The majority of cases are found in children under three.
ABDULLAH BAKAR (Translation): I was already worried about him and then the news came about his brother, my heart sank.
MOTHER (Translation): This is a very dangerous disease.
Children here need at least five doses of the polio vaccine to be protected. Omer and his brother had only had two.
ABDULLAH BAKAR (Translation): When he developed a fever we took him to a local doctor. He was limping for two days. The nerves in his spine are damaged when means his feet don’t work.
It's only been five months since the children were both diagnosed with polio, and the family have worked through tremendously. What I notice is they've just resigned themselves to the fact that their
kids will never probably walk.
There have been 322 cases of polio across the country in the last two years. Big vaccination drives happen several times a year here in Karachi. I'm on my way to a planning meeting for one that's happening this week. And you can sense the urgency.
FARHINA TOUSEEF, POLIO VACCINATOR (Translation): It’s been six weeks since the beginning of 2015 and we already have six polio cases. If we have six cases in six weeks things could get a lot worse for the rest of the year.
One team is led by a mother of three, Farhina Touseef.
FARHINA TOUSEEF (Translation): If you follow this training and apply it in your field work we will make fewer mistakes.
Farhina's team get paid £1.50 a day, for going house to offering the free vaccine to parents. And they're worried.
WOMAN (Translation): Many people don’t take the medicine and are very hostile to us.
All of these women know that that hostility can be fatal. Two of Farhina's colleagues were gunned down on the job in 2012 by a faction of the Pakistani Taliban. She had recruited one of the murdered workers herself.
FARHINA TOUSEEF (Translation): The first incident really shook me. After that I had a lot of pressure from my family. They wanted me to give up work because it’s so risky. It’s life threatening. My husband said 100% I should resign. Initially I said OK, I’ll give up. Write me a resignation letter. But I couldn’t do it
The vaccination drive will begin tomorrow. One of Farhina's colleagues has a very personal reason for getting involved. Abrar Khan has lived with polio since he was three. His left leg is withered. He's dedicated his life to fighting the disease, because he doesn't want anyone else to suffer the way he has.
ABRAR KHAN, VACCINATION CAMPAIGNER (Translation): This society does not accept disabled people. This disability is for my entire life. I worry about what will happen when I grow older. I tell myself that if a single child is saved from polio it will make me happy.
Abrar's been working as a vaccinator for three years, but he's especially anxious about this week's initiative.
ABRAR KHAN (Translation): This campaign is in a super high risk area where polio workers have been killed. I don’t know what to expect. Someone may come from behind and kill me.
REPORTER: You're smiling!
ABRAR KHAN (Translation): What else can I do?
It's vaccination day. Attacks happen with alarming regularity. No-one on a vaccination drive is safe. Not the team or the security forces that try to protect them. Their job has become so dangerous that they can't do it without the protection of armed police. The vaccination drive is about to start. We've arrived at our rendezvous point in Ittehad Town., an area notorious for Taliban activity. It feels like a military operation.
The atmosphere is quite tense, police officers look a little bit nervous. Two of them have been shot in this area in the last month alone, so they know the risks involved.
POLICE (Translation): In this area, in the alleyways keep a close watch. When you lose your focus the enemy will not spare you. Remain alert
For Farhina, there's no time to waste. The goal is to vaccinate nearly 250,000 children across the city in two days. Farhina's target is 20,000 children.
FARHINA TOUSEEF (Translation): You do this area, team two will go ahead.
Some of the polio workers and the police officers that are going to be accompanying them are just getting ready to leave.
FARHINA TOUSEEF (Translation): Where are you? You’ll be left behind, hurry!
I join Farhina as she heads deeper into the neighbourhood.
FARHINA TOUSEEF (Translation): We are already ahead of you, hurry! Security, go with them. You two, go with them. You know the area we just left? A week ago three bombs were found in a rickshaw.
I've just been told, a couple of days ago in this very area, they found a little rickshaw with three bombs in it. And the ladies were just telling me that as I head out back into the area... We're just going door to door as quick as we can, asking who they are, if they've got any kids, and they're not hanging around at all.
FARHINA TOUSEEF (Translation): A man in the neighbourhood said you had two young girls.
WOMAN (Translation): Who said two young girls?
FARHINA TOUSEEF (Translation): Your neighbours are saying it.
WOMAN (Translation): What little girls? Mm, no.
Even getting people to talk is virtually impossible.
FARHINA TOUSEEF (Translation): Why have you refused?
MAN (Translation): You can’t force them.
FARHINA TOUSEEF (Translation): No listen…There is no cure.. It’s an untreatable illness. God forbid your child gets polio because you didn’t give him the drops. He’s going to be disabled for life. There is no treatment.
This has not been a good start to the day.
MAN (Translation): There is no one at home.
FARHINA TOUSEEF (Translation): There are no children under five at your house? Have they gone somewhere?
Each child needs multiple doses, so keeping tally is important. The vaccinators mark up their progress on each house. All Farhina can do today is chalk up refusal after refusal on their walls, frustrated after so many rejections, Farhina and her team resort to vaccinating children on the street.
FARHINA TOUSEEF (Translation): Where do we go next, I am not sure?
Just as they're ready to move on, a little girl opens the door. We follow Farhina inside, expecting to meet a family.
FARHINA TOUSEEF (Translation): This baby is around nine months old. Give him the drops.
But the children are alone.
REPORTER: Do you have permission to be here?
FARHINA TOUSEEF (Translation): Her mother isn't here.
Having vaccinated a baby without parental consent, it's clear that Farhina won't let anything stand in her way. She spots a second child.
FARHINA TOUSEEF (Translation): Where is he hiding? Do you want me to come after you? Just watch, come here, nothing is going to happen. Come I’ll give you money and you can buy a treat. We’ll have to bribe him to get him out. Here take this…come. Tell him I am not giving him any drops…take the money. He is not coming, he’s not taking the money. Let’s go. Write his name down, mark it as a refusal.
REPORTER: If someone went into my house without my permission like you did, I would be upset. Do you think that's OK?
FARHINA TOUSEEF (Translation): In my opinion, with polio, everything is OK. People will argue and fight with me. We will go to any lengths to do this work. This is our purpose. We will go to any extent to vaccinate a child. No matter what we must vaccinate every child.
I was starting to realise that both sides - those for and against vaccination - will go to extreme lengths to fight for what they believe. Later that night, I hear that four people working on the national campaign have been kidnapped. Soon, the news gets even worse.
NEWS REPORT (Translation): Latest news. Three out of four bodies found in Zhorb have been identified. One of them is the ambulance driver of the polio team. Geo News Salman Ashraf is at the scene for us.
The team had been abducted whilst vaccinating just one hour outside Karachi and shot dead. Abrar has heard the news too.
ABRAR KHAN (Translation): While doing their duty they’ve been taken from this world. I’ll call them martyrs. This is a type of jihad. They were fighting polio. Whoever attacks us is working against humanity. They have killed innocent people.
Abrar's job is to persuade those families that consistently refuse the vaccine - his mission is to win over hardliners.
ABRAR KHAN (Translation): So why are you refusing?
MAN (Translation): Is it a religious obligation? I will not vaccinate
WOMAN (Translation): It is harmful to avoid it.
MAN (Translation): What exactly is the harm, tell me? What is the benefit – is there any?
WOMAN (Translation): If you refuse you will get polio, like him.
Abrar often has to argue against anti-vaccination stories in hard-line local newspapers that claim the polio campaign is a fake.
MAN (Translation): There’s an article here that reported a case where a child was vaccinated but still got polio.
WOMAN (Translation): Around the city new cases are springing up of children getting the disease despite getting the polio vaccine.
But one of the papers appears to have had a change of opinion.
ABRAR KHAN (Translation): This is the same newspaper as yours. Look at the date. Your paper is from January 2013. In my article they are urging you to vaccinate and it was published in May 2014 -one year on.
Abrar has been persuasive, and the man agrees to have his children vaccinated for the first time.
MAN (Translation): Are you happy now?
This level of reluctance to have the vaccine isn't just down to Taliban propaganda - the CIA has admitted to using a vaccination campaign as a cover back in 2011 to allow them to go house to house in their hunt for Osama Bin Laden.
Polio is dividing Pakistan's conservative and moderate Muslims. Across the country, thousands of religious schools known as madrassas preach radical interpretations of Islam and conservative values. Polio is a controversial flashpoint. When Farhina goes out onto the streets, trying to convince people to get the vaccine, often she's fighting against what some madrasas are teaching people to do. Aisha Usmaini teaches 400 other women a hard line version of Islam in a madrasa like this one. I meet her at home, with her young son.
REPORTER: Do you think the polio drops are harmful for their health?
AISHA USMAINI, ANTI-VACCINATION ADVOCATE: They also include scary ingredients at least for the Muslims.
REPORTER: Like what?
AISHA USMAINI: One is human diploid cells, this is aborted foetal tissue that is included in the polio vaccine. A basic scary ingredient for us is alcohol. It is forbidden, it is haram in our religion.
Tests have confirmed that the polio drops given to children have never contained foetal cells, or other harmful substances. Yet for Usmaini, the vaccination represents an attack by foreigners on Pakistan's children, and needs to be resisted.
AISHA USMAINI: If you are defending something and for your defence if you kill someone that is right. It is not wrong.
REPORTER: So it's OK to kill the workers?
AISHA USMAINI: Maybe, when they have the loss so they will stop it. They have to finish it.
Usmaini is one of many who believe that the vaccine is part of a conspiracy to eradicate Muslims.
AISHA USMAINI: Basically it is used as a bio-weapon.
REPORTER: Polio drops are a bioweapon?
AISHA USMAINI: Yeah. They are killing our generations by giving the polio vaccine.
REPORTER: Who do you think is behind all of this?
AISHA USMAINI: The Americans, USAID, the UN is also included in this agenda against the Muslims. Israel is also funding it - why? Israel is the biggest enemy of the Muslims at this time.
The Israeli government has not directly financed this campaign. In the past 27 years, the US, UK and other developed nations have donated $11 billion in US dollars to combat polio globally.
REPORTER: This is your son? Do you give him the polio vaccine?
AISHA USMAINI: Ah, no.
AISHA USMAINI: No.
AISHA USMAINI: No.
REPORTER: No. But how would you feel, as his mother, if he became crippled because of polio? Would you feel responsible?
AISHA USMAINI: It's luck.
REPORTER: It's luck?
AISHA USMAINI: It's luck.
Attitudes to vaccination are also dividing families. In Orangi Town, I'm meeting a family devastated by polio. Maheen and Mariam's father is a conservative cleric. He refused to give polio drops, against their mother's wishes.
ALIYA (Translation): My in-laws believed it would make our girls infertile. That is why they were against it. I didn’t want to upset my husband.
The girl's mum was vaccinated as a child. She wanted the same for her daughters. Their grandmother, Khadija, now blames herself for the decision.
KHADIJA, GRANDMOTHER (Translation): If I could just take their pain myself. She is my life, a gift from God. We have to protect her. Maybe God will forgive our sins if we look after them.
Aliya hopes that, with the help of leg braces, Mariam may be able to walk again within three years. But for Maheen, despite her best efforts, it's just too late.
Back at home, Farhina is getting ready for another day vaccinating Karachi's children.
FARHINA TOUSEEF (Translation): I do have concerns when leaving for work. God forbid, I worry if something happens to me what will happen to my family? One day when Pakistan is free from polio I will have more time for my family. But right now my other children need me.
12th May 2015