SEVEN policemen were killed, allegedly by ‘anti-vaccine militants’, in Karachi on Wednesday. The vaccination team was attacked in Orangi Town, where much of the population is Pakhtun.

Data released by the government and their INGO partners suggests a decline in recorded polio cases since January 2015 (dropping from 54 in 2015, to eight reported cases so far in 2016), and government officials claim that resistance to immunisation has decreased.

However, continued attacks on vaccination teams in different parts of the country suggest otherwise. We cannot, therefore, correlate the two. As there is no margin to leave even a single child unvaccinated, we must continue efforts to counter resistance to immunisation. While we know that certain communities hesitate to vaccinate their children against polio, have we conducted appropriate research to find out why? Where are our current methods failing us?

Often, the paternalistic approach that admi­nis­­­­trators of these campaigns take is to blame the communities (particularly Pakhtuns) for not vaccinating their children; citing lack of education, religious, and ‘fatalistic’ beliefs. By blaming communities’ cultural and socio-economic conditions, public health officials cover up their own incompetence; failing to design political, administrative and communication strategies adapted for community engagement.

The fight against polio needs a new strategy.

As polio teams are attacked, the government fails to respond by arresting gunmen, and building trust with communities to talk about what perceptions or misgivings led to such attacks. Instead, their solution is to depute police officers to escort vaccination teams — creating a perception that children are being vaccinated by force, that their parents have no rights in the matter. Particularly for Pakhtuns, this kind of intervention is seen as invasive, disrespectful, and therefore, subject to resistance.

Other than involving law enforcement, the government also initiated communication campaigns at a national level. But this strategy favours a top-down, singular communication strategy, as opposed to several which holistically address the needs and concerns of affected communities.

This disconnect is not surprising given that INGOs fund these campaigns (also a source of anxiety for communities), and government officials implement them, using strategies devised behind closed doors — with little public engagement and stakeholder buy-in. The approach is entirely colonial in spirit. The ‘stick’ method of threatening to arrest resisting parents, begets further validation of their suspicions of an overreaching state trampling on community values.

Polio vaccination campaigns will only be successful when we engage directly with communities in dialogue, and follow a ‘culture-centred’ approach to make the case for immunisation. Policymakers will have to make brave, nuanced decisions — not resort to Western-style public health interventions, and police force.

It will require policymakers to recognise the underprivileged conditions of these communities, and their own privilege; to bridge the gap in how both sides conceptualise health; to understand how communities prioritise their healthcare needs. It requires self-reflexivity on the part of policymakers to shed their biases, and stop promulgating a simplistic narrative that resistance comes down to religious, cultural, or educational differences. The need is to partner with communities; to invite them to buy into, and participate in, their healthcare initiatives; to advocate for them, not to them.

In my village, my neighbours do not vaccinate their children. Recently, two children with diarrhoea were rushed to hospital, where in the absence of adequate facilities, they perished. To these people, what is the bigger issue: polio, or diarrhoea? They question how the government allocates funds for vaccination campaigns, perhaps at the cost of other health issues. They fear legal action if they chose to share their grievances; they feel controlled and policed, despite not being criminals.

Who is to blame: my neighbours, or a government that has failed to convince them on the importance of immunisation? Will a fatwa, or a TV ad, convince them? No, only dialogue will — a personal communication medium designed to directly deliver those messages which address their concerns, while respecting their culture.

Only dialogue will result in a community-centric research, upon which tailored interventions can be based. Only dialogue will encourage officials to shed their tendencies of treating communities as colonial, or alien, subjects. Only dialogue will fill the information vacuum which gives birth to conspiracy theories, and allow for grievances to be expressed (and addressed). Only dialogue will allow resistant communities to access the much-needed agency they require to deal with structural problems in healthcare delivery.

There is no room for bullying or cajoling tactics. Respect, recognition of rights, the ability to connect with one’s constituents — this is what will ensure the success of polio eradication in Pakistan.

The writer is a PhD scholar specialising in health communications.

Published in Dawn, April 24th, 2016