Pakistan Fights for Ground in War on Polio KARACHI, Pakistan - Usman, who limps on a leg bowed by the polio he caught as a child, made sure that his first three children were protected from the disease, but he turned away vaccinators when his youngest was born. He was furious that the Central Intelligence Agency, in its hunt for Osama bin Laden, had staged a fake vaccination campaign, and infuriated by American drone strikes, one of which, he said, had struck the son of a man he knew, blowing off his head. He had come to see the war on polio, the longest, most expensive disease eradication effort in history, as a Western plot. In January, his 2-year-old son, Musharaf, became the first child worldwide to be crippled by polio this year. "I know now I made a mistake," said Usman, 32, who, like many in his Pashtun tribe, uses only one name. But you Americans have caused pain in my community. Americans pay for the polio campaign, and that's good. But you abused a humanitarian mission for a military purpose. Anger like his over American foreign policy has led to a disastrous setback for the global effort against polio. In December, nine vaccinators were shot dead here, and two Taliban commanders banned vaccination in their areas, saying the vaccinations could resume only if drone strikes ended. In January, 10 vaccinators were killed in Nigeria's Muslim-dominated north. Since then, there have been isolated killings - of an activist, a police officer and vaccinators - each of which has temporarily halted the campaign. The war on polio, which costs $1 billion a year and is expected to take at least five more years, hangs in the balance. When it began 25 years ago, 350,000 people a year, mostly children, were paralyzed. Last year, fewer than 250 were, and only three countries - Afghanistan, Nigeria and Pakistan - have never halted its spread at any point. While some experts fear the killings will devastate the effort here, Pakistan's government insists that they will not, and has taken steps to ensure that. Vaccinators" pay was raised to $5 a day in the most dangerous areas, police and army escorts were increased and control rooms were created to speed crisis responses. But the real urgency to finish the job began earlier, for a very different reason. Two years ago, India, Pakistan's rival in everything from nuclear weapons to cricket, eliminated polio. "Nothing wounded our pride as much as that," said Dr. Zulfiqar A. Bhutta, a vaccine expert at Aga Khan University's medical school. Bill Gates, who is the campaign's largest private donor and calls beating the disease "the big thing I spend the majority of my time on," said that Pakistan's desire to not be further humiliated "is our biggest asset." After India's success and hints from the World Health Organization that it might issue travel warnings, Pakistan's government went on an emergency footing. A cabinet-level "polio cell" was created. Vaccinators" routine pay doubled to $2.50. More than 1,000 "mobilizers" were hired to visit schools and mosques to counter the ever-swirling rumors that the vaccine contained pork, birth control hormones or H.I.V., the virus that causes AIDS. Mullahs were courted to endorse vaccination. They issued 24 fatwas, and glossy booklets of their directives were printed for vaccinators to carry. Perhaps most important, local command was given to deputy commissioners, who have police powers that health officials lack. Now Pakistan is closer than ever. Although cases will not peak until after the summer monsoons, there have been only 21 so far this year. A few years ago, 39 substrains of the polio virus circulated; now only two do. About 300,000 children live in areas too dangerous for vaccinators, but almost all the sewage samples from those areas are clear of the virus. Ultimately, though, success will depend on more than political will and the rivalry with India. In the wake of the recent killings, it will rely most of all on individual acts of courage, like those by prominent imams who pose for pictures as they vaccinate children. Or by Usman, who appeared with his polio-stricken son, Musharaf, in a fund-raising video asking rich Persian Gulf nations to buy vaccines for poor Muslims elsewhere.