1. Deconstructing Social Resistance to the Polio Eradication Campaign in India: A Social Determinants FrameworkRajib Dasgupta 1 Rajib Dasgupta [JNU/JHSPH]

3. Less visible clusters of under/un-immunized children

4. Such clusters, however minuscule, sustain circulation of WPV

5. High urbanization rates; large populations of urban poor

6. Negative correlation between higher rates of urbanization, and, poverty and literacy

7. Poor marginalized communities in peri-urban slums

8. Up to 50% or more of the population in some urban local bodies reside in slums

10. Distinct social resistance among Muslim communities for polio vaccine during ‘pulse’ rounds

11. % of Muslim population: 4 times higher in endemic districts

12. 45.2% of urban Muslims in slums vs. 18.4% in the general population

14. J P Nagar District: 40.5% and 24.5%

15. ‘Excess’ illiteracy among urban-Muslim women in Moradabad: 10%

16. Head Count Ratios (HCR) for urban Muslims in UP up by 6 points in 61st Round of the NSS

18. Children accompanying parents to their workplace, mostly agricultural fields

19. Complacent : waiting someone to come home and deliver

20. Visiting relatives and social functions

21. Adverse past experience

22. ‘Reluctant’ -- due to (acute and chronic) illness and the newborns

23. ‘Resistant’Dasgupta et al (2008) Rajib Dasgupta [JNU/JHSPH]

24. 6 Circulating Rumors and Misconceptions Chaturvedi et al (2009) Rajib Dasgupta [JNU/JHSPH]

26. Locally restricted announcements through static and mobile (rickshaw bound) public address systems

27. Address by a religious leader after a prayer ceremony

28. Quasi-confirmed religious edicts, often disowned by the sources

29. Rational constituents of the society try to reach for the source

30. Sources go out of bounds or dissociate themselves from the episode

31. Public retraction/contradiction never available

32. At best, the sources adopt a neutral stand

33. By this time, the damage is already done.

34. Despite this, majority of the families in minority areas support SIAs

35. A significant number of parents among them, mostly from extremely marginalized sections, get decisively influenced by the rumors and continue to defeat SIAs

36. Though miniscule at the macro level, they may be able to sustain low level of transmission of WPV.

37. Underlying generalized lack of trust , and,suspicion

38. Through social osmosis, these rumors reach untargeted audience as well, and some economically and socially marginalized clusters from the majority community also get influenced

39. However in this case, seldom translate into a significant and lasting resistance to SIAsChaturvedi et al (2009) 7 Rajib Dasgupta [JNU/JHSPH]

41. Minority communities suspicious of highly visible, quasi-vertical and repetitive pulse polio program

42. Contents and concerns of rumors: ‘cultural wisdom’ of a ‘community under siege’

43. Religion a ‘confounding’ of sorts; a bargaining point among other communities and better-off states too8 Rajib Dasgupta [JNU/JHSPH]

46. Policy terrain can itself be exclusionary by using labels such as ‘hard to reach’

47. Hard to reach, or hardly reached?

48. Nature and characters of citizenship and legality in rural and urban societies

49. Structural inequities of urban health systems

50. Complex intersections with poverty, gender and culture

51. Assimilative nature of campaigns can be a core process of alienation10 Issues of Social Exclusion and Inclusion Rajib Dasgupta [JNU/JHSPH]

53. Reaching newborns

54. Reliable and responsive primary healthcare services

55. Community dialogue; complementary to social mobilization

56. Services in slums and peri-urban areas

57. Community fatigue and implementation fatigue

58. Engaging with ‘otherness’

59. Making micro-planning meaningful 11 Rajib Dasgupta [JNU/JHSPH] Key Last-Mile Challenges . . . .