Colonial Afterlives and the Gendered Politics of Global Health Governance: Polio Eradication in Pakistan

• In Event: Putting Sociology to Work for a More Equitable Global Health

Abstract

Drawing on archival analysis of Global Polio Eradication Initiative (GPEI) and national policy documents published between 2003 and 2025, alongside interviews with provincial and federal health officials, the paper traces how gendered labor remained administratively indispensable yet analytically marginal within global health governance until recently. Female community health workers, Lady Health Workers (LHWs), serve as the primary interface between households, the state, and international agencies. Their gendered access to domestic space enables vaccination campaigns in highly patriarchal contexts, even as their labor is frequently neutralized through bureaucratic categories such as “frontline workers” or “community-based vaccinators.”
The analysis situates contemporary eradication efforts within longer colonial genealogies in which medicine functioned as a technology of surveillance, legitimacy, and population management. After 9/11, the entanglement of health interventions with counterterrorism practices intensified mistrust toward vaccination campaigns, exposing frontline workers to suspicion and violence. At the bureaucratic level, governance is distributed across donors and state institutions, producing arrangements in which financial authority remains transnational while political accountability is localized.
A notable shift emerges after 2019, when gender becomes formally incorporated into eradication strategies through gender mainstreaming initiatives focused on retention, safety, and community engagement. Rather than signaling rupture, this shift reveals how feminist development frameworks are institutionalized as managerial solutions to problems long sustained by global health structures themselves.
The paper argues that equitable global health requires confronting these colonial afterlives and recognizing gendered labor not as a delivery mechanism but as a site of political negotiation and authority.

Author

• Sarah Ahmed, Providence College