Militant violence, anti-vaccination conspiracies, and religious hard-liners have long thwarted a drive to once-and-for-all eradicate the crippling polio disease in Pakistan. But now, vaccination teams in the South Asian nation of some 220 million people face a new obstacle: fake marker pens. Polio workers say parents who are suspicious of the government’s immunization campaigns have acquired special markers used by health workers to put a colored dot on the left pinky fingers of children after they have been vaccinated. Health workers say parents opposed to the vaccinations are marking their children’s pinkies to make it appear they have been vaccinated when, in fact, they weren’t. The deception causes vaccination teams to skip over children who need to be vaccinated — thereby preventing the disease from being eliminated in the country. With the disappearance of wild polio cases in Nigeria in recent years, Pakistan and Afghanistan are currently the only countries in the world where new polio cases are found. The issue with the fake markers in Pakistan highlights the varied obstacles that are keeping Pakistan from eliminating polio, a childhood virus that leads to deformed limbs, paralysis, and even death. Thorough vaccination campaigns in recent years have dramatically reduced the number of polio cases in Pakistan, with only a dozen cases recorded last year. Many residents of the province, which lies along the porous border with Afghanistan, have been suspicious of the polio vaccine, with conservative Islamic clerics and militants claiming it is a Western conspiracy to harm or sterilize children. Anti-vaccination propaganda has also been fueled by a distrust of Western governments who fund vaccine programs. Pakistani militants have also propagandized that Western-made vaccines contain pig fat or alcohol, which are both forbidden in Islam. Militants in Pakistan have kidnapped, beaten, and assassinated dozens of vaccinators or their armed police escorts in recent years in a bid to stop local anti-polio campaigns.