The majority of Western public health officials blame the security situation in Pakistan, Pakhtun culture, and CIA espionage activity in the guise of an infamous vaccination campaign for the failures of the anti-polio campaign in Pakistan. In fact, the government, international NGOs, and the media all appear to be driving home the point that these are the main reasons for the spread of polio in Pakistan.

We don’t see any alternative opinions. No one talks about the organisational structure of the polio vaccine initiatives. No one tries to find local solutions to this complex issue. The media has been reliant on press releases issued by international organisations and the government, about the polio eradication campaign. Academics appear to be sleeping and are not contributing anything to resolve this issue. In the absence of logical debate, conspiracy theories prevail.

If ‘Pakhtun culture’ is responsible for resistance to the polio vaccination campaigns, why do Pakhtun parents vaccinate their kids against other diseases? If the CIA’s fake vaccination campaign to track down Osama bin Laden is responsible for the collapse of the campaign, what was the situation before that operation?

Those who refuse polio vaccinations should be part of the debate.

A theory in public relations states that in case of a crisis people are more likely to affix responsibility on external factors than internal ones. People hold others responsible for mishaps or failures. We can notice this attribution game in the polio eradication initiatives. There are three main stakeholders that are supposed to make these initiatives successful: INGOs; the government; and the media.

Many international organisations working for polio eradication blame the Pakistan government and local cultural and security sensitivities for the failure of campaigns. They don’t take responsibility themselves. Despite spending billions of dollars, they have failed to create enough human resource in Pakistan to deal with local issues and come up with out-of-the-box solutions. A large number of health campaigns are funded and endorsed by international groups involving experts who are mainly Western public health officials.

Though most Western scholars claim to be culturally competent and well-versed in public health theories, they fail to gauge local realities and create successful campaigns. A Western expert can get paid as much as $500 a day for his/her services in Pakistan, whereas vaccine workers get as little as $3 a day for their untiring efforts. Why would someone put his/her life in danger for $3 a day or work in the sweltering heat for about 10 hours a day for such a small amount? This is why many vaccinators don’t bother visiting all houses allotted to them.

The government, despite its tall claims, has also failed to focus on the polio eradication initiative. If by taking the polio eradication initiative seriously, officials mean taking pictures of inauguration campaigns and issuing press releases, then definitely the government has been successful. However, ‘seriousness’ demands more. Ministers, lawmakers and members of the opposition need to be part of the polio vaccination campaigns. They need to visit their constituencies regularly and try to mould public opinion in favour of the vaccination campaigns, the way they do to get votes. They should also involve local clerics in the campaign.

Have you ever seen a feature in a newspaper focusing on those people who are refusing to vaccinate their kids? Have you ever seen a TV show in which those who refuse to vaccinate their kids are invited? The media need to play a positive role to find a solution. The masses need to know why people are refusing to vaccinate their kids. Those who refuse should be part of the larger debate. Instead of believing in conspiracy theories, we should motivate those who refuse to explain their grievances.

If we want to eradicate polio from Pakistan, we will have to come up with alternative solutions. We will have to include parents who refuse to vaccinate their kids in the discourse and then come up with logical campaigns based on their responses. Policing is not a solution. Including the police means that the state is forcing something on citizens.

International groups will have to change their strategies and force both themselves and the government to do more. Just creating a polio eradication cell should not be acceptable. In order to create successful health campaigns, the stakeholders need to hire the services of health communication and public health experts who have expertise in creating culturally sensitive and tailored messages.

Physicians or bureaucrats or international health experts without cultural humility should not be asked to create anti-polio campaigns. Perhaps we need to start community-based participatory research projects to increase vaccination in the communities that are refusing to vaccinate their kids. Let’s do something different this time.

The writer is a PhD scholar at the University of New Mexico, focusing on health communication.

Published in Dawn, November 26th, 2015