Struggles of polio vaccination teams captured in Image Nation’s ‘Every Last Child’

Image Nation's Every Last Child records the resistance that awaits Pakistan's polio-vaccination teams, who carry on their work despite attacks by Islamists, and the real danger that every unvaccinated child represents.

“Human life is a gust of air that passes. I may be a cripple in this life, but I’ll be fit in the afterlife.”

These are the words of Habib Rehman, 31, a Pakistani beggar who lost the use of his legs to polio and now spends his days on the dirty streets of Karachi.

His desperate story will be told at a film festival in New York this month, with the premiere of the Image Nation documentary Every Last Child.

Mr Rehman’s story is one of five in the film, highlighting the efforts of vaccination teams and the daily battles and dangers they face.

In the past two years in Pakistan more than 60 people have been killed in attacks by the Taliban on vaccinators and their security teams.

The country is one of three where polio remains endemic. The infection mainly affects children younger than 5, and one in 200 cases causes permanent paralysis.

Cases have decreased by more than 99 per cent in the past 25 years. There were 416 cases of polio reported around the world last year.

But the World Health Organisation maintains that even if one child carries the virus, the whole world remains at risk. And the last strongholds – Pakistan, Afghanistan and Nigeria – could result in “as many as 200,000 new cases every year, within 10 years, all over the world”.

“Firstly I thought, ‘Polio? What’s the big deal? It has almost gone’,” says director and filmmaker Tom Roberts. “But when I got into it and studied it, it became utterly fascinating.”

Roberts, originally from the US but a British resident for more than 40 years, spent five months living in Pakistan, following those trying to eradicate the virus.

“Polio has been forgotten by the western public because it has been successful at getting rid of it. In a sense, it is a good thing it has been forgotten,” he says.

“Some people say, ‘Why bother? What is the big deal when you have people dying of measles or malaria?’.

“At the end of the day, when we kick this disease we can then say measles is our next target.”

The five central characters in the film are Mr Rehman, an expert who has successfully eradicated the virus elsewhere, a vaccinator, a cynic and a sick child.

Gulnaz Shesazi, the team leader of a vaccination programme, was one of Roberts’s heroes.

Ms Shesazi works with a team that earns US$1 (Dh3.67) or $2 a day vaccinating the children. It can be deadly work, even for those associated with the vaccinators.

“The Taliban came up and shot her niece and sister-in-law,” Roberts says. “She has suffered hugely from that.

“Her response was not to say, ‘I’m going to walk away from this’. It was to recruit other members of her family and recommit herself to the polio campaign.

“She spoke out publicly and her family were threatened. But she was determined to do this right.”

The film shows bloodied streets where attacks were carried out. In one scene Ms Shesazi points out bullet holes around the front door at the spot where her niece was shot dead.

In March, a Taliban bomb killed at least 12 in a targeted attack against a vaccination team in north-west Pakistan.

The Islamist group claims that the attacks were spurred by its suspicions that the vaccination programmes are part of a western plan to sterilise Muslims.

Others accuse the teams of spying for western governments.

Dr Elias Durry, another of the film’s characters, says it is hard to counter the Taliban’s claims in the community.

“The Taliban or anybody else propagating these wrong perceptions, they have a better narrative than us,” Dr Durry says. “They say we are spies, they say the vaccine is non-Islamic.

“We don’t have a counter-narrative that is being used as strongly as theirs. We stick with facts – the vaccine is safe.

“In Peshawar we took away some of the misconceptions. When they say vaccinators are spies we say no, these vaccinators are your vaccinators, they are coming from your community.”

Resistance remains strong in some areas and parents still refuse to have their children vaccinated.

Men from the tribal regions, who have travelled to Karachi for work, bring with them tribal roots and beliefs, and the misconceptions they have been fed by the Taliban.

But resistance to vaccination programmes is not a new thing, Roberts says.

“Every single vaccination programme in the world has found a level of resistance. It is not a Jewish thing, it is not a Christian thing, it is not a Muslim thing.

“There is a cultural resistance to federal agents and interference.”

Dr Durry agrees, saying the polio crisis has more to do with the misconceptions and mistrust than it does with the efficacy of the vaccine or sanitation levels.

“If you look at all the countries that have struggled to finish the job, whether it is Pakistan or India or Egypt, they have one common denominator – the fact that we have to go back and immunise children multiple times, and most of this activity is done by governments,” he says.

“Countries with a population that has some kind of suspicion or mistrust of the central government is where we are struggling. What it always lacks is the willingness of the population to accept that the programme is run by the government.”

Dr Durry has fought successfully for police escorts, who are also being killed, and for whole communities to be cordoned off during mass vaccinations.

He has also studied the amount of time needed between the initial vaccine and boosters to minimise the exposure risk to his teams and security.

“A year and a half ago everyone was laughing at me when I said we needed to reduce the campaign from three days to one day to reduce the threat to the vaccinators out in the field,” Dr Durry says.

The frustrating fact in Pakistan is that the vaccination programme is so close and yet so far from eradicating the virus.

While a great many of the country’s children have been successfully immunised there are still a large number unvaccinated, allowing the virus to survive.

“Wherever you have large numbers of densely populated areas and that population has some mistrust in the government, they will start to not accept this immunity drive willingly and then you will keep missing a large number of children,” Dr Durry says.

“By nature these are places where sanitation is bad. It all comes together and makes the job of reaching every child, every time, very difficult. And of course sanitation and lack of other health services play with it too.”

In the film Roberts meets men from tribes who do not believe in the vaccine. One told the crew it “makes girls prematurely adult and boys impotent”.

Roberts says it was important for him to not mock the men but simply record their views.

“These are Muslims and this is Pakistan,” he says. “That is one of the reasons why in the film some of the guys had really radical theories.

“I left out the mentions of the Bermuda triangle, aliens and the CIA mixed together. They were treated with respect. I didn’t laugh at them.

“They think there was something wrong with the vaccination campaign. One man said, ‘I love my children. I would never do anything to harm them, and the polio vaccine will harm them’. He will never let them have it. Hopefully his children will never have to pay for that mistake.”

But unfortunately, children do.

The final character in the documentary is Zabih Ullah, the father of an 18-month-old baby boy who is taken to a clinic where Roberts is filming.

“He is told that his son has polio,” the filmmaker says. “We were filming when that happened, the shock and pain on his face ... he has tears running down his face and asks, ‘what can I do? I would give my arm, my leg, my life for him’.”

The crew follows the story of the father and his toddler as the clinic tries to teach him to walk.

For Dr Durry, this year and next are critical if polio is to be eradicated from Pakistan and the world.

“The international community may not have a lot of problems and in Pakistan the narrative might change a bit as time goes by, especially next year, because it looks like because of all of these problems the country will stand very, very obviously as the only country in the world that is harbouring the virus,” he says.

“We are seeking from the society and from the government and from the country itself to do whatever it needs to change that direction – engineering the fact that some of the problems are very complex and difficult.

“Despite that, we are pushing and we want to see things happening in a way that the situation is changed.”

Every Last Child will premiere at the DOC NYC film festival on November 14.

munderwood@thenational.ae