London School of Hygiene & Tropical Medicine
"The tragic murders should be a wake-up call to the polio eradication effort. The last leg of eradication cannot be business as usual. Each step will need to carefully consider the local political, cultural and operational dynamics - and not the dynamics of the past year, but of the current week, and even each new day they operate in."
In this SciDev.net editorial, Heidi Larson reflects on the murders of 9 anti-polio workers in Pakistan in December 2012, followed by the New Year's Day (January 1 2013) killing of 7 more local community development workers, in the context of the Global Polio Eradication Initiative (GPEI) in its current form. She says: "The past month of public reporting and private discussions on what happened, why and what happens next have revealed a complex web of governance failings, inadequate development structures and a landscape of multiple security threats, both locally and internationally."
Citing some of the explanations for why the murders occurred, she moves on to explore what needs to be done to maintain the GPEI momentum while remaining conscious of the realities that have put polio workers' lives at risk. She suggests that efforts to eradicate polio need to combine with activities addressing other local priorities - not by temporarily adding other services to polio campaigns, but instead by supporting measures that contribute to long-term, sustainable development. This need is reflected in the fact that, for example, lady health workers (LHWs) have used the polio platform to draw attention to, for instance, their inadequate wages and job uncertainty. Also, community leaders, for instance, have boycotted the polio eradication initiative in Pakistan for various reasons, including for access to safe water and against power shortages. Even a high-level meeting of environmentalists and health experts used polio as leverage for better sanitation.
Along these lines, Larson observes that the November 2012 report of the International Monitoring Board for the Global Polio Eradication Initiative summed up the interface between the polio initiative and broader health and development issues. On the cover page, the subtitle lists a number of "essentials" for the polio virus to survive, including "political misalignment, weak local leadership, disengaged traditional and religious leaders, corruption and underfinanced programmes". She stresses that health and development concerns, as well as political dynamics, vary considerably at provincial - and even neighbourhood - levels, so the GPEI needs to consider such dynamics going forward.
Image credit: flickr/ UNICEF Sverige