Hanging in the balance: the politics of global polio eradication in Pakistan.
Poliomyelitis is reemerging in the public conscious after decades of obscurity. The Global Polio Eradication Initiative (GPEI) is the largest, most ambitious international public health program currently in operation. Since its inception in 1988 the GPEI has immunized 2.5 billion children across 200 countries, resulting in the reduction of worldwide polio cases by 99%. Despite this success the disease continue to circulate in Pakistan, inhibiting efforts to achieve worldwide eradication. A number of issues relating to both the national health infrastructure (NHI) and broader socio-political factors impede polio eradication in Pakistan, particularly in the Federally Administered Tribal Areas (FATA). Current literature is dominated by a narrow focus upon NHI problems. However a broader discussion of the non-NHI issues impeding vaccination is required, including recognition of the connection between the non-NHI problems and Western intervention in the region. This paper will address non-NHI issues impeding the GPEI in the FATA and border regions, arguing that polio eradication in Pakistan is not achievable in the current context of political instability, social opposition and inaccessibility within volatile areas. Unless these complex issues in the FATA and border regions are addressed, polio eradication in Pakistan will remain unachievable.