Every Last Child is the dramatic story of five people impacted by the current polio crisis in Pakistan. Taking place on the front line of the fight against the disease, it is a story of sacrifice, fearless determination, and sorrow in the face of mistrust, cynicism, and violence. Just a few years ago, polio persisted in only three countries and the number of victims was steadily decreasing. Pakistan was the key battleground with over 80% of all endemic cases. However, when the Pakistan Taliban issued a ban against the polio vaccination program, and incited fatal attacks against vaccinators, Pakistan’s campaign was thrown into disarray. Today families and healthcare workers find themselves in the cross hairs of politics and bloodshed as they attempt to protect their children from polio. At this critical time, when we are closer than ever before to global eradication, increased international support and commitment can see the end of polio, once and for all. Through the vivid stories of its five subjects — a medical specialist, a vaccinator who lost a member of her own family to Taliban anti-vaccination violence, a vaccination skeptic, an adult polio victim, and a parent with an afflicted child — we are drawn in to the desperate search for a solution to this devastating disease. Will these everyday heroes succeed and end polio in our lifetime, or will another young generation be at risk? I spoke to award-winning filmmaker Tom Roberts about this important documentary.
Danny Miller: I’m a little ashamed to admit that before I saw this film, I wasn’t even aware that polio was still an issue anywhere in the world.
Tom Roberts: Oh, don’t be ashamed about that. When I got the first phone call from the people who wanted me to get involved with this story, my first thought was, “Why would I want to make a film about polio when that crisis is all over?” I think that’s the natural reaction many people have because we all know the history of polio and the polio vaccine. Of course in the 20th century it swept through North America and terrified the entire population. At one time it was all over the world and now it’s down to three countries.
My wife’s uncle got it when he was 10 years old in the 1940s and was in a wheelchair the rest of this life.
Yes, and for the most part the eradication of the disease was a success thanks to the polio vaccine that was developed in the 1950s. But what you discover when you look at this crisis is how polio is so much more infectious than other diseases including ebola. While many people who get polio don’t come down with the worse symptoms, the problem is that they then excrete the virus for months, passing it on to others. And when you have poor sanitary conditions, polio becomes endemic and lives in the streams and rivers and ponds of that country, ready to strike another child. You could contract polio in Peshawar by drinking some water this morning and you could travel to Islamabad and take a flight to New York a couple of hours later and there would be polio in the water system in New York that evening.
Wow. It’s a miracle it hasn’t spread more than it has.
That’s because many countries’ sanitation systems are now quite robust. It’s been off and on in Egypt’s sanitation system for the better part of a decade, for example, but thankfully nobody’s caught it because they’ve been able to trace it to specific areas and treat the water properly. But the danger is always there.
It’s crazy that the vaccine is available but that children are still getting the disease in this part of the world.
We have the ability to eradicate it once and for all. We took on polio — it was supposed to be finished in 2002, then 2008, then 2012, now they’re thinking 2018, but when that finally happens we can say, “We did it!” Not the West, not the East, but the world did it. It was worldwide cooperation that made the children of the world safe from that horrible disease. That’s a very important thing to be able to say.
I understand why the focus in Pakistan has been on vaccinating children, but can unvaccinated adults get it just as easily?
Well, not just as easily, but yes, anyone can contract polio — Roosevelt got it when he was in his 30s. But what happens in countries where there is endemic polio is that not many adults get it because they had it when they were younger and therefore have the immunities. The irony of the terrible epidemic of polio that swept through America in the 2oth century was that the numbers were so bad because the sanitation systems in the U.S. were so effective. No one had been exposed to it and there were no immunities in the population so no one was protected, whereas in Pakistan people are exposed to it every day of their lives so it’s the young and most vulnerable people who get it.
As if we needed one more reason to be horrified by the Taliban, their violent campaign against the people who are trying to administer the polio vaccine is beyond chilling.
You can see in the film how the people in these countries have tried to take the focus off polio without dropping the ball. It’s really important that the mainstream Islamic population and the Islamic leadership in those countries support this work. The truth is that every vaccination campaign organized anywhere in the world has had pockets of resistance, people who distrust the motives or feel alienated from the central government. I understand that in the hills of Kentucky there was resistance to polio vaccinations in the 1950s because of the attempts years earlier by federal agents to stop the local production of hooch, which was the primary source of alcohol during the Prohibition. So when these same Feds, at least in the eyes of the local population, who had been harassing the people there, came back to the community and said they now wanted to protect their children, there wasn’t a lot of trust. Look at the people in California who are against the measles vaccination despite the recent outbreak. In London, too, we have this large group of highly educated suburbanites who are refusing to give their children the MMR vaccine (measles, mumps, rubella). Why? Because years ago one doctor published a study that he had done that made links between vaccinations and autism.
Yes, that’s the study that’s often cited by the anti-vaccination people here, too, even though it has been thoroughly discredited.
It has been completely discredited and no other scientist on the planet has found the connection, it doesn’t exist. So why is this happening? Because certain people tend to be distrustful of Big Government.
Far be it from me to EVER agree with anything said by a pro-Taliban person, but when that guy in the film says, “If they really cared about our children, why are they killing them with drone strikes?” you can empathize with his line of thinking. The situation is so complicated. Why should they trust the people responsible for that?
Of course. And that’s why it’s so important to get buy-in from the local community. But I’ve been told two very interesting things by reliable sources. One was that in Peshawar, a number of senior Taliban officials have appeared in hospitals late at night with armed men to force the hospital staff to give them all of their polio vaccine — not to destroy it, but to give it to their own children. And at the other extreme, there was a senior leader at a rally who held up his three-year-old daughter who was crippled by polio and called her a martyr and went on to say that they have to keep polio alive, even with their own children, so that one day they can re-infect the rest of the world.
Oh, God, that is horrifying.
What you have to remember is that the Taliban is made up of roughly 80 different groups. Some of them are moderate and some are very extreme. Any serious political intervention with these people needs to make some accommodations with the moderates to help push the crazies out since there’s absolutely no dealing with them. That’s the long-term solution — we can’t just look at them as one group. And we have to deal with the leaders. The majority of the people who believe that vaccines are bad think that only because that’s what their leaders tell them.
The individuals you profile in the film are so compelling. I was especially moved by the father who was having his little boy fitted for braces. Do you know how that boy is doing?
We get reports back. He’s getting a considerable amount of attention, partly because of the film, and they’re getting him to therapy. But we’ll have to wait until he’s much older to see if his muscles have atrophied and if they’ve been consistent. There are so many children like this in Pakistan.
The access you seemed to have for this film was amazing. Were there ever moments when you felt you were in serious danger?
I’ve been doing this for a very long time so I know how to build access. One of the key ways we did it was that I was the only member of the production team in the field who was not from Pakistan. You have to find the local talent —they speak the language, they know the culture. They can say, “Here’s the reason she’s refusing to talk right now,” they have insights that you can’t get any other way. As far as the risks involved, there were certain moments you see in the film that I wasn’t present for, I was a short distance away on the telephone. Occasionally we made an assessment that the area was too hot. If I walked into certain environments, the people there would definitely think I was CIA, why else would a white man be there? And when a situation is that volatile, even if I or my crew were not attacked, the family we were visiting could be shot dead a few days later. You can’t put people in that kind of risk so we were constantly assessing the situation in each location.
Despite all of the problems with the vaccination program, the film seems to end on an optimistic note. Do you think the situation in Pakistan has improved?
Dramatically so. They have less than a third of cases this year than they did last year and they are now seriously talking about total eradication by 2018. It doesn’t mean they’re going to make it but at least the level of infection is down and optimism has finally returned.