Attackers in Pakistan Kill Anti-Polio Workers

“It is a blow, no doubt,” said Shahnaz Wazir Ali, an adviser on polio to Prime Minister Raja Pervez Ashraf. “Never before have female health workers been targeted like this in Pakistan. Clearly there will have to be more and better arrangements for security.”

No group claimed responsibility for the attacks, but most suspicion focused on the Pakistani Taliban, which has previously blocked polio vaccinators and complained that the United States is using the program as a cover for espionage.

The killings were a serious reversal for the multibillion-dollar global polio immunization effort, which over the past quarter century has reduced the number of endemic countries from 120 to just three: Pakistan, Afghanistan and Nigeria.

Nonetheless, United Nations officials insisted that the drive would be revived after a period for investigation and regrouping, as it had been after previous attacks on vaccinators here, in Afghanistan and elsewhere.

Pakistan has made solid gains against polio, with 56 new recorded cases of the diseases in 2012, compared with 192 at the same point last year, according to the government. Worldwide, cases of death and paralysis from polio have been reduced to less than 1,000 last year, from 350,000 worldwide in 1988.

But the campaign here has been deeply shaken by Taliban threats and intimidation, though several officials said Tuesday that they had never seen such a focused and deadly attack before.

Insurgents have long been suspicious of polio vaccinators, seeing them as potential spies. But that greatly intensified after the C.I.A. used a vaccination team headed by a local doctor, Shakil Afridi, to visit Osama bin Laden’s compound in Abbottabad, reportedly in an attempt to obtain DNA proof that the Bin Laden family was there before an American commando raid attacked it in May 2011.

In North Waziristan, one prominent warlord has banned polio vaccinations until the United States ceases drone strikes in the area.

Most new infections in Pakistan occur in the tribal belt and adjoining Khyber-Pakhtunkhwa Province — some of the most remote areas of the country, and also those with the strongest militant presence. People fleeing fighting in those areas have also spread the disease to Karachi, the country’s largest city, where the disease has been making a worrisome comeback in recent years.

After Tuesday’s attacks, witnesses described violence that was both disciplined and well coordinated. Five attacks occurred within an hour in different Karachi neighborhoods. In several cases, the killers traveled in pairs on motorcycle, opening fire on female health workers as they administered polio drops or moved between houses in crowded neighborhoods.

Of the five victims, three were teenagers, and some had been shot in the head, a senior government official said. Two male health workers were also wounded by gunfire; early reports incorrectly stated that one of them had died, the official said.

In Peshawar, the capital of Khyber-Pakhtunkhwa Province, gunmen opened fire on two sisters participating in the polio vaccination program, killing one of them. It was unclear whether that shooting was directly linked to the Karachi attacks.

In remote parts of the northwest, the Taliban threat is exacerbated by the government’s crumbling writ. In Bannu, on the edge of the tribal belt, one polio worker, Noor Khan, said he quit work on Tuesday once news of the attacks in Karachi and Peshawar filtered in. “We were told to stop immediately,” he said by phone.

Still, the Pakistani government has engaged considerable political and financial capital in fighting polio. President Asif Ali Zardari and his daughter Aseefa have been at the forefront of immunization drives. With the help of international donors, including the Bill and Melinda Gates Foundation, they have mounted a huge vaccination campaign aimed at up to 35 million children younger than 5, usually in three-day bursts that can involve 225,000 health workers.

The plan seeks to have every child in Pakistan immunized at least four times per year, although in the hardest-hit areas one child could be reached as many as 12 times in a year.

Declan Walsh reported from Islamabad, and Donald G. McNeil Jr. from New York. Salman Masood contributed reporting from Islamabad, and Zia ur-Rehman from Karachi, Pakistan.

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Pentagon to Reimburse Pakistan $688 Million

The biggest proponent of putting foreign aid and military reimbursements to Pakistan on a steady footing is the man President Barack Obama is leaning toward naming as secretary of state: Senator John Kerry, Democrat of Massachusetts. Mr. Kerry, the chairman of the Senate Foreign Relations Committee, has frequently served as an envoy to Pakistan, including after the killing of Osama bin Laden, and was a co-author of a law that authorized five years and about $7.5 billion of nonmilitary assistance to Pakistan.

The United States also provides about $2 billion in annual security assistance, roughly half of which goes to reimburse Pakistan for conducting military operations to fight terrorism.

Until now, many of these reimbursements, called coalition support funds, have been held up, in part because of disputes with Pakistan over the Bin Laden raid, the operations of the C.I.A., and its decision to block supply lines into Afghanistan last year.

The $688 million payment — the first since this summer, covering food, ammunition and other expenses from June through November 2011 — has caused barely a ripple of protest since it was sent to Capitol Hill on Dec. 7.

The absence of a reaction, American and Pakistani officials say, underscores how relations between the two countries have been gradually thawing since Pakistan reopened the NATO supply routes in July after an apology from the Obama administration for an errant American airstrike that killed 24 Pakistani soldiers in November 2011.

Mr. Kerry’s nomination would be welcomed in Pakistan, where he is seen as perhaps the most sympathetic to Pakistani concerns of any senior lawmaker. He has nurtured relationships with top civilian and military officials, as well as the I.S.I., Pakistan’s most powerful intelligence agency.

But if he becomes secretary of state, Mr. Kerry will inherit one of the hardest diplomatic tasks in South Asia: helping Pakistan find a role in steering Afghanistan toward a political agreement with the Taliban. As the United States, which tried and failed to broker such an agreement, begins to step back, Pakistan’s role is increasing.

For a relationship rocked in the past two years by a C.I.A. contractor’s shooting of two Pakistanis, the Navy SEAL raid that killed Bin Laden and the accidental airstrike, perhaps the most remarkable event in recent months has been relative calm. A senior American official dealing with Pakistan said recently that “this is the longest we’ve gone in a while without a crisis.”

Sherry Rehman, Pakistan’s ambassador to the United States, said, “Pakistan-United States relations are settling down to a more stable trajectory.”

The interlude has allowed the United States to reduce the huge backlog of NATO supplies at the border — down to about 3,000 containers from 7,000 when the border crossings reopened — and to conduct dry runs for the tons of equipment that will flow out of Afghanistan to Pakistani ports when the American drawdown steps up early next year.

Moreover, the two sides have resumed a series of high-level meetings — capped by Secretary of State Hillary Rodham Clinton’s meeting this month with top Pakistani officials in Brussels — on a range of topics including counterterrorism, economic cooperation, energy and the security of Pakistan’s growing nuclear arsenal.

Maleeha Lodhi, a former Pakistani ambassador to Washington, concurred. “There’s greater convergence between the two countries than there has been in eight years,” she said. “It’s been a fairly quick kiss and make up, but it’s been driven by the approaching urgency of 2014, and by their shared desire for a stable outcome in the region.”

The one exception to the state of calm has been a tense set of discussions about Pakistan’s nuclear arsenal. United States officials have told their Pakistani colleagues that Islamabad’s move to smaller, more portable weapons creates a greater risk that one could be stolen or diverted. A delegation of American nuclear experts was in Pakistan last week, but found that the two countries had fundamentally divergent views about whether Pakistan’s changes to its arsenal pose a danger.

Declan Walsh contributed reporting from Islamabad, Pakistan.

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