In comparison to Pakistan, elsewhere in the subcontinent, India was removed from the WHO list of endemic countries in 2012, and Bangladesh, following a 2006 outbreak, is now also considered polio free.

There are numerous conditions that make eradicating polio from Pakistan difficult: Pakistan’s weak state and health system, particularly in the tribal areas; ongoing conflict in the region, including drone strikes; prejudices among the population against the polio vaccine; and backlash against the use of health campaigns by security and intelligence agencies. All these factors threaten the efficacy of Pakistan’s polio eradication efforts — and the people administering it.

Security remains a deep challenge for Pakistani society, and anti-polio efforts are no exception. On 11 March this year, two policemen guarding a polio vaccination team in Gandi Umar Khan village (about 25 kilometres from Dera Ismail Khan in Khyber Pakhtunkhwa province) were shot dead by armed men. And, according to reports, in 2013 there were 30 incidents of attack on polio workers in Pakistan.

Polio vaccination workers were targeted directly for the first time back in 2012. In December of that year, nine anti-polio workers were murdered by gunmen believed to be Pakistani Taliban, leading to a temporary suspension of the eradication program by the UN. And earlier in June 2012, the militant Taliban leaders of North and South Waziristan declared a ban on vaccinations until US drone strikes ceased. According to sources, around 54 people have been killed in such attacks since December 2012.

A key feature of the Taliban militancy is the systematic attack on people suspected of behaviour in violation of the Taliban’s interpretation of the principles of Islam. The Taliban have prohibited vaccination campaigns for children, school-age girls, and women working outside the home. According to sources, ‘[t]he militants, and other orthodox elements … say Allah alone decides about sickness or health and no one should interfere’.

But public confidence in the vaccination program is also low. In May 2012, expired polio vaccines were administered to about 3000 children, further deteriorating the already wavering trust in the vaccine program. In addition, suspicion about polio workers worsened after the 2011 US operation to kill Osama Bin Laden. In the aftermath, it emerged that the CIA had recruited a Pakistani doctor, Shakil Afridi, to organise a fake vaccination drive to try to obtain a DNA sample from the children living inside Bin Laden’s Abbottabad hideout.

But, in spite of all this, Pakistan has come a long way in its struggle to eradicate polio. In the early 1990s there was estimated to be more than 20,000 polio cases a year, now declined to an average of about 100 cases annually. And data suggests that, excluding the northwest’s Federally Administered Tribal Areas, a decrease of about 40 per cent occurred in 2013. So far, in 2014, there have been 43 cases.

Pakistan’s goal of eradicating polio this year, as declared by Ambassador Masood Khan in February, will be difficult but not impossible. The declining frequency of polio incidents in Pakistan over time provides promising evidence that the country might be progressing towards eradication of the disease in the near future. Khan noted that, ‘[t]o accomplish this mission, the Prime Minister has created a Polio Eradication Cell in his office and has designated a focal point to coordinate actions between the federal, provincial and local governments’. And ‘[d]espite security challenges, our valiant polio workers continue to perform their tasks with devotion and dedication’, he added.

But complete eradication will require a more stable security environment, especially one that has curtailed terror activities in the country. An all-encompassing strategy must also be developed, along with cooperation from the community-based religious clerics for better mass support and participation in the polio immunisation program.

Dr Sanchita Bhattacharya is a New Delhi based researcher working on Political Islam in the Indian Sub-continent. Currently she is working as Research Associate for the Institute for Conflict Management.