When asked if he plans to participate in Pakistan’s coronavirus vaccine rollout, Qasim Gul laughs flippantly. Gul, 32, is a clerk at a teaching hospital in Pakistan’s southeastern city of Karachi. Over the past 10 months, he has been in close proximity with several coronavirus patients, and yet, he says, the virus is a hoax.
While speaking with me outside of his hospital, Gul drags his surgical mask down to his chin. I balk and ask him to cover his nose and mouth; he tells me to seek faith in God.
“The media is controlled by Europe and Western powers,” he says. “Of course, they obfuscate the truth, and tell us that this so-called disease can only be eradicated with a lab-made vaccine containing haram ingredients [products that are forbidden in Islam], created by countries that are dropping bombs on us, that don’t want us to live.”
Gul has two children—a four-month-old boy, and a two-year-old girl. Both, he says, received routine at-birth immunizations without his consent. Nurses at the clinic where they were born whisked them away and administered two soon-after-birth vaccines, or pedaishi teekas as they are called colloquially in Pakistan: the BCG or Childhood TB vaccine, and the first of four oral polio vaccines. And that was it. Once his children came home, they never received another shot. When polio vaccinators showed up at his doorstep bearing blue ice boxes with vials of the oral polio vaccine, he shooed them away.
Pakistan remains one of the three countries in the world where polio has not yet been eradicated. Violence against polio vaccinators, most of them women, continues unabated. Just last month, a team of polio vaccinators was attacked in a remote town in Pakistan’s Khyber Pakhtunkhwa province during the second day of a five-day anti polio campaign.
Now, as Pakistan launches its coronavirus vaccination drive, scores of Pakistanis are reluctant to receive the vaccine. According to a survey conducted by Gallup Pakistan, 49 percent of respondents said they will not get vaccinated.
Their reluctance, however, goes beyond trafficked global conspiracy theories concerning the coronavirus vaccine; Gul and others's mistrust stems from a much more sinister source, involving the murky legacy of American intervention and involvement in Pakistan, and the hunt for Osama bin Laden.
While hunting for Bin Laden in the sleepy Pakistani city of Abbottabad, the CIA organized a fake hepatitis B vaccination program to aid in their search.
Operatives recruited Pakistani health official Shakil Afridi, who, in March 2011 with a team of nurses, began conducting the vaccination program in the city. Afridi began first in poorer neighborhoods before moving to the well-to-do suburb of Bilal Town, where Bin Laden was thought to be hiding. The program was part of an elaborate ruse meant to obtain DNA evidence from members of Bin Laden’s family, but did not work as planned. Afridi and his team were turned away by the woman who answered the door. Instead, he was given a phone number—it belonged to Bin Laden’s messenger.
On May 1, 2011, Bin Laden was killed by U.S. Navy SEALs in the Abbottabad home Afridi had attempted to enter. Months later, when news of the fake vaccination program broke, Pakistani health officials issued words of caution, fearing vaccine refusals in regions of the country frequently targeted by American drones. But the damage had already been done.
Pakistan moved from being a country that had almost eradicated polio to one whose polio cases accounted for a whopping 85 percent of the global share.
In May 2014, over the course of a decade and though the White House announced that the CIA would no longer use vaccination programs as cover for espionage, Pakistan moved from being a country that had almost eradicated polio to one whose polio cases accounted for a whopping 85 percent of the global share.
The Pakistani Taliban banned polio vaccines in the country’s tribal areas, linking the ban to American drone strikes and the CIA’s prior use of vaccination programs for espionage purposes. After repeated attacks and assassination attempts on health workers administering vaccines—nine were shot dead in December 2012, another seven in January 2013—the United Nations suspended their polio eradication campaign in the country. In the years that followed, over 100 vaccinators were killed in targeted attacks.
Taimur Khan Jhagra, the health minister of Pakistan’s Khyber Pakhtunkhwa province which faced the bulk of violence against polio vaccinators, said the CIA’s vaccine ruse has undoubtedly obstructed healthcare workers for years to come. “If you want to set us back by a decade, then you do what [the CIA] did,” he told me over the phone from Peshawar. “Because it gives every conspiracy theorist, every vaccine avoider, ammunition to feed public damage.”
Now, Jhagra believes that local messaging is key when it comes to coronavirus vaccine distribution. “The vaccine rollout has to be seen as a local, indigenous, Pakistani effort—a lot of public communication, a lot [of] leadership by example, a lot of more proactive myth-busting,” he said. “Our partners at DFID, USAID, Gates Foundation certainly help us, but they must not become the face of our campaigns. And when these [healthcare] campaigns are used for the sort of purpose the Shakil Afridi [CIA ruse] campaign was used for, it sets us back a decade.”
“If you want to set us back by a decade, then you do what [the CIA] did.”
Forty miles East of Peshawar, in the town of Mardan in the same province, Almeena Iftikhar, a polio vaccinator, told me she is always scared for her life in the field. Iftikhar is a Lady Health Worker, a program she said is the reerkh ki haddi, or the backbone of the country’s healthcare infrastructure. Lady Health Workers like Iftikhar are salaried government employees, and foot-soldiers in the country’s fight to eradicate polio. They go door-to-door in far flung, rural areas of the country bearing vials of the oral polio vaccine, interact with families in their communities, and provide health education and basic health services.
But in Pakistan, where aid and vaccination programs are commonly associated with the CIA and Western interests, Lady Health Workers have subsequently become easy targets.
“Certainly, we will step in to assist when we are required to, just as we have in every crisis this country has encountered, from polio, to the floods, to dengue, to helping out with contact tracing during the early days of the pandemic,” Iftikhar said. “But I am concerned about my safety.” Iftikhar says she has been pelted with stones and that some of her colleagues have been killed; now, as the coronavirus vaccine has started making its way to Pakistan, she is far from the only healthcare provider worried about the CIA’s lasting impact on the country.
“Of course, the CIA fake vaccination campaign was unhelpful,” said Svea Closser, a medical anthropologist who has been monitoring Pakistan’s polio eradication campaign since 2006, and spent 10 months studying communities receiving door-to-door vaccinations from Lady Health Workers. Closer believes vaccine refusals also have a lot to do with overall health infrastructure, and the absence of basic health services. “A lot of it is about: Why are you pushing this one vaccine so hard when you don't seem to care about anything else for my family?” she added. “Why are you coming door to door with the polio vaccine and I go to the health center and there's no medicines there?”
Closser said this hesitancy, partially fueled by frustration with the abysmal state of country-wide healthcare, has been a dynamic that has been around since the inception of the polio program. But the longer the program has gone on, and the harder the polio vaccine gets pushed, the more it has created hesitancy issues. “Delivery of the vaccine is everything,” Closser said. “It matters that delivery is integrated and takes the needs of the community into account.”
Fatima Akram Hayat, a health adviser to the Pakistani government, thinks that health workers may have to eventually go door-to-door in far flung areas of the country to administer coronavirus vaccines. But for now, she is working to differentiate the coronavirus rollout from polio and other vaccine programs as much as possible.
“We are working very hard to distinguish it from polio in the way it is marketed and introduced to people. Less invasive. More autonomy in the hands of people. Giving citizens decision-making power,” she said. “We want to encourage folks to line up outside vaccination centers themselves.”
“People that have witnessed U.S. drone strikes on Pakistani territory, and know of the CIA-backed fake vaccination drive to find Bin Laden, are likely to find it hard to trust any western vaccines.”
There also seems to be some degree of acceptance for the Chinese vaccines in Pakistan, even as these sentiments are not mirrored elsewhere. Among the four vaccines approved by Pakistan’s Drug Regulatory Authority for emergency use, two are Chinese: Sinopharm and the one-dose CanSinoBIO, along with the AstraZeneca vaccine developed by Oxford University, and the Russian Sputnik V. Pakistan also conducted Stage III clinical trials for CanSinoBIO, registering up to 18,000 volunteers. In terms of vaccines, the country started the rollout with half a million doses of China's Sinopharm vaccine meant for healthcare workers and 2.8 million doses of the AstraZeneca vaccine through COVAX meant for populations above the age of 60; a month into the distribution, 72,822 doses of the vaccine have been administered.
“People that have witnessed U.S. drone strikes on Pakistani territory, and know of the CIA-backed fake vaccination drive to find Bin Laden, are likely to find it hard to trust any western vaccines,” Hayat told me. “On the other hand, it is widely believed that China has never tried to hurt Pakistan.”
But the road ahead is daunting. As the Pakistani government rolls out the second phase of its coronavirus vaccine rollout for citizens above the age of 60, only 180,000 people out of a total of 8.5 million have registered. Meanwhile, the country has registered over 587,014 cases of the virus since the beginning of the pandemic, and nearly 11,000 over the past two months, according to government data. On Friday, the health minister, Dr Faisal Sultan, issued a warning on Twitter, asking citizens to wear masks, avoid public places, and health workers and citizens above the age of 60 to register for vaccinations.
In Mardan, Iftikhar says life has continued. Ramadan is starting in a month, and soon, she said, mosques will be filled to the brim with worshippers. “Locals here say, we believe in God, we don't believe in corona, we don't believe in haram vaccines imported from the West,” she told me. “But we, as health workers, try our best to convince them to take precautions.”