Culture and Behaviour in Mass Health Interventions: Lessons from the Global Polio Eradication Initiative

"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."

This is the central thesis advanced in this paper, which draws on a desk-based review of literature, real-time epidemiological evidence, and the author's own field-based experience working with the Global Polio Eradication Initiative (GPEI) over periods since 2001 in Nigeria, India, Pakistan, and Afghanistan. Noting that the definitive eradication of polio worldwide now hinges on maximising household oral polio vaccine (OPV) acceptance and delivery in just a few endemic countries, author Sebastian A.J. Taylor cites evidence suggesting that, "while vaccinator performance generally, and physical access related to security, create blockages in the vaccination supply-side, unwillingness to be vaccinated by small groups of households and communities constitutes the principal demand-side barrier."

In exploring why this is the case, Taylor 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 Taylor describes as "problematically merged in a religio-cultural interpretation of resistance as a kind of Islamic obscurantism." Yet, he observes, 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."