Vaccination campaigns to eradicate polio will overcome local resistance only if health workers listen to the concerns of marginalised communities, and design communication strategies that take into account social and political complexities, say Heidi J. Larson and Isaac Ghinai.
The global campaign for polio eradication led to a 99 per cent drop in the estimated number of cases between 1988 and 2001. But the last one per cent of cases has been difficult to wipe out.
Anti-vaccine rumours in marginalised communities and a lack of political will are some of the key reasons behind the failure to rid the world of the disease. In Nigeria, for example, "religious and political leaders endorsed rumours that oral polio vaccine was an American conspiracy to spread HIV and cause infertility". Similarly, in India, rumours spread that the vaccine was being used to sterilise Muslims.
But the public health community must not give up the fight or adopt costly long-term measures against the disease, argue Larson and Ghinai. Instead it must learn from immunisation initiatives and ensure that concerns about vaccination are identified before they snowball into community-wide refusal.
The authors say that immunisation campaigns should incorporate social and political analyses in feasibility studies, find out who drives anti-vaccination resistance, and ensure that communication strategies give local people a sense of ownership over the campaigns in their community.
Work by the Global Polio Eradication Initiative in India's Uttar Pradesh state shows that campaigns can be successful if they work closely with formal and informal social networks, or collaborate with local institutions. "The state has not seen a case of polio for more than one year," say the authors.
In Nigeria, understanding the influence of religious or political leaders was essential, and the governor of Kano state vaccinating his child was a high-profile move to promote vaccination. Local barriers vary, say the authors, so different ways of engaging will work for different communities.