In pursuit of zero: Polio, global health security and the politics of eradication in Peshawar, Pakistan

Abstract

Whilst global health scholars have observed a resurgent interest in the idea of disease eradication, little has been said about the manner in which evidence of progress towards “zero” has been collected, compiled and circulated. I focus on two polio immunisation campaigns conducted in Peshawar, Pakistan, to illuminate the relationship between eradication, calculation and governmentality. Both of these campaigns relied on an epistemologically different set of governmental practices – one statistical, the other moral – to evidence progress towards zero polio cases and secure the compliance of reluctant individuals. I demonstrate how the calculative practices of national and global eradication initiatives encountered political limits whilst attempting to produce intelligible fields to guide interventions in the city. In response, a new set of governmental techniques, reliant upon legal decrees and operating through the inculcation of compliant behavioural norms, sought to re-establish a commitment to eradication over a series of unruly individuals and spaces. I argue that a central tenet of these polio campaigns, and eradication initiatives generally, is a recourse to the governance of conduct, as marginal yet politically significant populations contest the diagnoses and prescriptions of public health interventions. Approaching the epistemology of global health governance through this problematisation of individual behaviours reveals the contingencies and reversals that are the hallmarks of the politics of eradication – from manipulation of data to the suppression of individual behaviour – and the nascent forms of counter-conduct that they increasingly provoke.