There is no military drone as stealthy as a virus—and there may be no virus as stealthy as polio. That is a very bad thing for the 161,000 children under five in Pakistan’s North Waziristan tribal area, any number of whom will enter this summer healthy and active, and exit it unable ever to walk again. And, given the slippery nature of the polio virus, what happens in North Waziristan could soon be happening all over Asia.
Until very recently, polio appeared to be at the very brink of eradication—which would make it only the second disease ever to be wiped out in the wild, following smallpox, which was finally vaccinated out of existence in 1977. As recently as 1988, there were 350,000 cases of polio world wide, distributed across 125 countries. Thanks to an aggressive, 24-year eradication campaign headed by UNICEF, WHO, the CDC and Rotary International, however, there were only 650 cases worldwide last year and only 73 so far this year—confined to just three countries: Afghanistan, Pakistan and Nigeria.
But that was then—then being just last week. Now politics, the drones, the Taliban, the CIA and even the death of Osama bin Laden have gotten in the way. Yesterday, the Taliban commander in North Waziristan canceled the UNICEF-led vaccinations that were to have taken place next in the region next week—vaccinations that were to have provided crucial second doses to 143,000 kids and first doses for the rest. The work can only resume, the Taliban announced, when American drone strikes stop.
“Under these circumstances we cannot continue,” North Waziristan surgeon general Dr. Muhammed Sadiq told the New York Times by phone.
Using children as medical poker chips is indefensible under any circumstances, but the Pakistanis do have other reasons to be suspicious of Westerners bearing vaccines. In the months leading up to bin Laden’s killing in May 2011, a local doctor who was also working for the CIA ran a hepatitis vaccination campaign in and around Abbottabad, where bin Laden was holed up. The real purpose of was to try to obtain DNA samples that would confirm bin Laden or his family members were indeed in residence. That, surely, figured in the Taliban’s decision.
“[This has been] a huge setback for us,” Dr. Rahim Jan Afridi, head of medicine in Khyber Pakhtunkhwa province, told TIME’s Aryn Baker in Pakistan last week. “Our polio campaign has suffered immensely. Our teams are getting attacked, and we are having a hard time hiring health workers because they are worried about being called a spy.”
The medical effects of all this are already being felt: Pakistan had had only 22 cases of polio so far this year, but new cases have lately turned up in all four of the country’s provinces. They will surely not be the last. In a world in which millions of people suffer from HIV/AIDS, tuberculosis, malaria and other epidemic diseases, a few dozen or even a few hundred cases of polio seem like a small thing. But they’re actually very big.
For every clinical case of polio there are 200 subclinical ones that can present themselves merely as a bad summer cold; but that’s 200 active carriers who can and do spread the wild virus. Even people who are infected with what will turn out to be a crippling strain of the disease do not know they’re sick for a week or more, as the virus makes the long journey from the throat to the gut to the bloodstream—multiplying explosively all the way—and finally to the anterior horns of the spinal cord and the medulla oblongota of the brain where it wipes out the cells that signal the muscles, paralyzing them forever.
All this stealth infection means that smallest hole in the vaccination net can cause the virus to pour out. In 2003, there were just 784 cases worldwide confined to six countries and then too, the belief was that the virus was at the brink of being snuffed out for good. That same year, however, northern Nigerian clerics banned the vaccine, saying, alternately, that it contained the AIDS virus or was being used to sterilize Muslim girls. Within two years, the Nigerian strain had exploded across 16 countries, as far away as Indonesia.
Much the same thing will likely happen again if the vaccinations don’t resume—and soon—in Pakistan. It is humanity’s great disgrace that children are often the collateral casualties of war. Denying them even the medicine they need to stay well is one more dimension of that moral crime.
—with reporting by Aryn Baker/Peshawar