Chasing Polio in Pakistan: Why the World's Largest Public Health Initiative May Fail

by Svea Closser

The number of global polio cases has fallen dramatically and eradication is within sight, but despite extraordinary efforts, polio retains its grip in a few areas. Anthropologist Svea Closser follows the trajectory of the polio eradication effort in Pakistan, one of the last four countries in the world with endemic polio. Journeying from vaccination campaigns in rural Pakistan to the center of global health decision making at the World Health Organization in Geneva, the author explores the historical and cultural underpinnings of eradication as a public health strategy, and reveals the culture of optimism that characterizes—and sometimes cripples—global health institutions.

With a keen ethnographic eye, Closser describes the complex power negotiations that underlie the eradication effort at every level, tracking techniques of resistance employed by district health workers and state governments alike. This book offers an analysis of local politics, social relations, and global political economy in the implementation of a worldwide public health effort, with broad implications for understanding what is possible in global health, now and for the future.

This book is the recipient of the annual Norman L. and Roselea J. Goldberg Prize for the best project in the area of medicine.

Genres: Anthropology, Nonfiction, History

256 pages, Paperback

First published August 16, 2010

Reviews

[Andrew Chan · Rating 5 out of 5]

okay so does someone want to write a summary of this book for me for my anthropology class by Monday? please?

[Shadow2333 · Rating 3 out of 5]

1. Svea Closser was capable of discovering and reporting common phenomena which the locals got used to but not beneficial for the eradication of polio in Pakistan. For example, she described the zonal supervisors and area in charge as irresponsible people who falsify data, strictly following the rules and writing down the number of unvaccinated children. "*People assigned to a new district were likely to go after problems proactively, but after some time, the foreign consultants often felt accountable for the results there and began defending the quality of the work rather than finding problems*," said one WHO official. Under his assumption, if Closser were not a foreign consultant but a regional health worker, she wouldn't seriously check other's work and thus would not be such resolute to report others' mistakes and existing "problems". As part of the local health system, a person would be unwilling to report their own mistakes and would be more likely to turn a blind eye. Therefore, this positionality as an outsider enables people to make up their minds to follow protocols and report problems when it's the time to do so.

2. The problems are fundamentally management issues, as emphasized by Closser several times. Resistance forces (including the use of networks of patron-clientism) coming from both local workers and national government result in disobedience of health workers, either because they are under-paid, or because the goal was too ideal to reach, despite established plans and provided funding. As a foreign monitor, there is rather a small possibility that Closser herself will voluntarily resist tasks assigned. However, as she proceeds with the immunization project, she would have become more closely related to the local workers, even though she didn't want it that way. For example, when mentioning how one of the campaigns was carried out, she described that people buy her foods. Later, she realized that this buying behavior was one of the ways that local professionals build up patron-clientism, which is like Guanxi in Chinese's terminology. Another example would be Fahad. It seems like Closser was almost intimidated when she decided to report three missed children rather than less to the superiority. If there were another less determinant foreign monitor, he/she would probably acknowledge allegiance to the campaign support person and Fahad. As a result, she/he will be entangled in the patron-client relationship.

[Ibrahim Rasheed · Rating 4 out of 5]

A surprising look into the reason why polio vaccination was difficult in Pakistan along with an analysis of the Polio Eradication Initiative. The author conducts a thorough investigation into the various power structures, from the on-the-ground vaccinators, to the Pakistan ministry officials, and all the way to the UN and WHO. Furthermore, the author reflects on her findings to suggest future aspects to consider for global and long-term eradication health initiatives.

However, the frequent referencing to "why the project may fail" is a bit humorous now that in 2017, there were only 8 cases of polio in Pakistan. A reflection by the author now that some progress has been made would be great.

[Sarah · Rating 3 out of 5]

An interesting read and deeper look at eliminating polio in Pakistan.

[Auster Caeli · Rating 4 out of 5]

Excellent, rounded ethnography of polio eradication work in Pakistan

[clare · Rating 3 out of 5]

An intriguing look at a global public health initiative in Pakistan. The other demonstrates considerable bias on the part of the WHO and their representatives, which is understandable given the WHO is the reason Closser was allowed to study the Polio Eradication Initiative and take part in the first place for her dissertation work. It's very clear the book is a dissertation, and the organization of the chapters and information presented suffers as a result.

[Matt · Rating 3 out of 5]

This is an interesting account of the Polio Eradication Initiative in Pakistan. It is thought provoking regarding the areas of vertical programming and global health politics, policy, and culture. Overall, a useful perspective and account of a troubled program that could serve public health practitioners well.

[Rebecca · Rating 5 out of 5]

Great example of applied medical anthropology in action.