The Global Context of Vaccine Refusal: Insights from a Systematic Comparative Ethnography of the Global Polio Eradication Initiative

Abstract

Many of medical anthropology's most pressing research questions require an understanding how infections, money, and ideas move around the globe. The Global Polio Eradication Initiative (GPEI) is a $9 billion project that has delivered 20 billion doses of oral polio vaccine in campaigns across the world. With its array of global activities, it cannot be comprehensively explored by the traditional anthropological method of research at one field site. This article describes an ethnographic study of the GPEI, a collaborative effort between researchers at eight sites in seven countries. We developed a methodology grounded in nuanced understandings of local context but structured to allow analysis of global trends. Here, we examine polio vaccine acceptance and refusal to understand how global phenomena-in this case, policy decisions by donors and global health organizations to support vaccination campaigns rather than building health systems-shape local behavior.

COVID-19 and Vaccination Campaigns as “Western Plots” in Pakistan: Government Policies, (Geo-)politics, Local Perceptions, and Beliefs

“…As described above, low vaccination uptake results from the problems related to administering vaccines, and from people's distrust of vaccines, of the government, and of the global stakeholders. The phenomenon of vaccine refusals is complex and related to "the histories, politics, and social structures" (Closser et al, 2016). Also refusals are associated with the government's failure not to meet other responsibilities toward people (Closser et al, 2015).…”

30 years of polio campaigns in Ethiopia, India and Nigeria: the impacts of campaign design on vaccine hesitancy and health worker motivation

“…Unlike previous analyses, which have focused on the polio programme's impacts on health systems, our analysis focuses on how interactions between the polio programme and the health system influence two key outcomes, frontline health worker (FLHW) motivation and vaccine hesitancy. (We take the definition of vaccine hesitancy as 'delay in acceptance or refusal of vaccination despite availability of vaccination services' 21 ; hesitancy has multifactorial determinants, including issues beyond the vaccine itself, and varies by population and context [22][23][24] ). These two factors, in turn, affect campaign coverage in the polio programme itself.…”

‘Anti-Vaxxers’ and Vaccine Citizenship: Insights for Medical Education

“…It is an umbrella term, which gives no space for the heterogeneity of antivaccination sentiment. For example, individuals may reject some vaccines but not others; may have experienced adverse effects from prior vaccination; may reject vaccines for entirely political reasons; or use the rejection of vaccination to symbolise something else [6,7]. The 'anti-vaxxer' label elides all vaccine refusal into a fixed, static opposition to vaccinationdespite the fact that most who decline vaccines are more accurately described as being hesitant towards them [8].…”

“…5. Recognise that vaccine hesitancy is a spectrum, not a binary between accepters and refusers [6]. It may take more time for people to gain confidence.…”