Polio vaccination in Kashmir: the women trekking miles to reach the last unvaccinated children

Before sunrise breaks over the mountains of Kashmir, Shameema slips on her worn rubber sandals and checks the insulated box she is about to carry for miles. Inside, ice packs must keep a supply of oral polio vaccine within a narrow cold-chain range of 2C to 8C — a temperature window health workers are trained to protect at all costs, even as the day ahead promises punishing summer heat. She hoists the container onto one shoulder and steps out into the dark. A short distance away, her colleague Tanzeela follows, retying the laces of her canvas shoes before setting off with her own pack.

Both women live and work in Pulwama, a district in Indian-administered Kashmir where summer temperatures climb to around 37C. Their destination on this particular morning lies higher still, out of the valley floor where the asphalt gives way first to a rough dirt track and then to a barely distinguishable footpath threading through mountain pine forest — the only route to a scattering of homes too remote for a vehicle to reach.

The trek is physically demanding in a way that few health interventions require of the people who deliver them. Carrying a sealed, insulated vaccine box for miles over uneven terrain in rising heat is itself a logistical feat, one made harder by the need to keep the ice packs inside cold enough to preserve the vaccine's effectiveness by the time it reaches a child's mouth. A single lapse in that cold chain, health officials say, can render an entire batch of doses useless — meaning the walk has to be planned, timed and executed with almost as much precision as the vaccination itself.

Shameema and Tanzeela are two of thousands of frontline workers taking part in a vast national immunisation programme aimed at reaching every child in India with the oral polio vaccine, no matter how remote their home. The vaccine itself is delivered in a matter of seconds — a couple of drops placed directly on a child's tongue — but that brief moment is the culmination of a supply chain, a health system and, in mountain districts like Pulwama, a physically exhausting journey on foot.

The stakes behind that brief moment are considerable. Polio is a viral disease that can cause irreversible paralysis within hours of infection, and there is no cure once someone is infected — only prevention through vaccination. Campaigns like the one Shameema and Tanzeela work for have driven the disease to the edge of eradication across much of the world, but public health officials caution that as long as any child anywhere remains unvaccinated, the virus retains a foothold that can allow it to resurface.

That is precisely why reaching remote, hard-to-access communities carries outsized importance in the broader eradication effort. A single unvaccinated pocket, however small or isolated, can become the place where the virus persists and eventually spreads again — which is why health workers are dispatched not just to towns and roadside villages, but to the mountain hamlets that appear on few maps and can only be reached by walking.

The work asks something significant of the women who do it. Days that begin before dawn to beat the worst of the heat, treks that can last hours over terrain with no shade, and the responsibility of protecting a temperature-sensitive medical supply the entire way — all before the actual vaccination begins, going door to door or gathering point to gathering point to find every child in a scattered community.

Trust matters as much as logistics. Health workers in remote areas often need to build relationships with families over repeated visits, answering questions and addressing concerns before parents agree to have their children vaccinated. In villages that see few visitors of any kind, a familiar face returning campaign after campaign can matter as much as the vaccine itself in determining whether a child ultimately receives it.

The effort in places like Pulwama sits within a much larger global campaign against polio, one of the longest-running public health initiatives in history. Vaccination coverage has to be sustained and near-universal to keep the virus from finding new footholds, which is why national programmes continue to send workers back to the same remote communities year after year rather than treating a single successful campaign as the end of the job.

For Shameema, Tanzeela and the thousands of women like them across India's most difficult terrain, the work rarely makes headlines. But each trek up into the highlands, each insulated box carried carefully over miles of dirt track and forest path, represents a small, deliberate act of closing the gap between a life-saving vaccine and the children who might otherwise never receive it — drops that take seconds to administer, but that can determine the entire course of a child's life.