Underserved and overdosed? Muslims and the Pulse Polio Initiative in rural north India

Abstract

During the 2000s, confirmed polio cases in India have been increasingly localised in Uttar Pradesh (UP) and Bihar, especially amongst Muslim children. Muslims have also been at the sharp end of the Pulse Polio Initiative (PPI) and the associated ‘Underserved Strategy’ designed to counter civilian resistance to the programme. Our critique of the PPI draws on long-term research in rural UP and focuses on the programme's socio-political implications. We discuss popular rumours about polio vaccine and official responses to resistance. Taking a longer term view of top-down single-issue public health programmes, we argue that Muslims in western UP, as a marginalised minority, have good reason to be suspicious of the PPI. Moreover, the PPI arguably reflects the agendas of global funders, not the priorities of local communities. Villagers – Hindu and Muslim alike – have repeatedly criticised government health services for failing to deal with the health issues that worry them most. Their concerns echo other critiques of the PPI, particularly the diversion of resources from other health-related activities that could address the social determinants of health and health inequalities.

Keywords:

• India
• Uttar Pradesh
• Muslims
• Pulse Polio Initiative
• Underserved Strategy

Acknowledgements

Our research in Bijnor district was funded in 1982–3 and 1985 by ESRC (G00230027 and G00232238) and Hayter Fund, in 1990–1991 by Overseas Development Administration and Rockefeller Foundation, in 2000–3 by ESRC (with Craig Jeffrey, R000238495), Ford Foundation and Royal Geographical Society, and in 2002–5 by Wellcome Trust (GR067231). None of these bears any responsibility for what we have written here. We also thank the people of our study villages in Bijnor for their forbearance and good humour; and our research assistants over the years, Swaleha Begum, Zarin Rais, Shaila Rais, the late Radha Rani Sharma, Chhaya Sharma and Manjula Sharma. Thanks also for comments on earlier versions of this paper to: participants in the “Polio histories, ‘Geographies of Blame’ and Global Health Workshop”, at the Society for Medical Anthropology Conference (Yale) in September 2009; Petra Brhlikova, Rajib Dasgupta, Ian Harper, Sarah Hill, Laura Jeffery, Craig Jeffrey, Mohan Rao, Elisha Renne, and three anonymous reviewers.

Notes

1. For a brief discussion of Pulse Polio, see Jeffery and Jeffery (2010b).

2. Chaturvedi (2008, 14) notes that achieving full coverage of birth doses is difficult because of high birth rates, low birth registration and few institutional deliveries.

3. WHO has recently recommended adjustments to the deployment of different combinations of oral vaccines, as well as supplementing oral vaccines with inactivated poliovirus vaccine (IPV), using a new higher vaccine titre mOPV1 and reducing infants’ susceptibility to diarrhoea by providing zinc supplements (see WHO 2006c, 2009c, 2009d, 2009e, 2010).

4. These and other related issues continue to be raised about the Global Health Initiatives that have developed during the 2000s. See WHO Maximizing Positive Synergies Collaborative Group (2009) and Editorial (2009).