I wanted to let you know about a new publication from Dr Sebastian Taylor titled "Culture and Behaviour in Mass Health Interventions: Lessons from the Global Polio Eradication Initiative". Dr Taylor has worked on several polio communication reviews, is on the polio Technical Advisory Group for Pakistan and Afghanistan and has written several other papers on polio communication.
In this paper he poses a number of challenging questions regarding how the polio programme evaluates and responds to communities that resist immunisation. In his own words the main thesis is that, "Interpreting resistance to vaccination as essentially religio-cultural marginalises an understanding of resistance as the rational and strategic response by households and communities to systematic conditions of inequity and exclusion."
He notes that culture "has been treated as a dominant factor determining resistance to vaccination" in the GPEI. This resistance, "often occurring in areas with substantial Muslim population, has been associated with fear and rumour fuelled by ignorance", as well as religious objection, which he describes as "problematically merged in a religio-cultural interpretation of resistance as a kind of Islamic obscurantism." Yet attitudes about the polio programme "appear to vary substantially within small geographic areas. Rather than being a matter of common belief, public orientation appears to be shaped by a combination of religio-cultural and more localised socio-economic and political factors - in particular, the potentially aggressive nature of mass vaccination, and the perceived under-supply of other development goods."
I'd be interested in hearing your perspectives. Does this analysis ring true to you? Do we leave the polio programme and other health interventions vulnerable by seeking overly simplistic explanations for resistance? Do we place too much emphasis on a lens that paints such resistance as a matter of poor information, ignorance or propaganda?
You can read a summary of the paper on CIs polio website here.
Unfortunately Dr Taylor's full paper is only available through subscription to the Journal of Critical Public Health. You can read the abstract and purchase a copy here.