Svea Closser has focused her research in Pakistan for the past ten years. She has worked with Polio Eradication Initiative employees to examine why the initiative has yet to realize its goals and has developed insightful ideas as to why polio remains a threat.
Interest in Global Health
- Closser first became interested in global health during a semester she spent in Nepal while earning her undergraduate degree. While in Nepal, she realized that development programs may look good on paper but “may be ineffective at best in practice” (Middlebury, Department of Sociology/Anthropology. 2012.).
- Closser applied for and was awarded a Fulbright to study medicine in Pakistan. There, she studied the relationship between traditional healers (also known as ethnomedical practitioners) and Primary Care Providers. “I concluded that in some areas, ethnomedical practitioners could be great assets in providing basic yet crucial health interventions. However, barriers to effectively working with these healers existed in the culture of health institutions” (Middlebury, Department of Sociology/Anthropology. 2012.).
- Closser continued her work in Pakistan and wrote her dissertation, “Global Development in Policy and Practice: The Polio Eradication Initiative from Atlanta to Rural Pakistan” while at Emory University.
- Closser lists her research interests as centered “on global health interventions in South Asia, and the global political, economic, and cultural environments that affect their shape and trajectory” (Middlebury, Department of Sociology/Anthropology. 2012.).
- “My research is driven by the question: What are the reasons for the lackluster results of many global health interventions?” She is driven by the fact that “even now one in thirteen children born worldwide die before they turn five, the vast majority from preventable and treatable disease” (Middlebury, Department of Sociology/Anthropology. 2012.).
Fieldwork in Pakistan
During 2006 and 2007, Closser was awarded funding to continue studying the Polio Eradication Initiative in Pakistan from the Wenner-Gren Foundation and the National Science Foundation. She published an ethnography titled “Chasing Polio in Pakistan: Why the World’s Largest Public Health Initiative May Fail.”
Closser’s research consisted of twelve months of fieldwork, ten of which were spent in Pakistan. Her time in Pakistan centered on studying the communities that received door-to-door immunizations as well as the local bureaucracies carrying out the immunizations and surveillance. Her two months outside Pakistani borders were spent at the offices of eradication officials in Geneva and Atlanta. Closser explains that this ethnography “describes the power relations that both make the Polio Eradication Initiative possible and foster resistance to international mandates by the local government workers responsible for conducting door-to-door immunization campaigns” (Middlebury, Department of Sociology/Anthropology. 2012.). The book was published in 2010 by Vanderbilt University Press and received the annual Norman L. and Roselea J. Goldberg Prize for the best project in the area of medicine.
Closser went on to publish a review of the treatment of ground-level health workers in Pakistan for UNICEF that includes recommendations for improving the livelihoods and productivity of lady health workers. That document can be found here.
- The Global Eradication Initiative has thus far blamed the failure of polio eradication in Pakistan on operational failures where operational feasibility is understood to be “the capacity to deliver the necessary interventions at the necessary scale to the populations where they are needed” and technical feasibility is defined as the “biological features of the pathogen and available vaccines or other control measures” (Closser 2010: 31). As an alternative, Closser argues that Pakistan has yet to eradicate polio because of its low political and social feasibility. For example, eradicating polio is not the government’s first priority.
- “False optimism” addresses the optimistic situation presented by international bodies such as the WHO, Rotary, and the CDC compared to the local realities hindering eradication Closser identifies. International bodies present an optimistic picture to increase funding and encourage donors to financially support the last vaccination push that will finally eradicate polio from Pakistan. Closser argues fundamental changes must be made within the Eradication Initiative before eradication will be accomplished.
- Lady health workers face a number of difficulties that influence their resistance including long days filled with walking, low pay, and a lack of reasonable childcare. As a result, they find total compliance with strict official protocol difficult.
- Government health workers resist their work in a number of ways including “foot-dragging, false compliance, and the use of networks of patron-clientism” (Closser 2010: 6). Closser offers adequate compensation as one solution to resistant employees.
Current Position and Research
- Closser is currently an Assistant Professor of Anthropology and Sociology at Middlebury College.
- She has recently teamed up with collaborators at Brown University to look into community health worker pay (Sheridan 2010).
- first year seminar of epidemics
- African studies senior thesis
- South Asian studies in the International Department
- advised a number of independent projects and senior theses
- global health
- ethnographic research
- anthropology of Muslim cultures
- medical anthropology
- success/failure global health
Click here for a list of Closser’s publications.
Interview with Svea Closser, 1 May 2012
Question: What, if any, effects has your research had on the Polio Eradication Initiative since your ethnography was published in 2010? Are you glad you highlighted the Initiative’s shortcomings like you did? Was there any personal or professional backlash to the critiques you presented in your book?
Closser: One outcome was that the Global Independent Monitoring Board read the book and found it useful. This was very gratifying! Not everyone agrees with the arguments I make in the book. But respectful disagreement and debate are important parts of healthy academic inquiry.
Question: You mention early on that your fieldwork caused you to use interdisciplinary analysis and thought. Do you think anthropology as a whole has gone too far to distinguish itself from other disciplines? What benefits are there of coming out of the ivory tower in terms of using additional disciplines or doing activist work during a project?
Closser: I don’t think anthropology is alone in having a disciplinary silo. But I consistently find that working with people from other disciplines broadens my outlook and my understanding–while at times making me aware of what an anthropologist I am!
Personally, I think the line between “academic” and “activist” is a bit overblown. All of my academic work is done with practical goals in mind, but that doesn’t make it any less rigorous or theoretical. I find having the ‘so what’ of my work firmly in view keeps me motivated.
Question: With the removal of India from the WHO’s list of countries with polio last month, do you think Pakistan’s agenda will change at all? Will funding for the project increase? Do you agree with the mandatory vaccinations imposed on Pakistanis traveling in India?
Closser: Pakistan is under an enormous amount of pressure currently for polio. In terms of the agenda changing, I think the fundamental issues are the same if not exacerbated since I wrote the book: even with as much pressure as there is for polio, Pakistan has a lot of very serious issues that demand high level attention and given these extremely pressing competing priorities, it’s unlikely that polio is truly at the top of the agenda of any major politician. Also, responsibility for health has been largely devolved to the states in Pakistan since I wrote the book, so although there is still some central control for polio, it may be less direct than it used to be. Funding for the project in Pakistan may increase slightly but it’s unlikely to go through the roof.
India is not the only country to impose mandatory polio vaccinations on Pakistanis. For example, Pakistanis already have to get mandatory polio vaccination to go to Saudi Arabia on the Hajj.
Question: You talk a lot about resistance and the role resistance plays in the failure of fully eradicating polio. Do you think the Initiative in Pakistan will learn to work cohesively without resistance to accomplish eradication without larger changes (here, I’m thinking about the low pay standards and tough working conditions of lady health workers).
Closser: There is some talk of improving working conditions of Lady Health Workers, and UNICEF and some other donors have taken an interest in this issue since I wrote the book. But, the working conditions are the responsibility of the government as well. Accomplishing change in this arena is difficult, and not everyone agrees that it should be a priority.
Question: You mention Paul Farmer and his focus on poverty as the root of all disease. Do you think that eradicating polio will contribute to the eradication of poverty and subsequently, the disease burden of the poor? Do you think more structural changes are needed to address the root cause, poverty, instead of what Farmer would argue is the system, polio?
Closser: I think eradicating polio would be a very good thing, but it will not contribute to the eradication of poverty or the overall burden of disease. Yes, more structural changes are needed.
Question: In terms of active anthropologists, you mention that anthropologists can play a critical role as planners of health initiatives and other programs. Do you see anthropologists ever playing the role of advocate? activist? expert? legal witness?
Closser: All of the above, if appropriate. As I mentioned above, I really think that rigorous academic work has a very important place in the ‘real world.’