Carrying a cold box full of vials of the oral polio vaccine over one arm, Farah Deba works her way down a street, knocking on every door she passes. Accompanied by a police officer charged with her protection, she vaccinates every child under the age of five living in her district in Peshawar, Khyber Pakhtunkhwa province in the north-west of Pakistan. This is a job she has done diligently for 16 years. “Polio cripples children. I am proud to say that because of my continuous hard work, there have been no polio cases in my area for a number of years now.” Farah says.
This is not an easy job. Farah and her family have received threats because of her role in polio vaccination campaigns on numerous occasions. Her family has asked her to stop to keep her safe; but she refuses to let anything stand in her way. “Someone needs to get the job done. I feel that my role is very important because if field workers do not go door-to-door to vaccinate children, the disease won’t be eradicated from Pakistan.”

While polio eradication is a global effort featuring many international partners, governments and donors, without health workers such as Farah none of it would not be possible. Local staff provide the crucial connection with the people who need the vaccines. Often working as volunteers or in conditions that can be challenging, these men and women are motivated by one thing: making sure that the children in their districts are not left vulnerable to the disease.

Giving the children for whom he is responsible the highest level of service is the greatest priority for health worker Mohammad Arshad, who is in charge of teams who vaccinate children at Cantonment Railway Station in Karachi. “I take it upon myself to ensure vaccinators’ performance is always up to a high standard and not a single child should be missed.” Says Mohammad proudly. Like Farah, he has also received threats, but nothing can dampen his commitment to polio eradication, which he sees as his moral responsibility.

While nationally fewer than 1% of parents refuse to vaccinate their children, some communities are hesitant and a few outright resistant. The reasons for the hesitation can often be traced to lack of information, or suspicion of government, particularly among communities which are under-served by government services. Nearly all can be addressed with sensitivity and engagement. Sajid Ali, a student in his early twenties, is one of thousands of volunteers who have committed to fight polio after attending the Jirga – a Pashtun tribal assembly of elders – in Lahore this year. At the same time as pursuing his religious studies in Lahore, Ali spends his time going door-to-door to reduce family and community resistance to vaccination. Nearly 80 % of the polio-affected children in Pakistan come from Pashtu speaking communities who are likely to receive fewer doses of polio vaccine.

The Jirga has been important in motivating volunteers such as Ali and changing hostile attitudes to health workers. By drawing on influential members of Pashtun communities, this initiative has demonstrated the essential impact that health workers can have when enabled to do their jobs. “Jirga has given us immense penetration in the high risk community. Now we have all Pashtun elders and young men at our back. Pashtun boys go with health workers in all neighbourhoods wherever a family refusing vaccination based on religious misunderstanding or lack of communication has been identified,” District Health Communication Support Officer Naeema Khan explained.

Farah, Mohammad and Ali are the heroes of polio eradication. Driven by their conviction that no child should go unprotected, they work tirelessly to raise awareness, to reach every traveller and to visit every home with the vaccine. And it is their local knowledge and pride that drives that work. As Ali proudly says, “I could count several issues listed by the Pashtun community to refuse polio vaccination: but all of them can be solved ‘over a cup of tea’.”