Medicare’s Chief Actuary, Richard Foster, Retiring

Carol T. Powers for The New York Times

Richard S. Foster testifying before the House Ways and Means Committee in 2004

WASHINGTON — Richard S. Foster, who as chief actuary of the Medicare program for the last 18 years nettled presidents of both parties with his projections of rapid growth in federal health care spending, will retire next month, the Obama administration said Friday.

Mr. Foster, 63, a career civil servant known for his fierce independence, has been an influential voice on Medicare, Medicaid and the new health care law.

With 100 million people on Medicare or Medicaid and an additional 20 million expected to get federal subsidies for private insurance under President Obama’s health care law, the need for accurate estimates of health spending has never been greater, lawmakers say.

Mr. Foster said that Medicare savings in the 2010 health care law, based on cutbacks in payments to hospitals and other health care providers, were probably unsustainable and could jeopardize access to care for beneficiaries, a judgment that displeased the Obama administration.

In 2003, Mr. Foster found himself in conflict with the Bush administration when he raised questions about the cost of a Republican bill adding a prescription drug benefit to Medicare. Federal investigators later found that a top Medicare official had threatened to fire Mr. Foster if he provided certain cost estimates to Congress.

Marilyn B. Tavenner, acting administrator of the federal Centers for Medicare and Medicaid Services, praised Mr. Foster for “his adherence to the highest levels of professional independence and ethical conduct.” She said he “will be sorely missed by policy makers and officials throughout the administration and Congress.”

Ms. Tavenner said “we will soon begin a national recruitment effort” to find a successor to Mr. Foster, who began working for the federal government 40 years ago.

Proposals to rein in Medicare spending have been at the center of budget negotiations between President Obama and Speaker John A. Boehner. Both sides have relied on data from Mr. Foster’s office.

Congress bolstered the actuary’s independence in a 1997 law stipulating that the holder of the job can be removed from office “only for cause.”

In a report accompanying the law, Congress said that “the office of the actuary has a unique role,” serving both the administration and Congress, and often must work with lawmakers developing legislation.

With help from a staff of nearly 100, the chief actuary issues detailed annual reports on national health spending and the financial outlook for Medicare. In addition, the actuary’s office collects data used to calculate Medicare payment rates for doctors, hospitals and many other health care providers.

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Emanuel explores Midway privatization

Mayor Rahm Emanuel's administration will explore the possibility of privatizing Midway Airport but will take a shorter-term, more tightly controlled approach than was employed by former Mayor Richard Daley's team on the city's first go-round.

Chicago's last try, a 99-year lease that would have brought in $2.5 billion, died in 2009 when the financial markets froze up.

The city's latest intentions are expected to be formally announced Friday, ahead of a Dec. 31 deadline for deciding whether to retain a slot for Midway in the Federal Aviation Administration's airport privatization pilot program. The city put off this decision several times previously.

The move, preliminary as it is, is sure to be politically charged, given the anger over the way Daley's 75-year parking meter privatization deal has played out, with proceeds used to plug operating deficits and meter rates rising sharply.

With that historical backdrop, Emanuel is suggesting a more conservative approach. It includes a shorter-term lease of less than 40 years; a "travelers' bill of rights" aimed at ensuring any changes will benefit passengers; and a continuing stream of revenue for the city, giving it a shot to capture some growth.

And unlike the parking meter and Chicago Skyway lease deals, a new Midway transaction would not allow proceeds to be used to plug operating deficits or to pay for operations in any way, Emanuel said in an interview Thursday.

"I will not let the city use it as a crutch to not make the tough decisions on the budget," he said.

But while a shorter lease and greater city control may play well locally, those sorts of terms may not appeal to investors, experts said in interviews this month.

"The shorter the lease term, the lower the bid prices are going to be — that's just the math," said Steve Steckler, chairman of the Infrastructure Management Group, a Bethesda, Md.-based company that advises infrastructure owners and operators. "I'd be shocked if investors offered more than $2 billion for a 40-year lease," Steckler said.

Emanuel said: "Nobody knows until you talk to people. … I'm the mayor and I'm not agreeing to … 99 years. I'm saying it's either 40 years or less." His office has not offered an estimate of what such a deal could bring in, saying it would be premature.

"No final decisions have been made, but we can't make a decision until we evaluate fully if this could be a win for Chicagoans," Emanuel said.

A private operator would take over management of such revenue-producing activities as food, beverage and car rental concessions and parking lots. The FAA would continue to provide air traffic control, while the Transportation Security Administration would continue to provide security operations. The city would retain ownership.

Few details were provided about how privatization would affect travelers and Midway employees. Emanuel said specifics will emerge over time.

By year's end, the city will send the FAA a preliminary application, a timetable and a draft "request for qualification," a document the city will put out early next year to identify qualified bidders for the project. A review of the potential bidders will be conducted in the spring.

Last year, Emanuel expressed hesitation in pursuing a private lease for Midway unless a careful vetting process was in place, saying taxpayers were correct to be wary, given the city's history.

The evaluation process will be deliberate and open to public view, he said Thursday.

He pledged to create a committee of business, labor and civic leaders that will provide updates to the public on a regular basis and that will select an independent adviser to vet the transaction. The committee will deliver a report to the City Council, and there will be a 30-day review period before any vote.

"I set up a different process and a different set of principles that stand in stark contrast to what was discussed or done in the past," Emanuel said.

The FAA pilot program frees cities from regulations that require airport revenue to be used for airport purposes. It allows money to be withdrawn for other uses.

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Firefighters battle extra-alarm fire on Far South Side, 1 injured

Chicago Firefighters extinguish a 4-alarm fire at regency Technologies Dec., 20 2012. (Armando L. Sanchez / December 20, 2012)

By Deanese Williams-Harris




Tribune reporter

9:52 p.m. CST, December 20, 2012

Firefighters battled an extra-alarm fire Thursday night in an unused warehouse on the city's Far South Side where the building partially collapsed.

The fire broke out Thursday evening at the South Chicago Recycling company near 116th Street and Burley Avenue, according to Fire Media information.

About 6:45 p.m., firefighters were experiencing water issues and a fire boat was on the way to help supply water, officials said. But the fire boat and a helicopter were unable to reach the scene due to visibility issues, officials said.

One firefighter was reported to have a slight injury and was taken to St. Margaret Hospital in Hammond, Ind., officials said.

A 4-11 alarm was eventually called at the scene as fire poured through the roof of the warehouse.  The warehouse was believed to house plastic materials and electronics.

The warehouse is located in a remote area of the city, official said.

Firefighters pumped water from the Calumet River located about 200 feet from the warehouse, officials said. The fire was struck out at about 9:15 p.m.

The cause of the fire was under investigation.

dawilliams@tribune.com

Twitter: @neacynewslady

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North Korean Video Game Has Western Ties

Video games represent a true luxury for most North Koreans living in a country where even the elite have only hours of electricity each day. That has not stopped a Western company in the capital city of Pyonyang from creating what may be the first North Korean game widely available online.

The game, called “Pyongyang Racer,” is a simple Web browser game that allows players to drive a car around North Korea’s capitol city of Pyongyang, according to Beijing Cream. Players must avoid hitting cars and collect gasoline in the form of petrol barrels to keep their run going as long as possible — all while getting warnings from one of Pyongyang’s famously picturesque traffic girls.

“Pyongyang Racer” has an unusual development history as a video game. The North Korean programmers who made the game work for Nosotek, a Western company that describes itself as the “first western IT venture” in North Korea.

Nosotek’s North Korean programmers previously made mobile-phone games based on the Hollywood films “The Big Lebowski” and “Men in Black.” Those games ended up getting published through a subsidiary of Rupert Murdoch‘s News Corp (owner of Fox News), according to Bloomberg News.

Nosotek claims to have “attracted the cream of local talent as the only company in Pyongyang offering Western working conditions and Internet access.” That would likely be true in North Korea, given the nuclear-armed country’s pariah status among Western countries and businesses.

The Nosotek website also praises the advantages of working in North Korea because “IP secrecy and minimum employee churn rate are structurally guaranteed.” Translation: North Korean programmers would likely never leave Nosotek with the company’s intellectual property secrets because they have practically no other employment options.

Nosotek built the game for Koryo Tours, a company based in Beijing, China, to distribute “Pyongyang Racer” through the Koryo Tours website. Koryo Tours is currently the leading company that runs tours of secretive North Korea for Westerners and other foreigners.

“This game was developed in 2012 and is not intended to be a high-end technological wonder hit game of the 21st century, but more a fun race game (arcade style) where you drive around in Pyongyang and learn more about the sites and get a glimpse of Pyongyang,” Koryo Tours said on the game’s website.

This story was provided by TechNewsDaily, a sister site to LiveScience. You can follow TechNewsDaily Senior Writer Jeremy Hsu on Twitter @jeremyhsu. Follow TechNewsDaily on Twitter @TechNewsDaily, or on Facebook.

Copyright 2012 LiveScience, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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‘Homeland’ star Claire Danes gives birth to first child

LOS ANGELES (Reuters) – Emmy-winning actress Claire Danes has given birth to her first child, a boy, the publicist for the “Homeland” star said on Wednesday.

Cyrus Michael Christopher Dancy was born on Monday to Danes, 33, and her husband, British actor Hugh Dancy.

Danes’ performance as CIA operative Carrie Matheson on Showtime’s “Homeland” series scored her an Emmy win in September, while the psychological thriller won the TV industry’s highest honor of best drama series.

Danes is nominated for her second Golden Globe award in the role at the Hollywood awards show in January. She also has won multiple awards for her past work on 2010 TV film “Temple Grandin,” and as a 15-year-old on the 1990s coming-of-age television drama “My So-Called Life.”

(Reporting by Eric Kelsey, editing by Jill Serjeant and Lisa Shumaker)

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Stigma Fading, Marijuana Common in California

Jim Wilson/The New York Times

At a San Francisco concert in 2010, marijuana use was general while signatures were collected for a measure to decriminalize it.

LOS ANGELES — Let Colorado and Washington be the marijuana trailblazers. Let them struggle with the messy details of what it means to actually legalize the drug. Marijuana is, as a practical matter, already legal in much of California.

No matter that its recreational use remains technically against the law. Marijuana has, in many parts of this state, become the equivalent of a beer in a paper bag on the streets of Greenwich Village. It is losing whatever stigma it ever had and still has in many parts of the country, including New York City, where the kind of open marijuana use that is common here would attract the attention of any passing law officer.

“It’s shocking, from my perspective, the number of people that we all know who are recreational marijuana users,” said Gavin Newsom, the lieutenant governor. “These are incredibly upstanding citizens: Leaders in our community, and exceptional people. Increasingly, people are willing to share how they use it and not be ashamed of it.”

Marijuana can be smelled in suburban backyards in neighborhoods from Hollywood to Topanga Canyon as dusk falls — what in other places is known as the cocktail hour — often wafting in from three sides. In some homes in Beverly Hills and San Francisco, it is offered at the start of a dinner party with the customary ease of a host offering a chilled Bombay Sapphire martini.

Lighting up a cigarette (the tobacco kind) can get you booted from many venues in this rigorously antitobacco state. But no one seemed to mind as marijuana smoke filled the air at an outdoor concert at the Hollywood Bowl in September or even in the much more intimate, enclosed atmosphere of the Troubadour in West Hollywood during a Mountain Goats concert last week.

Arnold Schwarzenegger, the former Republican governor, ticked off the acceptance of open marijuana smoking in a list of reasons he thought Venice was such a wonderful place for his morning bicycle rides. With so many people smoking in so many places, he said in an interview this year, there was no reason to light up one’s own joint.

“You just inhale, and you live off everyone else,” said Mr. Schwarzenegger, who as governor signed a law decriminalizing possession of small amounts of marijuana.

Some Californians react disdainfully to anyone from out of state who still harbors illicit associations with the drug. Bill Maher, the television host, was speaking about the prevalence of marijuana smoking at dinner parties hosted by Sue Mengers, a retired Hollywood agent famous for her high-powered gatherings of actors and journalists, in an interview after her death last year. “I used to bring her pot,” he said. “And I wasn’t the only one.”

When a reporter sought to ascertain whether this was an on-the-record conversation, Mr. Maher responded tartly: “Where do you think you are? This is California in the year 2011.”

John Burton, the state Democratic chairman, said he recalled an era when the drug was stigmatized under tough antidrug laws. He called the changes in thinking toward marijuana one of the two most striking shifts in public attitude he had seen in 40 years here (the other was gay rights).

“I can remember when your second conviction of having a single marijuana cigarette would get you two to 20 in San Quentin,” he said.

In a Field Poll of California voters conducted in October 2010, 47 percent of respondents said they had smoked marijuana at least once, and 50 percent said it should be legalized. The poll was taken shortly before Californians voted down, by a narrow margin, an initiative to decriminalize marijuana.

“In a Republican year, the legalization came within two points,” said Chris Lehane, a Democratic consultant who worked on the campaign in favor of the initiative. He said that was evidence of the “fact that the public has evolved on the issue and is ahead of the pols.”

A study by the California Office of Traffic Safety last month found that motorists were more likely to be driving under the influence of marijuana than under the influence of alcohol.

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Feds call for new safety review of airport scanners

Responding to critics, the Department of Homeland Security is launching another safety study of full-body scanners used to screen passengers at the nation's airports.

The Department of Homeland Security, which oversees the Transportation Security Administration, plans to award a contract to the National Academy of Sciences to perform the review.

But the nonprofit group of scientists will only be asked to review previous studies on the safety of a particular type of scanner used by the TSA.

The study comes in response to pressure from TSA critics, including Sen. Susan Collins (R-Maine), who introduced a bill this year to test the safety of the scanners.

[Updated, 3:35 p.m. Dec. 20: In a statement, Collins said she welcomes the new review.

"While TSA has told the public that the amount of radiation emitted from these machines is small, passengers and some scientific experts have raised questions about the impact of repeated exposure to this radiation," she said.] 

In an interview, TSA Administrator John Pistole said several previous studies have already shown the scanners do not expose passengers to dangerous levels of radiation, even for frequent travelers.

But he said he welcomes another study to address the concerns of members of Congress. "After all, they fund us," he said of the Senate and House.

The TSA uses two types of full-body scanners, both of which help the agency look for objects hidden under the clothes of passengers. About half of those scanners expose passengers to X-rays to see through their clothes, with the rest using non-ionizing radio frequency energy, known as millimeter waves.

The scanners that use X-rays, or backscatter technology, have received the most criticism from passenger advocates and scientists, including professors from UC San Francisco. The European Union last year banned the use of backscatter scanners at European airports over health concerns.

The Department of Homeland Security posted an advisory last week, saying it was awarding the National Academy of Science a contract to convene a committee to review whether exposure to backscatter scanners complies with health standards. The academy also is asked to determine whether the design of the machines and the procedures used by TSA staff prevent overexposure of radiation to travelers and the workers.

The proposal does not say when the academy should complete its review.

ALSO:

How new TSA body scans will work

TSA scanners pose negligible risk to passengers, new test shows

LAX's controversial full-body scanners out; new, faster scanners in

Follow Hugo Martin on Twitter at @hugomartin

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Unions offer to pay more on pensions if state adds new taxes

A coalition of public employee unions Wednesday blasted legislation to address the state's underfunded worker pension systems and offered instead to make increased contributions — if the state guarantees its share of retirement payments and raises $2 billion by ending corporate tax benefits and imposing new taxes.

Appearing at the James R. Thompson Center, members of the We Are One Illinois coalition said plans backed by Gov. Pat Quinn and another proposal supported by a bipartisan group of lawmakers would violate the state constitution by reducing pension benefits guaranteed to workers. They predicted such a change would be overturned by the courts.

The unions said the primary problem is the state's failure to regularly fund its annual required contribution. The offer to require state workers and teachers to pay 2 percent more toward their retirement was conditional upon getting an "ironclad guarantee" in state law that government would fund its share of pension obligations as workers have done over the years.

To help fund those obligations, the unions proposed eliminating several corporate tax benefits as well as imposing new taxes on auto trade-ins, satellite TV service and downloaded digital entertainment. The new money also could be used to help offset cuts in other public social services, the group said.

But even with a new General Assembly soon to be sworn in, the prospect of closing so-called corporate tax loopholes — many of which have been on the books for decades — as well as imposing new taxes remains politically unpopular.

The proposal was the first comprehensive offer on the pension crisis from the union coalition, which includes the state's two major teacher organizations and the American Federation of State, County and Municipal Employees. The unions also called for a summit with Quinn and legislative leaders when the new General Assembly convenes Jan. 9. Quinn has asked that lame-duck lawmakers consider pension legislation in the days before new lawmakers are sworn in.

Kathy Griffin, vice president of the Illinois Education Association, said teachers and the vast majority of workers covered by the state's pension plans are not eligible for and do not receive Social Security, meaning their state pensions represent their retirement income.

"Illinois' pension problem is a revenue problem, and it is crucial that we have a revenue solution," she said.

At an appearance in Cicero, Quinn said he has made the state's full share of pension payments as chief executive, unlike previous governors. But the Democratic governor, who has received sharp criticism from traditional Democratic allies in organized labor, stopped short of backing a guaranteed pension payment.

"We want to work with the labor unions and the employee groups as far as we can, but ultimately the taxpayers come first, and that's what we have to do," Quinn said.

Illinois has the nation's most troubled state public employee pension system, with an unfunded liability of $95 billion.

Quinn has tried to bring public attention to the problem, notably through an online video featuring Squeezy the Pension Python, to demonstrate how the growing amount of tax dollars devoted to pensions threatens to overwhelm funding for education and other services.

The governor has backed a Senate-passed proposal that would require state workers to forgo an automatic compounded 3 percent cost of living increase in their pensions in exchange for accessing state-subsidized health care. Those keeping the cost-of-living increase would lose access to state health care in retirement. In addition, their pension benefits would be capped at their current salary level even if their paychecks went up.

Union officials said Quinn's plan was a "no-win" choice for workers who would see a significant loss of purchasing power as they grew older in their retirement years.

A more recent plan offered by a bipartisan group of lawmakers is also problematic, the unions said, including its cuts in cost-of-living increases and increased retirement ages.

Both bills would be subject to lengthy and costly lawsuits "and we think ultimately the courts will find it unconstitutional, which means all the work that they're putting into those bills will have been for naught," said Henry Bayer, executive director of AFSCME Council 31.

The unions said their offer of increased employee contributions of 2 percent of income would generate about $350 million a year toward pensions, or about $10 billion if amortized over 30 years.

At the same time, the unions proposed the end to more than $1.5 billion worth of tax exemptions. They include repealing recent tax breaks for CME Group Inc. and the Chicago Board Options Exchange, a tax break for for-profit hospitals, lowering the size of estates subject to taxes and curbing spending on economic development incentives for business.

The group also proposed a 5 percent tax on satellite TV service; requiring sales tax to be paid on the entire price of a new car rather than just the remaining balance after trade-in; and imposing the sales tax on e-books, movies, music and games digitally downloaded to smartphones and other electronic devices.

The new-car sales tax would raise an estimated $300 million, the group said; it pegged revenue estimates for the satellite tax at $75 million and the digital tax at $10 million. Quinn already has suggested the new-car sales tax as a way to plug a $300 million hole in repaying bonds used to fund public works projects.

rap30@aol.com mcgarcia@tribune.com

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Leah Remini sued by former managers over “Family Tools” commissions

LOS ANGELES (TheWrap.com) – Leah Remini‘s new TV gig is already giving her a headache, months before it even starts. Former “King of Queens” star Remini is being sued by her former managers, the Collective Management Group, which claims that it’s owed $ 67,000 in commissions relating to her upcoming ABC comedy “Family Tools,” which debuts May 1.

In a complaint filed with Los Angeles Superior Court on Tuesday, the Collective says that it entered into an agreement with the actress in November 2011 that guaranteed the company 10 percent of the earnings that emerged from projects that Remini “discussed, negotiated, contemplated, or procured/booked during Plaintiff’s representation of Remini,” regardless of whether the income was earned after she and the Collective parted ways.

According to the lawsuit, that would include the $ 1 million that it says Remini will earn for the first season of “Family Tools.” (The suit allows that it isn’t owed commission on a $ 330,000 talent holding fee that Remini received from ABC prior to officially being booked on the show.)

Remini, pictured above wearing the self-satisfied smirk of someone who just might stiff her former managers out of their commission, terminated her agreement with the Collective “without warning or justification” in October, the suit says.

Alleging breach of oral contract among other charges, the suit is asking for an order stipulating that it’s owed the $ 67,000, plus unspecified damages, interest and court costs.

Remini’s agent has not yet responded to TheWrap’s request for comment.

(Pamela Chelin contributed to this report)

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U.N. Suspends Polio Campaign in Pakistan After Killings of Workers

B.K. Bangash/Associated Press

A Pakistani woman administered polio vaccine to an infant on Wednesday in the slums of Islamabad. Militants have killed eight polio workers over three days.

LAHORE, Pakistan — The front-line heroes of Pakistan’s war on polio are its volunteers: young women who tread fearlessly from door to door, in slums and highland villages, administering precious drops of vaccine to children in places where their immunization campaign is often viewed with suspicion.

Now, those workers have become quarry. After militants stalked and killed eight of them over the course of a three-day, nationwide vaccination drive, the United Nations suspended its anti-polio work in Pakistan on Wednesday, and one of Pakistan’s most crucial public health campaigns has been plunged into crisis.

The World Health Organization and Unicef ordered their staff members off the streets, while government officials reported that some polio volunteers — especially women — were afraid to show up for work.

At the ground level, it is those female health workers who are essential, allowed privileged entrance into private homes to meet and help children in situations denied to men because of conservative rural culture. “They are on the front line; they are the backbone,” said Imtiaz Ali Shah, a polio coordinator in Peshawar.

The killings started in the port city of Karachi on Monday, the first day of a vaccination drive aimed at the worst affected areas, with the shooting of a male health worker. On Tuesday four female polio workers were killed, all gunned down by men on motorcycles in what appeared to be closely coordinated attacks.

The hit jobs then moved to Peshawar, the capital of Khyber-Pakhtunkhwa Province, which, along with the adjoining tribal belt, constitutes Pakistan’s main reservoir of new polio infections. The first victim there was one of two sisters who had volunteered as polio vaccinators. Men on motorcycles shadowed them as they walked from house to house. Once the sisters entered a quiet street, the gunmen opened fire. One of the sisters, Farzana, died instantly; the other was uninjured.

On Wednesday, a man working on the polio campaign was shot dead as he made a chalk mark on the door of a house in a suburb of Peshawar. Later, a female health supervisor in Charsadda, 15 miles to the north, was shot dead in a car she shared with her cousin.

Yet again, Pakistani militants are making a point of attacking women who stand for something larger. In October, it was Malala Yousafzai, a schoolgirl advocate for education who was gunned down by a Pakistani Taliban attacker in the Swat Valley. She was grievously wounded, and the militants vowed they would try again until they had killed her. The result was a tidal wave of public anger that clearly unsettled the Pakistani Taliban.

In singling out the core workers in one of Pakistan’s most crucial public health initiatives, militants seem to have resolved to harden their stance against immunization drives, and declared anew that they consider women to be legitimate targets. Until this week, vaccinators had never been targeted with such violence in such numbers.

Government officials in Peshawar said that they believe a Taliban faction in Mohmand, a tribal area near Peshawar, was behind at least some of the shootings. Still, the Pakistani Taliban have been uncharacteristically silent about the attacks, with no official claims of responsibility. In staying quiet, the militants may be trying to blunt any public backlash like the huge demonstrations over the attack on Ms. Yousafzai.

Female polio workers here make for easy targets. They wear no uniform but are readily recognizable, with clipboards and refrigerated vaccine boxes, walking door to door. They work in pairs — including at least one woman — and are paid just over $2.50 a day. Most days one team can vaccinate 150 to 200 children.

Faced with suspicious or recalcitrant parents, their only weapon is reassurance: a gentle pat on the hand, a shared cup of tea, an offer to seek religious assurances from a pro-vaccine cleric. “The whole program is dependent on them,” said Mr. Shah, in Peshawar. “If they do good work, and talk well to the parents, then they will vaccinate the children.”

That has happened with increasing frequency in Pakistan over the past year. A concerted immunization drive, involving up to 225,000 vaccination workers, drove the number of newly infected polio victims down to 52. Several high-profile groups shouldered the program forward — at the global level, donors like the Bill and Melinda Gates Foundation, the United Nations and Rotary International; and at the national level, President Asif Ali Zardari and his daughter Aseefa, who have made polio eradication a “personal mission.”

On a global scale, setbacks are not unusual in polio vaccination campaigns, which, by dint of their massive scale and need to reach deep inside conservative societies, end up grappling with more than just medical challenges. In other campaigns in Africa and South Asia, vaccinators have grappled with natural disaster, virulent opposition from conservative clerics and sudden outbreaks of mysterious strains of the disease.

Declan Walsh reported from Lahore, and Donald G. McNeil Jr. from New York. Ismail Khan contributed reporting from Peshawar, Pakistan.

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