Working ‘off the record’: polio eradication and state immunity in Chad

Abstract

The reappearance of polio in Chad generates anxieties about governance as well as public health. Since Chad was declared polio-free in 2003, at least 180 cases of paralytic polio have been linked to importations of wild poliovirus from Nigeria. In efforts to eradicate polio through house-to-house vaccination campaigns, international agencies have aggressively implicated political leaders, placing those authorities in a bind. On the one hand, governments are required to demonstrate compliance in the form of universal vaccination. On the other hand, the legitimacy of political leaders and of local authorities in particular depends upon their ability to show compassion for their populations and to be responsive to individual circumstances and concerns about the drops. This article looks at how the obligation of the African state to adopt global public health policy as its own becomes problematic when the goals and protocols of international agencies rely on the assumption that the state controls its population. Under pressure to render account to international agencies, state officials deploy high-level politicians to enforce vaccination mandates at critical moments, create administrative forms to record campaign progress that conceal difficulties in vaccinating children, and use statistics to portray the campaigns as success stories. Local authorities, who feel the bind most acutely, grant exceptions to the mandate of universal vaccination to certain subjects and work with local vaccinators and supervisors to keep cases of unvaccinated children ‘off the record’. These efforts allow the vaccination campaigns to be carried out without incident even as they work against the goal of polio eradication.

Keywords:

• Chad
• disease eradication
• exception
• governance
• polio
• state
• vaccination

Acknowledgments

The National Science Foundation's Human and Social Dynamics Program (BCS-0527280) provided funding for the larger study within which this research was nested. An early version of this article was presented at the Society for Medical Anthropology conference in New Haven, CT in September 2009. Thanks to Joshua Garoon, Siba Grovogui, Randy Packard, Elisha Renne, Lindsey Reynolds, Emma Tsui and two anonymous reviewers for helpful comments on earlier drafts of this article. A special thanks to Ngondoloum Salathiel for assistance with interviews in Chad.

Notes

Notes

1. This figure is based on polio cases confirmed through 16 March 2010 (World Health Organization 2010).

2. In the house-to-house campaigns, vaccinators register a child's vaccination status by marking a fingernail with permanent marker, allowing supervisors to verify the vaccination status of children.

3. The Ministry of Public Health changed the designation from ‘poliomyelitis’ to ‘acute flaccid paralysis’ in 2002 to reflect the fact that reported cases of paralysis are not always confirmed as cases of polio.

4. Translated by the author.