Polio beyond a medical problem

 

Polio—a disease that was once believed to be close to eradication worldwide—has reemerged in Pakistan compared  with previous years, according to World Health Organization. The country reported 70 cases of poliomyelitis due to wild poliovirus 1 in 2024. This emerging situation impacts decades of global and national progress. Vaccination drives are under obstruction, with health workers facing assaults, and refusals and resentment remains high in some regions, causing “immunity gap”. This begs the following question: why? Why do communities refuse vaccines? Why do vaccination teams face violence? Why has polio resurfaced despite medical advancements and sustained eradication efforts?

To address these questions, the relevant actors must expand their perspective. Polio cannot be understood solely as a medical problem. It is deeply entangled within Pakistan’s intricate web of social, cultural, political, and economic realities. Drawing on Bruno Latour’s Actor-Network Theory (ANT), we can see entities such as the poliovirus not only as biological agents but also as actors embedded in networks that link the natural, social, and semiotic worlds. Understanding polio’s persistence, therefore, requires rethinking it as part of a dynamic and multifaceted network where humans and nonhumans alike interact, act, and reshape outcomes: they influence each other.

At the heart of the polio crisis lies Pakistan’s challenged public health infrastructure, which is characterized by underfunding, resource shortages, and systemic inefficiencies. ANT reminds us that infrastructure cannot be viewed in isolation. Waterborne diseases and poor sanitation, for example, amplify the spread of poliovirus in marginalized communities. These porous boundaries between health, infrastructure, and socioeconomic conditions reveal synergistic relationships among them called “syndemics.”

Furthermore, building infrastructure alone is insufficient, as networks succeed or fail based on the basis of connections between their nodes. Public health systems need more than bricks and mortar; they need resources, trust, cooperation, and accountability. The repeated breakdown of health campaigns demonstrates how fragile these connections can be when strained by societal mistrust and logistical failures.

Vaccine hesitancy in Pakistan, while often linked to “ignorance,” is a deeply entangled or networked issue rooted in sociocultural, political, and historical narratives. Widespread rumors about vaccines causing infertility or being part of Western conspiracies to harm Muslims are not isolated beliefs. They are constructed and perpetuated within networks of mistrust compounded by colonial legacies, geopolitical conflicts, and failed state interventions. ANT emphasizes that networks are strengthened by the interactions of their parts: these rumours gain traction not in a vacuum but through their repetition by influential actors, from community leaders to social media misinformation campaigns.

Moreover, these narratives cannot be easily dismissed as “irrational.” As Latour suggested, the meanings and resistances associated with any entity—be it a vaccine or a syringe—are shaped by the histories and power dynamics embedded within the network. Decades of governmentality with broken promises have left communities suspicious of external interventions, including “fake” vaccination or health campaigns. Addressing vaccine hesitancy thus requires acknowledging and addressing these historical grievances.

The ANT lens allows to highlight the need to consider multiple dimensions and actants within any network. For instance, gender plays a crucial yet under explored role in  polio eradication efforts. Female health workers, who often lead vaccination drives, face significant obstacles in patriarchal societies. Their public roles are scrutinized and, at times, resisted in regions where traditional gender norms, i.e., patriarchy, dominate. This gendered dimension creates unique vulnerabilities within the network. Female health workers are not only met with societal resistance but also exposed to physical risks, ranging from harassment to violent attacks. The failure to recognize these challenges weakens the network, allowing the virus to exploit its gaps.

As mentioned earlier, the geopolitical dimension of polio eradication is another critical factor. In regions such as Khyber Pakhtunkhwa and Balochistan, critical situations such as various forms of “violence” create an environment of fear and hostility. Health workers are often targeted by those people who view vaccination campaigns as tools of foreign interference. The violent dynamics in these regions are not external to the problem but are deeply woven into the network itself. Efforts to depoliticize vaccination campaigns often overlook how the virus exploits these geopolitical fractures. When health teams are unable to operate due to security concerns, the virus finds fertile ground to spread. Polio thus transforms from a medical challenge into a geopolitical issue, entangling questions of national security, sovereignty, and international collaboration.

Economic inequality exacerbates the challenges of polio eradication. Poverty-stricken families living in unsanitary conditions with limited access to healthcare are disproportionately affected. ANT helps us understand how these conditions are not merely confounding factors but also active components in  persistence of the virus. For many families, vaccination may seem to be a distant priority compared with immediate survival needs such as food and shelter. This economic marginalization creates pockets of vulnerability where the virus thrives, further entrenching cycles of poverty and illness.

Polio is not just a disease. It is a reflection of ruptures and inequities in our society. A purely biomedical strategy—focused solely on administering vaccines—ignores the broader network of factors enabling the virus to persist. Instead, a synergistic approach is needed, one that acknowledges the virus as an actor enmeshed in a complex network of sociocultural, economic and geopolitical interactions. This acceptance will require engaging anthropologists, sociologists, and political scientists to play transformative roles in this effort. These social scientists can map, for instance, the pathways of mistrust and misinformation and design culturally sensitive interventions. With this, we can create a network resilient enough to overcome the adverse impact of microorganisms, including viruses, bacteria and fungi.

 

About the author: Inayat Ali is an Assistant Professor at the Department of Anthropology, Fatima Jinnah Women University, The Mall, Rawalpindi, Pakistan, and a Research Fellow at the Department of Social and Cultural Anthropology, University of Vienna, Vienna, Austria. He served as the founding Incharge, Department of Public Health and Allied Sciences, FJWU, Rawalpindi, Pakistan.

Competing interest: None

Handling Editor: Neha Faruqui

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