Vaccine Refusal: A Major, Underestimated Obstacle for the Poliomyelitis Eradication Initiative

In 1988, the WHO launched the Global Poliomyelitis Eradication Initiative with the goal of eradication by 2000. Not only has this goal, which has been repeatedly postponed, still not been achieved, but while the wild polio virus is still endemic in two Asian countries, a new epidemic caused by a vaccine-derived virus is spreading and is now affecting numerous developing and industrialized countries, including the United Kingdom and the United States. In addition to biological explanations for the failure of eradication, vaccination refusal by communities in mainly two regions of Africa and Asia has prevented mass vaccination campaigns from achieving their immunization coverage targets. The way these campaigns have been deployed has contributed to mistrust and hostility. The negative reactions of some communities, expressed from the first vaccination campaigns, were belatedly considered, which gave time for rumors to flourish and settle permanently. This failure underscores the importance of taking into account, before any vaccination campaign begins, the "health culture" of target populations-meaning their representations of the vaccines and the health authorities that promote vaccination, as well as their knowledge, fears, and hopes.