Public Support – The Diplomat

This week has seen Pakistan report its highest number of COVID-19 deaths since the start of the pandemic. This week’s average daily infections of 5,397 this week are already 92 percent of the peak number of 5,839 reported on June 17 of last year. Given a positivity rate hovering around a daunting 25-30 percent in many urban centers, coupled with the widespread underreporting since the start of the pandemic, Pakistan’s actual COVID-19 numbers are likely to be even higher than the menacing stats officially acknowledged by the government.

While COVID-19 variants are wreak inghavoc globally, the vaccination drives in various countries have set up a line of defense to curb the impact of a worldwide third wave of coronavirus. However, at the time of writing, Pakistan’s tally of administered vaccines was around 800,000, enough to vaccinate just 0.2 percent of the population. At this rate Pakistan would need another four-and-a-half years to vaccinate just 10 percent of its 220 million people.

For reference, Israel already has 60 percent of its population vaccinated, the U.K. 50 percent, Chile 42 percent, and Bahrain 40 percent. In South Asia, Bhutan has vaccinated 63 percent, the Maldives 55 percent, and even India – with a population six times larger than Pakistan, which is currently being pulverized by the third wave – has provided vaccines to 8.1 percent of its populace.

Despite Pakistan becoming one of the first countries to allow the private sector to import vaccines, the country’s anti-COVID-19 drive was hit by delays and lack of availability before finally being initiated last month. After initially opening the vaccinations to citizens over the age of 60, the National Command and Operation Center (NCOC) has already begun vaccinating the 50-59 age group, with plans already announced to make all citizens eligible next month.

Even though the vaccination rate remains strikingly slow, the NCOC’s fast-tracking of age groups signifies the reality feared by health officials since the start of the pandemic: that only a minuscule percentage of the Pakistani population actually wants to get vaccinated.

“The government is providing vaccinations and spreading awareness, but people aren’t coming to get vaccinated. We have even started a door-to-door service, but people have their own reservations and are reluctant. Only the educated ones are getting vaccinated,” Dr. Waseem Baig, the coordinator of Balochistan’s COVID-19 vaccination cell, told The Diplomat.

“They are scared of the vaccines. They fear something might happen to them because of it. We’ve spread awareness through newspapers, ulema [clerics], interviews of senior doctors, showing public office holders getting vaccinated on media and social media. But still very few people are coming to get the vaccines,” Baig added.

Health experts and local doctors cite a gamut of reasons behind the vast majority’s reluctance to get themselves vaccinated. Much of it is rooted in conspiracy theories that range from the infamous “microchip implantation” notion to the more localized dubbing of the vaccinations being a part of a Western “anti-Islam” agenda to weaken Pakistanis and Muslims.

The Diplomat’s visits to urban centers like Karachi, Islamabad, Multan, and Peshawar along with rural areas along the Punjab and Khyber Pakhtunkhwa (KP) underlined varying degrees of negligence and downright denial about the threat posed by COVID-19.

Since Pakistan’s relative success near the end of the first COVID-19 wave, it has been common to see a lack of adherence to health guidelines even in urban hospitals. In rural areas, COVID-19 guidelines have been limited to banners in front of hospitals, or government sponsored advertisements on TV and radio and in newspapers. Face masks have been nonexistent in rural areas throughout the pandemic, while urban centers have seen the number of residents adhering to the government’s standard operating procedures (SOPs) – already a minority last year – shrink to a minuscule number since the start of 2021.

Locals across the country have been circumventing bans on indoor gatherings such as weddings by setting up the events under tents. Even in areas in urban cities where smart lockdowns have been imposed by the government, it has been common to see masses come out in numbers in blatant breaches of the apparent policies. The economic elite have been defying the government bans with impunity.

Similarly, none of the mosques visited by The Diplomat across the nation over the past nine months maintained social distancing during congregational prayers, with face masks a rarity. Where hundreds of devotees thronged various shrines across the country, some of the few that were wearing a mask while paying respect at the tombs were even being asked to remove the face masks to ensure “respect” for the saint.

“It is sinful to cover your face like this. Take off the face mask and let the holy smell of the itr [perfume] in,” an organizer of the weekly rituals at Lahore’s Data Darbar – South Asia’s largest Sufi shrine, where thousands have continued to throng on Thursday evenings throughout the pandemic – told this correspondent.

Last month the Council of Islamic Ideology (CII), the government’s legislative advisory body on the compliance of laws and policies with Islam, pushed a change in the original anti-COVID-19 slogan of Pakistan, “Corona se darna nahi larna hai” [“Let’s not be scared of corona, let’s fight it”] dubbing it “un-Islamic”. The slogan has now been changed to “Corona waba hai, ehtiyat jiski shafa hai” [“Corona is an infectious disease, the cure for which lies in precaution”]. The government’s acceptance that fighting COVID-19 equals challenging Allah’s will is echoed across the country, with many saying that they are “only scared of Allah, and not any virus.”

Locals nationwide have similarly been skeptical of the government’s own sincerity when it comes to fighting the pandemic. Many believe that the government’s COVID-19 rhetoric is designed for the consumption of global health organizers and funders, resulting in a stark contrast between official messages and the realities on the ground, even in government healthcare centers. Many government officials are similarly seen flouting their own guidelines, as witnessed during last month’s Senate elections and by ministers of the ruling party who have openly shared images of private gatherings.

“Have you ever seen Imran Khan wearing a mask? In press conferences, [the political leaders] are sitting next to each other rarely following any SOPs. They are still holding massive rallies where no one follows any health guidelines,” remarked a Hyderabad-born cab driver, Mohammed Shakil, during The Diplomat’s visit to Karachi earlier this year.

Prime Minister Imran Khan was often seen without a face mask during the first 12 months of the pandemic, before being infected himself last month. Days after being infected, Khan chaired a meeting with his media team at his residence, in complete defiance of his own issued health guidelines for the pandemic.

Khan’s infection was reported days after he received the first vaccination for COVID-19, which was broadcast nationwide. Health experts underline that in a country where many still doubt the danger, if not the very existence, of coronavirus, and are apprehensive about the vaccination, it has been hard to convince the masses that vaccines actually do work.

Pakistan has struggled with vaccine hesitancy for years in regard to another epidemic: polio.

“Addressing the resistance to vaccinations and convincing the people that they are a health imperative remains the most complicated question. If we had a 100 percent resolution for this, we can end polio in Pakistan this year,” said Dr. Shahzad Baig, coordinator of the National Emergency Operations Center Polio Eradication Initiative (PEI), in an interview with The Diplomat.

As 40 million children received anti-polio vaccinations this month, Pakistan took steps closer to reaching its decades-old goal of eliminating the virus, as one of the two countries worldwide where polio still exists. Pakistan’s protracted fight against polio is rooted in many of the challenges that await the country in fighting COVID-19, with the coronavirus pandemic itself halting the fight against poliovirus last year.

The multipronged conspiracy seeking to halt Pakistan’s anti-polio drive was epitomized in 2019 by an organized effort to fabricate a series of videos alleging that hundreds of children had fallen ill after receiving vaccinations in Peshawar – dubbed by the World Health Organization the “most stubborn hotbed of poliovirus” – sparking panic across Khyber Pakhtunkhwa (KP) province. A Peshawar hospital was set on fire as a result of the fabricated videos.

“We had overcome many of the challenges of recent years, but the Peshawar incident severely dented the anti-polio drive. It proves that where the government has increased its efforts to ensure vaccinations across the country, those against the vaccines have similarly organized themselves to conspire against the campaign,” said Dr. Shahzad Baig.

Much of the anti-vaccination sentiment has come from Islamists and is expanded into gory proportions by jihadist groups, owing to the longstanding beliefs that vaccinations are designed by the “non-Muslim world” to damage the fertility of Muslim men. Among the first messages delivered by the Tehreek-e-Taliban Pakistan (TTP) since resurfacing in KP’s tribal areas in 2019 was to ask the health workers not to administer polio vaccinations.

Health workers, especially women, face a daunting task when it comes to vaccination drives. Many female health workers have been killed nationwide, with a bulk of the attacks coming in KP. A polio vaccination team was targeted in KP’s Karak town in January, with the policeman deployed for their security being killed. Four female social workers were killed in North Waziristan in February. The attacks have increased in synchrony with the recent resurgence of the Taliban and the Islamic State in the region.

“In FATA [the former Federally Administered Tribal Areas] barely any woman is allowed to work, let alone work in a vaccination program. This is why we become easy targets. I have to work because there are so few job opportunities, especially for women, but I’m also fortunate that I live with my mother and don’t have a male guardian to restrict my movement,” a KP-based female health worker told The Diplomat, requesting anonymity.

“I’ve seen discrimination in so many families while administering polio drops. Some get their girl children vaccinated but not the boys. Many believe the vaccine targets male fertility. I’ve heard all kinds of reasons from parents not wanting to get their children vaccinated, from the vaccines being accused of taking eemaan [faith] out of a Muslim to its ingredients carrying George Bush’s urine,” she added.

Gender discrimination is also hampering COVID-19 vaccinations in many rural parts of the country, especially the former FATA, where patriarchal elders prevent women from even getting the national identity cards, which is NCOC’s prerequisite for anyone to get vaccinated.

“I’m among the relatively privileged people from FATA but even my mother still doesn’t have an ID card. This is the story of every other family in FATA,” Saifullah Mehsud, the president and founder of FATA Research Center, told The Diplomat.

Mehsud notes that while the government’s negligence has been witnessed across KP, global powers have played a negative role in aggravating the health crisis in the region as well. He points toward the role of Shakil Afridi, who reportedly helped the United States track down Osama bin Laden in Pakistan by adopting the garb of a hepatitis vaccination campaign.

“How can the locals trust any global vaccine program now? It was criminal on the part of the U.S. to do that. Even war regulations dictate protocols against jeopardizing the health sector,” maintained Mehsud.

The clampdown on Pashtun nationalism in the aftermath of over a decade of military operations in the region has further enhanced the distrust that many feel with regards to the state. The locals, especially in the former FATA, feel that the state has long betrayed them. “In the tribal Pashtunwali code there is no crime greater than betrayal,” said Mehsud.

Despite these multipronged challenges and inertia against vaccination campaigns, health experts still find a few reasons to be optimistic. Some analysts say that while polio’s limitation to Pakistan and Afghanistan made locals more apprehensive about a global agenda, the fact that COVID-19 vaccines are still being administered around the world might allay a few fears. Observers also urge the government to launch community-based programs to ensure the word spreads among the populace.

Even so, experts maintain that that Islamist backlash against vaccination campaigns, especially those upholding conspiracy theories, remains the biggest stumbling block, and countering that remains imperative if the state is to win its vaccination battle. While the government has issued fatwas via clerics in support of vaccinations, the erstwhile resistance of the clergy has meant that the locals view these edicts with skepticism, deeming those changing their tune over vaccines as having been compromised by the state. There similarly remains a lack of local clerics who are willing to echo the fatwas being broadcast on national media.

“The day the local imam says in the mosque sermon that people should get vaccinated, the reluctance of the locals would completely transform. If we have religious figures on board, we can fight the viruses,” said Dr. Shahzad Baig.

“But still we hope to eliminate polio from Pakistan by the end of next year. And hopefully the anti-COVID campaign would pick up pace as well, if we achieve the needed consensus.”