The Law Reaches the Attack, Not the Rumour

On 2nd April 2026 Nature Medicine carried a Correspondence by Lawrence O. Gostin, Scott C. Ratzan and Carolina Batista, co-chairs of its Quality Health Information for All Commission, contending that "accurate, evidence-informed information is a major health determinant" and defining “Quality Health Information” as material which is "scientifically sound, accessible, clear, understandable"; the Commission announced itself in the same journal on 22nd January 2025, and its proposition is that the digital information environment is now public health infrastructure in the sense that a water supply or a cold chain is, so that a state which leaves it unattended has left a determinant of health unattended.

No country tests that proposition more severely than Pakistan. Pakistan and Afghanistan are the only two countries in which wild poliovirus type 1 remains endemic; Pakistan recorded six cases in 2023, seventy-four in 2024 and thirty-one in 2025, while Afghanistan recorded twenty-five in 2024. The virus did not come back because the vaccine failed. It came back because campaigns could not reach children, and in the refusing union councils the obstacle was something that had been said rather than anything that had been done.

What a rumour cost in three days

On 20th April 2019 vaccination teams administered oral polio vaccine at a private school in Mashokhel, on the southern edge of Peshawar, after which several children complained of nausea, cramps and vomiting; within hours unverified reports that children had died were circulating on WhatsApp, Facebook and Twitter, and parents across the district began carrying their children to the city hospitals. More than twenty-five thousand children were brought to health facilities around Peshawar, and the episode was afterwards classified as mass hysteria rather than vaccine injury. On 22nd April 2019 a crowd ransacked the “Basic Health Unit” at Mashokhel and set it on fire.

Twenty-five thousand children, and not one case of vaccine injury.

What followed was criminal in character and nothing else. Police registered cases under the Pakistan Penal Code, 1860 (Act XLV of 1860) and arrested fourteen persons; on 29th May 2019 the provincial authorities sealed and de-registered seven private schools for inciting parents; and the inquiry report attributed the affair to elected representatives and prayer leaders, and recommended prosecution and the regulation of mosque loudspeakers. No part of that response required any state functionary to place accurate information before a single parent, before the panic or after it.

Prosecution after the funeral

The pattern has held, and its sharpest expression is the treatment of attacks on vaccinators and their escorts as terrorism. On 1st November 2024 an improvised device was detonated beside a police vehicle sent to collect a polio team near a girls’ school in Mastung, Balochistan; the blast killed nine persons including five children aged between five and ten years and injured twenty-nine, and the FIR registered the same afternoon at Mastung City police station invoked Section 7 and Section 21(i) of the Anti-Terrorism Act, 1997 (Act XXVII of 1997), Sections 3 and 4 of the Explosive Substances Act, 1908, and Sections 302, 324, 353, 427, 186 and 120B of the Pakistan Penal Code, 1860.

The South Asia Terrorism Portal counted at least twenty policemen and three polio workers killed in thirty-one attacks in 2024; on 13th April 2026 an officer escorting vaccinators in Hangu was shot dead on the opening day of a national campaign; and on 18th May 2026 two officers were killed in Bajaur as a campaign covering nearly nineteen million children began.

More than two hundred polio workers and police escorts have been killed in Pakistan since the campaigns began in the 1990s.

The Anti-Terrorism Act, 1997 is the right instrument for the men who plant the device, and nothing here asks for its relaxation; the complaint is that it is the only instrument the state reliably reaches for, and it operates after a child is dead.

The health statutes are silent on information

The health legislation in field imposes no duty on anybody to tell the public the truth about a vaccine. The Epidemic Diseases Act, 1897 (Act III of 1897) contains one substantive power, under Section 2, to take special measures and prescribe temporary regulations; it carries no penalty and says nothing about communication with the public. The National Institute of Health (Re-organization) Act, 2021 makes public communication an activity of its Emerging Infections Unit under Section 12 and requires a national surveillance system under Section 12(3), yet it creates no obligation owed to any citizen and, for the reasons best known to the Federal Government, no rules have been framed under Section 29. The Khyber Pakhtunkhwa Public Health Surveillance and Response Act, 2017 obliges detection and reporting under Sections 10 and 12 but is silent on risk communication; and the Punjab Vaccination Ordinance, 1958 (Ordinance XXVII of 1958) obliges a parent to have an unprotected child vaccinated, on pain of three months’ imprisonment and a fine of one hundred Rupees, while imposing no duty on the state to explain the vaccine to that parent.

Since no statute in field obliges any state functionary to correct a falsehood about a vaccine therefore the whole weight of the Mashokhel episode fell upon the criminal law, which arrived after the “Basic Health Unit” had been burnt; the surveillance duty detects the case and never the rumour that produced it.

The one law on falsehood was not written for this

What Pakistan does have is a speech offence. The Prevention of Electronic Crimes Act, 2016 (Act XL of 2016), as amended by the Prevention of Electronic Crimes (Amendment) Act, 2025 of 29th January 2025, now carries Section 26A, which punishes the intentional dissemination through an information system of information the sender knows or believes to be false and likely to cause fear, panic, disorder or unrest, with up to three years’ imprisonment or a fine up to two million Rupees. Very unfortunately, Section 26A neither names health nor gives any health authority a role in its administration: 689 cases were registered under it between January and August 2025, nine of them against journalists, and the words "false" and "fake" are left undefined, so the discretion belongs to the investigating officer. An offence framed against fear, panic and unrest is not a public health instrument; it is a public order instrument, and it will be used as one.

Keeping in view that Article 19 of the Constitution of the Islamic Republic of Pakistan, 1973 permits reasonable restrictions on speech only in the interest of the glory of Islam, the integrity, security or defence of Pakistan, friendly relations with foreign States, public order, decency or morality, contempt of court and the commission of or incitement to an offence, the absence of any ground of public health is the governing fact. Article 19(3)(b) of the International Covenant on Civil and Political Rights does allow restriction for the protection of public health, but Pakistan ratified the Covenant on 23rd June 2010 subject to a declaration, retained on the partial withdrawal of 20th September 2011, that Article 19 applies only so far as it is not repugnant to the Constitution and to Sharia. Every measure against vaccine falsehood must therefore be justified as public order or as incitement, which is what drives the state towards an FIR against the frightened forwarder and away from any duty to publish the truth; and that line belongs to Parliament, drawn in a health statute with defined terms and a named officer, not to a station house officer at three in the afternoon.

The comparator next door

India met the same violence and answered it inside the health statute. The Epidemic Diseases (Amendment) Act, 2020 (Act 34 of 2020) inserted Section 2B, prohibiting any act of violence against healthcare service personnel during an epidemic, and amended Section 3 to punish it with three months to five years, rising to seven years where grievous hurt is caused, cognizable and non-bailable. Pakistan’s parent statute of 1897 is unamended in this respect.

What is to be done

In the light of the above, it is urgently required that a statutory duty of “Health Risk Communication” be enacted at federal level and mirrored in each province: a duty owed continuously and not merely on the declaration of a “Public Health Emergency”, obliging the health department to publish “Quality Health Information”, to answer a circulating falsehood about an immunisation campaign within a fixed number of hours, and to record what was published and when. Section 65 of the Draft National Health Security and Infectious Disease Contingency Act 2026, which requires communication by all reasonable means, in local languages, with counter-misinformation coordinated between the health authorities, PEMRA and the PTA, is the drafting already available; its defect is that it switches on only upon a declared “Public Health Emergency”, whereas polio refusal is a permanent condition and not an emergency.

Two further things are required. Rumour detection must be added expressly to the surveillance duty under Section 12(3) of the National Institute of Health (Re-organization) Act, 2021 and to Section 10 of the Khyber Pakhtunkhwa Public Health Surveillance and Response Act, 2017, so that the state learns of a Mashokhel on the first afternoon and not on the third; and any criminal provision aimed at vaccine falsehood must be enacted separately from Section 26A, confined to statements about a notified immunisation campaign made with knowledge of their falsity, and set in motion only on the complaint of a health officer named in the statute.

Pakistan is willing to place an armed constable beside every vaccinator, and it buries him when he is shot. It has never been willing to place a legal duty on any officer to reach the parent before the rumour does, and that imbalance between the force deployed after the harm and the information owed before it hence needs serious reconsideration.