While Nigeria recently celebrated three years without a single case of polio, Pakistan is facing an alarming surge in new cases. Pakistan has seen over 50 cases of polio this year, kicking off various mass awareness campaigns and a mass immunization program across the country that will give drops to 8.6 million children in 48 districts of Pakistan.

One of the main reasons for the resurgence of new cases of polio, according to government officials and health activists, is an increasing disinformation campaign against vaccination, especially in remote parts of the country’s poor tribal areas.

“The refusal rate [to the vaccination] is increasing and it’s basically [because] the disinformation and propaganda are going against polio vaccine,” Dr Nausheen Hamid, Parliamentary Secretary for National Health Services, told me. There were only 12 cases of polio in the country in 2018 and eight in 2017.

Social media has also unleashed conspiracy theories about vaccination. Earlier this week, on the request of the government’s polio program, Facebook blocked as many as 31 accounts and pages which were involved in spreading propaganda against vaccination in Pakistan.

“Many international organizations are working with Polio Eradication Program,” said Dr Hamid. The awareness campaign includes online, as well as print media and billboards across 48 districts and a number of cities. “People have not seen people with polio, so they don’t understand the gravity of this disease. And now the media are showing them the consequences,” she added.

Just as the anti-vax movement is rising across the globe, it’s also hindering the anti-polio battle in Pakistan. More and more parents are refusing vaccine drops for their children amid baseless theories that the drugs are harmful. In some cases, polio workers have marked children as vaccinated, fearing they will be held accountable for failing to administer vaccinations. “Fake finger marking was a big issue,” said Dr Hamid.

The anti-vax propaganda spiked in April during a nationwide immunization campaign when a private school in Peshawar misreported the pupils had had negative reactions to the vaccine drops, which resulted in parents thousands of parents thronging medical centers and one mob setting fire to a health center. Suspicion of immunization is also fueled by theories that polio drops are part of Western bid to sterilize Pakistanis.

The skepticism over vaccines is common in tribal areas where religious leaders tend to have more influence over local populations. “Parental refusal is mostly in the tribal areas. They are saying these drops will cause infertility, this is a means of reducing your population and this is a foreign agenda,” Dr. Hamid said.

The current global increase in measles cases — widely seen as a result of parental refusal to inoculate children — serves as a cautionary tale. Experts say even decreasing measures to combat the spread of polio can lead to major outbreaks.

Dr Hamid believes public officials need to include community leaders in their awareness campaigns to more effectively tackle mistrust. “They took the drops in front of the media,” she said of provincial ministers in Pakistan who vaccinated themselves and their children in front of an audience. She believes the participation of religious leaders is also crucial. “If one religious leader says these are safe drops and there are no side effects, huge number of people will listen to them and that will be even better than many [online] campaigns.”