Pakistan has seen a long-running campaign by militants and conservative religious leaders against vaccines, female health workers and female educators. Long before the CIA vaccination campaign, Taliban leaders argued polio drops were American attempts to sterilize children or collect intelligence information. Militants often threatened anyone who represented the government of the West.
"Militants go after representation of the state," said Christine Fair, a Pakistan expert and professor at Georgetown University. "They go after health care workers as part of their evolving inventory of targets that really shake people's confidence in the state's ability to protect them."
But while in the past militants might have threatened vaccine distributors or aid workers, they usually stopped short of attacking them.
That's why Akhtar and other Pakistani health workers are pointing to the CIA campaign. The three deadly attacks on female health workers in the last three weeks is an unprecedented assault on polio vaccinations in Pakistan, one of only three countries in the world where the disease is still endemic.
Health workers have made massive gains against polio in Pakistan. In the early 1990s, more than 20,000 children contracted polio, but that dropped to 28 in 2005, according to the World Health Organization. Cases fluctuated in the years since. They rose to 190 in 2011 before dropping again this year.
But Pakistani health workers warn the violence may prevent them from doing their jobs, risking some of the hard-won progress.
"I am now too scared to carry on. My parents have told me that I cannot carry on my job," said Nazia, a health worker in northwest Pakistan who asked that neither her last name nor her exact location are disclosed. "I don't know yet but I would like to carry on with my job. If people like us stop doing our job, our children will be at risk."