AKORA KHATTAK, Pakistan -- In the tribal badlands of Pakistan's northwest, where Pakistani soldiers and American drones target Taliban insurgents, a parallel war is being waged over a crippling virus that endures in only three places in the world.
Last year, 83 new polio cases were reported in Pakistan, more than in either Afghanistan or Nigeria, the other countries where it is endemic.
But aggressive efforts to combat the virus are being hampered by a surge of attacks attributed to Islamist extremists. In the past three months, at least a dozen government vaccinators or their police escorts have been killed or wounded in the northwest region near the Afghan border.
Now officials hope that by enlisting influential Pakistanis, including Muslim scholars, in a high-profile campaign to endorse polio vaccines, they can defeat the shadowy gunmen and the remnants of doubt about the program among devout Muslims.
"This has been a very difficult campaign, but the problems are limited to a very few areas," said Elias Durry, a doctor with the World Health Organization in Islamabad who heads the national polio vaccine campaign. "In places where the vaccinators can go, there is very little resistance. The major problem is that most cases are coming from areas where the vaccinators are not able to go."
Health workers and officials have tried for years to persuade conservative Muslims to accept the vaccines. Violence against polio workers flared after revelations in 2011 that the CIA used a separate immunization campaign as a ruse to gain information about Osama bin Laden before he was killed in Pakistan. The attacks have continued sporadically ever since.
Spokesmen for the Pakistani Taliban deny carrying out the recent attacks, none of which has been solved. But the extremist group opposes the vaccines as a Western conspiracy against Islam. In districts that are too dangerous for health workers to enter, officials said, several hundred thousand children have not been immunized. As a consequence, the number of new cases has risen sharply, from 51 in 2012.
Sami ul-Haq, a conservative Sunni cleric whose seminary, or madrassa, in this northwest town once trained Afghan Taliban fighters, is part of the new effort in support of the anti-polio campaign. He recently issued an Islamic edict declaring that vaccines against polio and other diseases are "useful" for health, that there is "no prohibition in Islam" against them, and that "suspicions being spread about them have no basis in fact."
"I felt it was important for the facts to be clear so people will not be confused," ul-Haq, who was recently named as a government peace emissary to the Pakistani Taliban, said in an interview at his seminary. His vaccinated grandson Mohammed, 2, sat on his lap. "Islam says that treating all diseases is a must."
One reason prominent Pakistanis are speaking up about polio is because of the growing threat of foreign quarantines and travel restrictions, especially for Pakistani workers abroad whose wages help prop up the nation's teetering economy.
On Jan. 3, the government of India issued a mid-February deadline for all Pakistani visitors to obtain proof of polio immunization.
In a one-room vaccine clinic at a hospital near ul-Haq's seminary, several women with covered faces waited on a recent afternoon for their babies to be immunized against polio and other diseases. The women said they did not know what the word "polio" meant, but they used a local term for "cripple" and said they wanted their children to be protected.
"We believe this is something good to serve humanity," said Momin Khan, 53, a turbaned cattle farmer who had brought his wife with their infant grandson to be immunized.
The clinic technician, Jamal Shah, recounted that when the government began immunizing children against polio in the 1980s, many people believed the vaccines were a Western plot to sterilize Muslims. With public education, he said, resistance gradually declined. Today, Shah's clinic inoculates about 5,000 children a month, and 34 million children in Pakistan have been immunized.
But Shah and other local medical officials said their work had been badly set back by the case of Shakil Afridi, a Pakistani surgeon from the tribal area. He was arrested in 2011 after being sent by the CIA to seek information about bin Laden, under the guise of conducting a hepatitis immunization survey in the northwest city where the al-Qaida leader was later killed in a U.S. raid.
Afridi's role was praised by U.S. officials but viewed as traitorous by many Pakistanis, and some Western medical charities said the false immunization scheme undermined their credibility. Afridi was convicted of treason and sentenced to 33 years in prison, though officials later said this was due to his alleged ties with Pakistani militant groups.
"That incident had a great effect on the minds of the people. After that, they started hating the polio teams," Shah said. "Now that we have celebrities coming to support us, people are thinking more positively, and they are coming to us on their own. We only have about 10 families in our area who are still refusing the vaccine."
In addition to ul-Haq's edict, one of Pakistan's most popular politicians, Imran Khan, visited clinics in this area late last month and was shown on television administering polio drops to children. The handsome former cricket star heads the party that holds power in Khyber Pakhtunkhwa province, which surrounds the semiautonomous tribal region.
Yet even though religious and cultural opposition to the vaccines has faded, and the Afridi case is no longer in the news, anti-Americanism still runs extremely high in this conservative region, largely because of the U.S. campaign of unmanned drone attacks against suspected militants.
In an email this month, Taliban spokesman Ehsanullah Ehsan insisted that the polio campaign is "used to spy on our holy fighters, and many have been martyred" as a result. He cited bin Laden's death in 2011 as an example.
Taliban officials have denied shooting the polio vaccinators, but lingering antipathy to a Western-backed medical campaign may well have motivated other militants or individuals to attack them. Even educated professionals in the area, including doctors, speak with deep anger about the Afridi espionage case and American drone attacks.
"I am a doctor, and I ask people to trust me. Afridi has done a very bad thing that also made him an enemy of every child in Pakistan," said Akbar Khaksar, medical director of the hospital that houses Shah's clinic.
He said the attacks against polio immunizers were orchestrated by "foreign terrorists" who want to weaken Pakistan.
The attacks have come despite stricter government oversight of the vaccine campaign, said the WHO's Durry, and despite requirements that every immunization team be escorted by police. In November and December, teams were fatally attacked in Khyber, a busy trading area, and in Swabi, a market region between the tribal belt and the main provincial highway.
An aide to ul-Haq, who researches religious groups and publications, offered a detailed hypothesis about the intellectual source of the attacks. He said he had located anti-polio pamphlets and propaganda from Nigeria, where anti-vaccine sentiment has also damaged immunization efforts. They had been funneled through Islamist extremists in India and spread by anti-Western religious groups in Pakistan, he said.
"This is still a very sensitive issue," said the aide, Izrar Madani. "All the madrassas have this kind of literature about the vaccine campaign being used by Western spies. The Afridi case really gave a boost to their argument." Now that ul-Haq has publicly vouched for the vaccines and shown his family being immunized, Madani said, "we hope that will change."