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The vital drop : Communication for Polio Eradication in India : [book review] Closser, Svea 2010

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Pacific Affairs: Volume 83, No. 4 – December 2010  76 THE VITAL DROP: Communication for Polio Eradication in India. By Gitanjali Chaturvedi. New Delhi: Sage Publications India, 2008. xviii, 319 pp. (Figures, tables, maps, B&W photos.) US$39.95, cloth. ISBN 978-81-7829- 866-5. In recent years the Global Polio Eradication Initiative has created one of the most comprehensive health communication campaigns in India’s history. As India is one of the last four countries with endemic polio (the others are Pakistan, Afghanistan and Nigeria), the goal of increasing public demand for polio immunization has garnered substantial investment. Drawing on interviews and the personal observations of the clearly knowledgeable and committed author, The Vital Drop describes in detail the methods and trajectory of this historic social mobilization project. The book includes a brief history of polio eradication globally and in India (chapters 1 and 2), detailed information on the communication strategy in India, with a focus on the endemic states of Uttar Pradesh and Bihar (chapters 3 through 5), additional information on strategies in Bihar and other areas of the country (chapters 6 and 7), and a discussion of data collected by the communication project (chapter 8). The strength of the book lies in the three core chapters (chapters 3 through 5), which describe in detail the multi-pronged approach used in India’s polio communication strategy. The descriptions of an intensive media campaign featuring the actor Amitabh Bachhan, of the organization of a network of door-to-door health educators, and of outreach to Muslim communities are useful and comprehensive. These three chapters would form an interesting case study in a course on health communication, and could be used as a resource for people designing health communication programmes in India and elsewhere. The availability of this information to people outside the Polio Eradication Initiative is an important contribution of this book. However, the book has some weaknesses. Statements are made that are inaccurate: for example, on the first page, the author claims that “through polio eradication, we are reducing one of the few contributing factors of physical disability,” disregarding the effects not only of other enteroviruses but of accidents, aging and war. Some of the information on technical issues could have been presented more carefully; for example, the author incorrectly claims that use of inactivated polio vaccine (IPV) cannot create herd immunity (10). Throughout, the author takes claims made by her interviewees working in polio eradication at face value, citing them as fact without critical reflection. The book tends to toe the party line in terms of how UNICEF, and the Polio Eradication Initiative more generally, would like to portray the project. For example, with little evidence other than the statements of her interviewees, the author claims that so-called “vertical” programmes are always better managed than more broad-based primary health-care projects, and that  77 Electronic Book Review: South Asia vertical programmes “tend to be both egalitarian and democratic” (31). Whether this is in fact the case is arguable, and more evidence to support such claims would have been welcomed. Also, the book describes recipient populations in ways that at times are problematic. The state of Bihar, for example, is described as “a cauldron of complex yet classical social, political and economic backwardness” (183). There is a related troubling tendency throughout the book to attribute irrationality to people who refuse to vaccinate their children. Chaturvedi states, for example, that “most people relied on hearsay and the opinion of local (often religious) leaders rather than on logic or reason” (96), and that rumours about vaccine efficacy “emanated from ignorance, illiteracy, and a fatalistic outlook towards life” (218). Throughout the book, Chaturvedi lays out very nicely the ways in which populations with low vaccination rates for polio are also marginalized from the health system and the society at large, and illustrates this point very well, with striking interview quotes. It would have been helpful to tie these factors more explicitly to reasons these communities might have for refusing vaccination. This book is a good example of the utility of mixed methods; Chaturvedi draws on a great deal of interesting data, including a number of interviews, participant observation, and internal documents and research. As an anthropologist, I would have liked a clearer elucidation of the methods used, but a great deal of information of many types was collected and is presented. In particular, the interview quotes, presented both in epigraphs and in the text, are lively and interesting. Throughout the book, descriptions of communication programmes are paired with the results of research on the effectiveness of those programmes, which is a major strength of the work. Despite some weaknesses, this book offers a useful description of an extensive, multi-pronged and quite successful communications strategy. As such, it will be helpful as a reference and source of ideas for those planning other health communication programmes, both in India and elsewhere. Middlebury College, Middlebury, USA  svea closser


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