While much of the world has attained polio-free status, and polio-endemic countries like Afghanistan and Nigeria are at least moving in the right direction, Pakistan, the only other polio-endemic country, is on a deadly backward slide.

The tally so far this year, 260 and counting, is the highest number of cases in a year since 2000.

The complex environment that bedevils the polio eradication effort in this country was brought home once again last Thursday when four polio workers, three of them women, were killed and three others injured when gunmen attacked them in Quetta.

Read: Polio workers boycott campaign in Balochistan as 4 workers gunned down

Rumours, which later proved unfounded, that WHO was terminating anti-polio operations in Balochistan following the murders sowed panic among health officials.

However, the issue of security, starkly illustrated by the murder of more than 60 polio workers or members of their security detail in Pakistan since 2012, is only one of several obstacles that hamper polio vaccination campaigns here.

Refusals by parents occur with disturbing frequency throughout the country, even among more educated, urban populations.

The government could take a leaf out of India’s book in this respect: the country achieved polio-free status earlier this year and has earned international accolades for its innovative programme and homegrown strategies. Significantly, refusals there were reportedly found most often among Muslim communities.

As a result, in 2004 for example, 62pc of polio cases in India were among Muslim children — Muslims account for only 13pc of the population.

To address this, ulema committees which included representatives of various Muslim sects as well as a doctor were formed to allay parental reservations regarding polio vaccinations.

This strategy is believed to have tipped the balance in favour of the anti-polio effort in India. In Pakistan, an initiative some years ago involving clerics in a polio communication campaign achieved appreciable results and it should be revitalised with added innovations in light of the Indian experience.

Also read: ‘Refusal major cause of Balochistan polio cases’

The effort must be reinforced by a sustained media campaign, particularly on TV and radio, in order to wrest the narrative from those who peddle misinformation about the ‘danger’ posed by the polio vaccine.

It may also be time to consider linking sanctions with parental refusals, perhaps in the form of making the issuance or renewal of certain documents contingent upon parents allowing their children to be vaccinated.

While such measures may seem drastic, the situation has assumed such critical proportions that it needs to be tackled on a war footing.

Published in Dawn, December 1st, 2014