Where Being A Vaccine Worker Can Be Deadly

Health workers in Afghanistan and Pakistan are vulnerable to violence in places where the polio vaccine is most needed.

Afghan health worker administers the polio vaccine to a child on the second day of a vaccination campaign on March 15, 2010, in Kabul, Afghanistan. (Photo by Majid Saeedi/Getty Images)

Shari Roan is an award-winning health writer based in Southern California.

Hanisa, an Afghani vaccine worker, was just 22 when she was killed. She'd just completed a polio vaccine training program and had set out for work on Saturday, December 1 from her village north of Kabul when she was ambushed and shot. She died hours later, and while it's not clear whether  Hanisa was killed because of her work, her death is the latest in a string of attacks against vaccine workers in Afghanistan and Pakistan. A few months ago, a Pakistani health worker involved in the polio vaccine campaign was killed, and the child of another worker was kidnapped but later safely returned. Earlier this month a polio vaccinator was caught in crossfire and killed.

This violence may have cast a pall on the international effort to eradicate polio from the few countries where the disease is still transmitted, but it will not derail the robust vaccination outreach program, stresses a World Health Organization spokeswoman. "We do not take the incidents of violence lightly," Sona Bari, of the World Health Organization's Global Polio Eradication Initiative, told TakePart. "People risk their lives for this work, and their sacrifice weighs heavily on the entire eradication program."

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The presence of vaccine workers in dangerous and unruly parts of the world has grown in the past year as international health organizations make a strong —and what they hope is a final—push to eradicate polio from the few remaining countries with outbreaks. Worldwide, there were just 177 polio cases through October 2012, a drop from 502 during the same period last year. Pakistan, Afghanistan, and Nigeria are the countries targeted for the intense eradication effort. "The circumstances that health workers face in so many parts of the world are so tragic," Bari says. "In Pakistan and Afghanistan, the rule of law is not very strong. There is a general level of insecurity in which one works—be it the threat of kidnapping, robbery, or terrorism."

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While it's unclear whether the Hanisa was killed because she was delivering vaccine, Bari says, it appears that some vaccine workers have been attacked due to their work. In some parts of these countries "there are deep social restrictions on women working outside the home, and therefore the woman vaccinator becomes a target," she adds. "It could be because some communities have been led to believe that vaccination is a Western conspiracy...and anyone associated with it should be killed."

Vaccine field workers are part of a large, organized network overseen by each country's government, Bari says. Millions of workers are dispatched across each country, going from home to home delivering vaccine. And while the workers are supervised and supported by managers, the field workers are "the most visible part of polio eradication," she says. "The workers involved are mostly hired by the government—they may have [other] jobs in other parts of the health system, they may be members of nurses’ associations, students, volunteers. They are usually local—from the district or even the very neighborhood. When we see incidents of violence against polio workers, it is mostly this frontline worker" who is the target—and the ones who live and work in dangerous areas are at the highest risk.

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In this push to finally eradicate polio, organizations are sending workers to areas that have been traditionally the hardest to reach, such as to groups of people who do not have permanent homes or who have been displaced from their villages due to conflict. "The virus now survives in the hardest-to-vaccinate communities," Bari says. "They are hard-to-vaccinate because they are the most marginalized, unreached by health services and neglected...They may be nomads or populations which are economic migrants and have no fixed address. So even as the threat level to polio workers has increased over the past two to three years, the countries are actually managing to reach more and more children with vaccine."

The violence, however sobering, will not stop efforts to reach children in these areas, Bari says. Data collected by the program show the importance of reaching those remaining pockets. "If polio is to be stopped worldwide, we have to reach all children with vaccine," she says.

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While more children today are reached by workers, parents sometimes refuse to have their children vaccinated due to suspicions about the vaccine. When possible, the eradication campaigns enlist trusted elders and village leaders to endorse vaccine delivery. Some Taliban groups are now supporting polio eradication and vaccination, Bari says.

"We are hopeful that the common human motivation to protect children will enable dialogue, as it has in many parts of the world, including Afghanistan and Pakistan," she says. "We need to keep our eye always on the ultimate goal—vaccinating the child—and do whatever it takes to get to that goal. "

Should health groups continue to send vaccine workers into dangerous areas? Tell us what you think in the comments.

Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.

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