Still a little shaken by the cold-blooded murder last month of the two lady health workers who also worked as polio workers, Faheem Bibi remains determined saying she will continue to administer polio drops in her village in Khyber Pakhtunkhwa's Swabi district.
The 45-year old unlettered mother of four does not have the luxury to be scared. She has little choice but to continue going door to door cajoling parents to get their children protected from the crippling virus.
With a husband who's unwell, Bibi is the sole bread winner of the family and desperately needs the extra Rs 4,050 she earns for the four days that she works as a vaccinator.
The incident comes as a five-day nationwide polio vaccination campaign is set to begin on Feb 17.
Aiming to inoculate approximately 40 million children, the campaign will involve approximately 265,000 polio workers going door-to-door to inoculate children under the age of five.
This will be the first of two nationwide polio campaigns aimed at plugging the immunity gap that emerged in Pakistan during 2019.
Bibi says the LHWs in Swabi were killed because extremist elements in her area "staunchly believe that polio drops are being given to Muslim children to make them sterile and to slash their population".
"They disapprove anyone carrying out this work, but they particularly target women because when women are killed the fear factor increases and acts as a deterrent for recruiting women," says Dr Yasmeen Jaseem, a gynecologist hailing from Swabi who has also been an MPA.
According to Dr Rana Muhammad Safdar, National Coordinator for Polio Eradication, the vaccine is administered in as many as 120 countries around the world, irrespective of religion. He adds that the idea that the vaccine was only being given to Muslim children was utterly preposterous and untrue.
Also read | Polio: What's behind the refusals?
The same mistrust travels all the way to Tarnol, some 20 kilometres from Islamabad.
Zonal supervisor Nasik Abbas has been involved in the anti-polio campaign for over 13 years. "There is a lot of mistrust and certain elements take advantage of this and stoke it further," he says.
We are often asked why "instead of providing their children food, shelter and education, does the government insist on administering the anti-polio vaccine".
Abbas adds that because foreign agencies support the cause of polio eradication, some parents and guardians get suspicious.
"They believe that some nefarious designs are underway against Pakistani children and that the aim of foreign assistance in this regard is to sterilise Muslim children."
While the number of people holding this view has decreased compared to a decade ago, the campaigners, Abbas says, have failed to address or quell this misconception completely.
In order to help parents and guardians understand that the vaccine is only for the children's and the community's benefit, "at times we have to take some notables or the area police chief along" on vaccination visits.
Abbas says lack of education is the biggest culprit behind prevalence of this mindset, which he says is the reason why polio still haunts Pakistani children.
To this, Dr Safdar adds that the vaccine is procured using "taxpayers' money, as well as with loans from the Islamic Development Bank".
"Meanwhile, international assistance is limited to the communications part of the programme."
More on this: Time to declare a polio emergency
"Then some parents say they have heard the vaccine is made of haram ingredients," says Abbas, adding that this misconception is also one reason why parents express reluctance to administering the drops.
When approached to respond to the above, Dr Safdar emphatically says that "that is out of question".
He explains that there are only three ingredients in the vaccine — a weakened virus, a mixture of water and salts that ensures that the virus does not change its characteristics, and a very small quantity of antibiotic to ensure that no bacteria grows in the vaccine.
Another view, though not so widely held but which does come up every now and then is that children get the disease when they have been given these drops.
"One in six million children may get parlaysed if the child is malnourished and with a compromised immunity," says Dr Safdar. He, however, points out that "the benefits of immunising the generation of Pakistani children are huge and far outweigh this rarity".
The power of digital media
Another bigger challenge is that social mobilisers have been unable to put an end to the propaganda on digital media.
"When anything comes on social media, it spreads faster than the outbreak of a disease. Our social mobilisers are few and unable to do damage control through conventional means," he says, giving the example of how a video shared on Twitter claiming polio drops were toxic led to a rise in refusals in Tarnol.
"These elements are very organised and the timing of their dissemination against the polio campaign or against the vaccine itself is usually just before we are about to begin our door-to-door drives, thereby jeopardising them," laments Dr Safdar.
To counter the digital propaganda against the vaccine, Dr Safdar says the polio programme has since last year "activated" a social media cell to monitor various platforms.
In addition, he says, "two months back we went into a partnership with Facebook after showing them evidence that certain elements were using social media to harm the global campaign".
Read further | Polio: no quick-fix solutions
In fact, a Facebook delegation had also visited Pakistan and committed to helping the campaign to combat the virus.
According to the Pakistan Polio Eradication Programme website, 144 cases of wild polio virus (WPV) were reported in Pakistan in 2019. In comparison, only 12 and eight cases had emerged in 2018 and 2017, respectively. Meanwhile, 12 cases of WPV have been reported across the country so far in 2020.
Communities growing weary of repeated visits
Polio worker Hifza Tahir, who works in Islamabad's Bahria Town, recalls that last December she ended up going to each home three times and that led to people becoming really irritable.
"They ask me why I visit again and again. They even say that they will take their children to the hospital to administer the drops," she says.
Tahir goes on to explain the reason for frequent visits. She says: "Because of so many new cases erupting, as well as refusals, we are sometimes required to carry out two to three drives in a month — one week campaigns after every 15 days. This is unusual but so is the situation with the rise in cases."
She says the campaign faced a large number of refusals even eight months after the bogus video episode and hopes that when the campaign begins this month, that problem will have mitigated to some extent by social mobilisers.
"Repeated knocks at times are annoying for communities," agrees Dr Safdar. "We are trying to minimise them without compromising on the quality of our campaigns."
Under a polio-linked travel restriction imposed by the WHO, Pakistan is one of the two countries in the world that have been unable to eradicate polio.
The restriction imposed since 2014 requires every person travelling abroad to carry a certificate to prove that they have been vaccinated against polio.