An interesting study (with thanks to Community Health Impact Coalition)
CITATION: Engage less, provide more: Community health workers’ perspectives on how to overcome opposition to polio vaccination in Pakistan
Arman Majidulla et al.
Article: 2465645 | Received 04 Apr 2023, Accepted 06 Feb 2025, Published online: 11 Feb 2025
https://doi.org/10.1080/17441692.2025.2465645
Study aims: To examine frontline polio workers’ experiences in Super High Risk Union Councils (SHRUCs) in Pakistan, understand community resistance to vaccination, and explore alternative strategies to improve vaccine uptake.
Methods: The study used participant observation, 116 interviews, and a Human-Centered Design (HCD) process with 171 teams of frontline polio workers from 2020 to 2022 in a major SHRUC in Pakistan.
Key messages:
• Households in SHRUCs experience "campaign fatigue" due to frequent vaccination visits and data collection, leading to increased resistance and mistrust.
• Some families refuse vaccination as a form of protest against government neglect, using it as leverage to demand essential services such as clean water, sanitation, and healthcare.
• Frontline workers advocate for fewer vaccination touchpoints and a broader role in providing essential services, including basic healthcare, nutrition, and hygiene supplies, to improve community trust and vaccine acceptance.
• The study argues that vaccine resistance is often not due to hesitancy or misinformation alone but is a response to systemic neglect and inequality.
Policy recommendations:
• Minimize redundant home visits that contribute to community fatigue and resentment (i.e. focus on high-quality engagement rather than frequent persuasion attempts).
• Pair immunization campaigns with the provision of food, medicine, sanitation improvements, and primary healthcare (i.e. integrated approach to care).
• Recognize that refusal is often a protest against broader socio-economic issues rather than a rejection of vaccines.
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org