In a worrying development, anti-polio vaccine refusals in Khyber Pakhtunkhwa (KP) rose by 6,527 in May 2018 compared to refusals in April 2018.

Health Department data acquired by DawnNewsTV shows that the number of refusals during an immunisation drive from May 1-3 were 26,610 compared to 20,083 in April.

Peshawar had the highest number of polio refusals in both April and May, but the refusals in May were nearly double ─ jumping from 7,492 to 13,489. The provincial capital was followed by Charsadda, which had 2,756 refusals in May, and Lakki Marwat, which had 2,684.

An official at the Health Department told DawnNewsTV that a number of government employees in KP, doctors included, are among those who refuse to allow administration of the anti-polio vaccine to their children.

Pakistan is the closest it has ever been to interrupting transmission of the polio virus. Cases have declined from 306 in 2014, to 54 in 2015, 20 in 2016, and eight in 2017. In 2018, only one polio case was reported in Balochistan's Dukki district.

Emergency Polio Centre Coordinator Atif Rahman earlier told Dawn that KP, which saw only one polio case last year, had not recorded any cases in 2018 but still risked the vaccine-preventable childhood ailment because of recent testing of positive samples from the Kohat and Bannu districts recently, apart from Shaheen Muslim Town, Peshawar where environmental water samples had consistently been positive.

Read more: Deaths of children after getting polio vaccine panic people

"Even if we don’t have cases, the virus is looming and vaccination is the only way to protect our children against disabilities... It is a proven fact that either of the polio vaccinations, oral or injectable, does not cause death," Rahman had said.

National Coordinator Pakistan Polio Eradication Programme Rana Muhammad Safdar believes that refusal cases are the main hurdle towards complete eradication of the virus from the country. He said the government had started employing various methods to address the issue.

"Yes, we are facing refusal cases," he confirmed, "And in our last campaign the number increased almost twice as much as compared to previous campaigns," Dr Safdar told DawnNewsTV.

Dr Safdar was of the opinion that a social media campaign against polio vaccinations had played a big role in the increasing number of refusals.

Dr Safdar also cited an incident regarding the deaths of three children in Peshawar's Shaheen Muslim Town after administration of the inactivated polio vaccine (IPV) during an anti-polio drive last month sowed fear and panic among locals, who alleged that the vaccine was responsible for the deaths and called for accountability for those responsible.

He said the deaths of the children were wrongly linked to the anti-polio vaccine, and had sparked an anti-immunisation campaign on social media which influenced a large number of parents to refuse the administration of the vaccine to their children.

After the social media campaign, 80,000 refusal cases were reported across the country, Dr Safdar said, adding that this was the highest refusal figure since 2014.

In 2014, refusals comprised 5 per cent of the total number targeted by the campaign. This proportion had been brought down to 1pc in 2018, but had now begun to increase again.

"In the last polio drive our target was to reach 38.7 million children below five years," he said.

Parents' refusal to allow administration of the anti-polio vaccine to their children is prevalent not just in small villages but also in large cities, Dr Safdar said, observing that of the total number of refusals, a large number had been reported from Karachi and Peshawar.

He said the government had stopped forcing parents to allow immunisation by threatening them with arrests if they refused. He argued that the use of force was not a permanent solution to the issue.

"We have different teams consisting of religious and medical notables to address the issue of refusals. We are trying to address the concerns and objections of parents instead of using force," he said.

He added that if refusing parents have medical concerns about the drops, the medical team attempts to motivate them by addressing their concerns, whereas if there are religious concerns, the religious leaders address these issues in order to affect permanent behavioural change.