Helen Epstein
Publication Date
December 22, 2012

"In order to avoid further tragedies, donors should work more closely with local people to improve the health of children in general, rather than strive for some romantic victory over a single virus alone."

Helen Epstein reflects on the murder of 9 members of a vaccination team working with the United Nations (UN)-sponsored Global Polio Eradication Initiative (GPEI) in Pakistan by gunmen thought to be linked to the Taliban. Epstein urges the GPEI to consider moving away from its one-disease focus in order to address broader community health issues. What she calls "the heroic approach" - "the lavishly funded, multiple immunizations the polio program requires" - does not always make sense to local political leaders and warlords or to ordinary poor people struggling just to keep their children alive.

Acknowledging that polio is a horrible disease, Epstein explains various reasons why the goal of eradication may be elusive. She notes that most child deaths are caused by diarrhoea and pneumonia, often exacerbated by malnutrition. "These diseases are easy to cure if basic health care is available, but often the only thing people see the government doing is intensive polio vaccination....Since the campaigns are usually run by local health workers, this means that during the campaigns, there may be no one at the local clinic to treat sick children in urgent need of care."

This situation presents communication challenges. "Faced with such invasive visits by foreigners, people living in a region of political turmoil may think the worst. This is why the polio campaigns have raised so much suspicion....In Pakistan, some think the vaccinators are spies, while others can't believe they have the interests of Pakistani children at heart because the campaigns are supported by the same white Westerners who are launching drone strikes that inadvertently kill those same children."

Thus, Epstein suggests that those involved with the GPEI should work closely with local leaders in Pakistan to improve the entire health system so that fewer children suffer from all diseases, including polio. For example, they could support a programme to ensure that clinics are adequately staffed and stocked with medicine and that parents are taught how to recognise and act on dangerous symptoms (fever, relentless coughing, diarrhoea) quickly. If parents delay seeking healthcare perhaps because they think their child's illness is caused by evil spirits or because there is no health worker or medicine at the clinic, it could be too late. "Addressing these problems would help give local people and health workers alike more control over their own well-being, as well as a sense that they are engaged in defining and solving their own problems, rather than relying on the largesse of institutions and states they are (sometimes with good reason) suspicious of."

To illustrate this strategy's potential, she concludes with an example of a programme run in Northern Ghana. Nurses based in clinics built by local volunteers regularly visit every family with a pregnant woman or small child and offer whatever medical help is needed. The nurses cost an additional US$1.92 per person per year, on top of what the government already spends on health - and polio vaccination is part of that programme. "There will be no Nobel Prizes for this type of work because the heroism is widely shared, but every so often, the entire community - chiefs, politicians, civil servants, villagers - gathers to sing and dance in celebration of the nurses, who are seen as champions, not adversaries."


The New York Review of Books (NYR) Blog, and email from Helen Epstein to The Communication Initiative on February 19 2013. Image credit: Behrouz Mehri/AFP/Getty Images