Via Dawn.com, a thoughtful op-ed by Fawad Ali Shah, a Ph.D. student specializing in health communication: Defeating polio. Excerpt:
Data released by the government and their INGO partners suggests a decline in recorded polio cases since January 2015 (dropping from 54 in 2015, to eight reported cases so far in 2016), and government officials claim that resistance to immunisation has decreased.
However, continued attacks on vaccination teams in different parts of the country suggest otherwise. We cannot, therefore, correlate the two. As there is no margin to leave even a single child unvaccinated, we must continue efforts to counter resistance to immunisation.
While we know that certain communities hesitate to vaccinate their children against polio, have we conducted appropriate research to find out why? Where are our current methods failing us?
Often, the paternalistic approach that administrators of these campaigns take is to blame the communities (particularly Pakhtuns) for not vaccinating their children; citing lack of education, religious, and ‘fatalistic’ beliefs. By blaming communities’ cultural and socio-economic conditions, public health officials cover up their own incompetence; failing to design political, administrative and communication strategies adapted for community engagement.
The fight against polio needs a new strategy.
As polio teams are attacked, the government fails to respond by arresting gunmen, and building trust with communities to talk about what perceptions or misgivings led to such attacks. Instead, their solution is to depute police officers to escort vaccination teams — creating a perception that children are being vaccinated by force, that their parents have no rights in the matter. Particularly for Pakhtuns, this kind of intervention is seen as invasive, disrespectful, and therefore, subject to resistance.
Other than involving law enforcement, the government also initiated communication campaigns at a national level. But this strategy favours a top-down, singular communication strategy, as opposed to several which holistically address the needs and concerns of affected communities.
This disconnect is not surprising given that INGOs fund these campaigns (also a source of anxiety for communities), and government officials implement them, using strategies devised behind closed doors — with little public engagement and stakeholder buy-in. The approach is entirely colonial in spirit. The ‘stick’ method of threatening to arrest resisting parents, begets further validation of their suspicions of an overreaching state trampling on community values.
Polio vaccination campaigns will only be successful when we engage directly with communities in dialogue, and follow a ‘culture-centred’ approach to make the case for immunisation. Policymakers will have to make brave, nuanced decisions — not resort to Western-style public health interventions, and police force.