Unexpected agency: participation as a bargaining chip for the poor.

Populations in the developing world that are targeted for disease eradication programs are commonly seen as passive recipients of international aid. Poor people can, however, "participate" in these interventions in unexpected ways. In the absence of traditional sources of leverage, some marginalized people have used their one remaining form of influence--their noncompliance in public health initiatives--to articulate a higher priority need and to assert their basic human rights to food and primary health care. Vertical international health initiatives whose goals are to eradicate and control diseases may be forced to contend with this phenomenon. The success of these interventions will hinge upon ensuring that the basic human rights of the target populations are addressed.