Polio Eradication and Health Systems in Karachi: Vaccine Refusals in Context

Abstract

Community and health worker engagement will be key to polio eradication in Karachi, Pakistan. In this study, the authors conducted participant observation, interviews, and a document review in SITE Town, Karachi, an area that in recent years has harbored poliovirus. SITE's diverse population includes large numbers of internally displaced persons who are disproportionately affected by polio and are more likely than other populations to refuse the polio vaccine. Vaccine acceptance and worker motivation in SITE Town were shaped by the discrepancy in funding and attention for polio eradication campaigns as compared with routine services. Parental vaccine refusals stemmed from a distrust of government and international actors that provided few services but administered polio vaccine door-to-door every month. Addressing this discrepancy could therefore be key to eliminating polio. The authors suggest short-term improvements to routine immunization and sanitation in key polio endemic areas, coupled with a longterm focus on sustainable improvements to routine immunization and broader health services.

A rapid qualitative assessment of oral cholera vaccine anticipated acceptability in a context of resistance towards cholera intervention in Nampula, Mozambique

“…Perceived insecurity (fear of being killed by an unidentified enemy or political opponent) likely exists because of the long-lasting civil war that pitted the coastal region against the central government, with some Nampula residents reporting a sense of still being at war, albeit in a different form [21] . Finally, vaccine refusals have been linked to immunization campaigns in contexts where demand refusal or inadequate funding for general health services and routine immunization is observed [22] . While Briggs and Briggs described cholera spread as a racially institutionalized uneven access to health services for the Warao [23] , Nampula respondents pointed to an institutional negligence, the lack of public waste management services as a root cause of cholera spread, which then translated into the perception of being abandoned by the central government and subsequent distrust in a variety of government-provided health interventions.…”

Eradicating polio in Pakistan: a systematic review of programs and policies

“…Several articles cited misbeliefs and misperceptions about polio vaccination as a barrier to increasing vaccination rates. The beliefs were of two different types; demographic, geopolitical, and religious concerns, and misbeliefs about when a child could be vaccinated [26,27,[31][32][33]36,[38][39][40][41][42]44,49,53,54,56,65]. Misbeliefs about when a child could be vaccinated were less common, and included caregivers who believed that they could not vaccinate their child if the child was unwell [33,42].…”

“…Demographic concerns were focused on the potential fertility impacts of the polio vaccine on increasing sterility [27,31,35,36,[38][39][40][41]44,[47][48][49]. Closely related to demographic concerns were geopolitical anxieties about the true motive underlying the vaccine [26,40,44,49]. Several studies described community fears that the polio campaign was part of a US, specifically CIA, agenda [40], while others highlighted community concerns about the involvement of foreign NGOs [44].…”

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

“…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). Parents' refusals and resentment chose not to vaccinate children are strong in those areas where the Pakhtun population lives due to a dearth of requiring knowledge about vaccination, low income, and formal education levels, as well as the number of children per household (Shah et al, 2019 Vaccination During COVID-19: Global Worries About Vaccination Programs COVID-19 is an emergent and continually evolving phenomena.…”