POST 00951E : THINKING THE UNTHINKABLE
Follow-up on Posts 00917E, 00923E, 00931E, 00937E, 00942E and 00947E
8 July 2006
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This posting contains two contributions. The first is a short message of
appreciation from Mogens Munck (mailto:[email protected]). The second
is from Robert Steinglass (mailto:[email protected]) who expresses
a divergent opinion. What he says in his introduction on freedom of
expression is both true and of great concern. Divergent opinions and
critics from consultants are often not welcomed, in many organizations, and
a guarantee of not being re-hired. Besides in many societies, it is still
only the chief who speaks. Others keep quiet and listen.
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Dear Technet,
On my part I want to express my gratitude for the many responses to this
topic, originally raised by Anthony. We have now a lively and friendly
discussion going on, with inputs from many colleagues, and we all gain more
insight.
So thanks to Stan, Nasim, Bob, Dr. Julien Milstien, Patrick, and Hans!
I will now read with detail all the inputs and not least the literature
references.
Best regards,
Mogens Munck
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These past few weeks, I have been hoping that field staff will contribute
their views before interjecting my own.
However, I also recognize that it is extremely risky for field staff,
especially those on short-term contracts, to openly share their views on
such a hot topic as polio eradication. With so many public resources
committed to PEI and with such high expectations, I believe that those
working both at global and field levels have a particular responsibility as
international civil servants to serve the public interest.
During the unquestioned and undebated build-up here in 2002 to the Iraq
war, I was introduced to a military term from the prestigious Jane's
Defense Weekly. "Incestuous amplification" apparently is "a condition in
warfare where one only listens to those who are already in lock-step
agreement, reinforcing set beliefs and creating a situation ripe for
miscalculation." I believe there are parallels with the polio debate.
Silence must not be interpreted as assent.
My intent now is NOT to question whether polio can or will be eradicated,
but instead to dust off some of the concerns that have been expressed,
widely and in private, for a very long time among field staff about HOW to
make PEI succeed while truly strengthening routine immunization. The
simplest way for me to summarize some of the concerns is to share the
following document, that can be downloaded from :
http://www.technet21.org/pdf_file/PolioEvaluationWHOdivergent.pdf (2.72
MB before encoding)
I had been invited to present the negative effect that PEI was having on
routine immunization.
The file includes a single document containing:
- the conclusions and recommendations from the "Thematic Evaluations in
2001: Eradication of Poliomyelitis. Report by the Director-General." It was
prepared for the WHO Programme Development Committee of the Executive Board
on 13 December 2001 (EBPDC8/3). It is not a document that would be widely
known to TECHNET readers. One of the key conclusions was that "it has been
demonstrated without doubt that the [Polio Eradication] Initiative has
contributed significantly to the development of the Expanded Programme on
Immunization."
- my perspectives (pages 11-17), which were invited by the evaluation
organizers and were included in the appendix as the "divergent" view on the
effect that PEI was having on strengthening routine immunization. I had
tried to capture what countless field workers had told me, what I had read
in so much "grey literature", what I had observed first-hand in many
countries, and what was not being sufficiently discussed and debated. Such
Orwellian concepts as "groupthink" and "thoughtcrime" did not (and do not)
generally encourage contrary views to be aired in public, and I appreciated
the opportunity from WHO to summarize the concerns.
My perspective has been (and continues to be) that with so much funding
flowing into PEI, we needed to ensure that the promised collateral benefits
for the routine immunization program - - on whose behalf the PEI
rhetorically claimed a positive contribution - - indeed materialized.
Constructive debate encompassing a broader set of disciplines should have
happened earlier. It would have been, and still can be, healthy. I hope
TECHNET will hear from others.
Sincerely,
Robert Steinglass
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