‘Then’ is 2014, the year of my first visit to Pakistan. Following a presentation to the New Zealand National Immunisation Conference and a subsequent article in the nursing press on Rotary’s role in polio eradication, I was invited to present at a Rotary polio conference in Lahore for World Polio Day (October 24th).
 
It was in Lahore that I experienced my ‘Rotary moment’. I am of the first generation who grew up without the fear of polio, the vaccine having been discovered a few years before my birth. Meeting polio victims in their teens and 20’s affected me profoundly and angered me. This should not be happening in the 21st century!
Pakistan is one of only three countries that has never ended the spread of polio. It faces the usual challenges of reaching every child in a large, developing nation and until 2012 polio case numbers had been falling steadily, driven by a huge army of polio ‘warriors’ otherwise known as Rotarians!
 
But, by early 2014 the polio eradication programme was going backward. The Taliban had control of areas in the northern part of Pakistan known as the Federally Administered Tribal Areas (FATA). In 2011, the CIA used a fake hepatitis vaccine campaign to locate the whereabouts of Osama bin Laden. This caused the Taliban to believe that the vaccine programmes were a conspiracy against Pakistan and, in 2012, they issued a fatwa (decree), demanding an end to polio vaccinations in FATA. 
 
They incited fear, and disseminated lies about the polio vaccine programme; e.g. the vaccine causes sterility in the children, it is ‘haram’ or not kosher and the vaccinators were spies for the West.
 
This caused anger in, and problems for, the polio advocates I met. How could they promote the polio vaccine in such an environment? Other factors were not helping; mismanagement and lack of commitment from the government, polio workers waiting months to be paid and the abhorrent killing of local vaccinators.
 
‘Now’ was October 2017 when I revisited Pakistan, and the progress was stunning. The government prioritised the Polio Eradication Initiative in 2014 after Pakistan’s polio cases spiraled to 306 the previous year. A military operation to clean up security-compromised regions enabled vaccine delivery to resume, and the programme was better managed. Local Rotarians like Aziz Memon (National Polio Chair, Pakistan) engaged with religious scholars and community leaders through workshops, meetings, and seminars, to reduce vaccine myths and refusals. All this is reflected in the number of polio cases which has fallen from 306 in 2013 to three in February 2018.
 
To memorialise the lives lost by local vaccinators, Rotary has launched a series of PolioPlus Memorial Scholarships. (For an example of how this has enabled one young medical student see Rotary Voices )
 
There is no doubt that polio will be eradicated, however, this progress should not deflect Rotarians from the challenge we still face. Getting from 99.8% to 100% eradication is the most expensive part of the campaign. The costs are high, but the cost of failure is even higher.
 
Rotary made a promise to the children of the world that we would ensure they live their lives free from the fear of polio. We must give PolioPlus a final push to keep that promise.
 
In eradicating polio, Rotary will leave two legacies; a polio-free world and, an amazing health infrastructure through which future programmes can be delivered to every child on the planet.
 
I would like to acknowledge Alina A. Visram Manager, Pakistan National PolioPlus Committee, for her assistance in writing this article.