POST 00951E : THINKING THE UNTHINKABLE

POST 00951E : THINKING THE UNTHINKABLE Follow-up on Posts 00917E, 00923E, 00931E, 00937E, 00942E and 00947E 8 July 2006 __________________________________________________________________ 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. _____________________________________ 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 --------------------------- 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 ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[email protected] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. 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