During the 2000s, confirmed polio cases in India have been increasingly localised in Uttar Pradesh (UP) and Bihar, especially amongst Muslim children. Muslims have also been at the sharp end of the Pulse Polio Initiative (PPI) and the associated ‘Underserved Strategy’ designed to counter civilian resistance to the programme. Our critique of the PPI draws on long-term research in rural UP and focuses on the programme's socio-political implications. We discuss popular rumours about polio vaccine and official responses to resistance. Taking a longer term view of top-down single-issue public health programmes, we argue that Muslims in western UP, as a marginalised minority, have good reason to be suspicious of the PPI. Moreover, the PPI arguably reflects the agendas of global funders, not the priorities of local communities. Villagers – Hindu and Muslim alike – have repeatedly criticised government health services for failing to deal with the health issues that worry them most. Their concerns echo other critiques of the PPI, particularly the diversion of resources from other health-related activities that could address the social determinants of health and health inequalities.
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