Defying Expectations: Polio Vaccination Programs Amid Political and Armed Conflict

Based on a panel discussion convened by the United States Institute of Peace (USIP) on June 29 2010, this brief explores strategies utilised by polio vaccination campaigns in areas of armed or serious political conflict. Communication-related elements explored in the brief include: involving interlocutors who are credible because they demonstrate neutrality; facilitating transparent discussions with opposition groups about the reasons for the campaigns; and involving opposition groups in facilitating the campaigns.

First, context is provided: "...immunization challenges are exacerbated during war. Supply lines are easily disrupted, vaccinators become potential targets for attacks, and manipulation of vaccination programs to gain political advantage is tempting."

Next, the strategy of organising "Days of Tranquility" is described. Here is an example: "In Afghanistan, prior to the start of U.S. [United States] military operations in 2001, the Taliban had cooperated in polio eradication campaigns. After the U.S.-led invasion in 2001, vaccination campaigns continued but as the Taliban presence strengthened over time, the initiative was hampered by insecurity. In response, the United Nations, upon request of the Afghanistan Ministry of Public Health, approached the International Committee of the Red Cross (ICRC), which was known by the Taliban for its neutral stance and making its health programs accessible to Taliban fighters, to take the lead as interlocutor with the Taliban. The ICRC enlisted the Taliban leader, Mullah Omar, to lend his support. As a result, he signed a letter, carried by every vaccinator, urging local Taliban commanders to cooperate in polio vaccination campaigns and reassuring parents that the campaign was a humanitarian activity. This letter significantly helped facilitate the movement of vaccinators and increase access to children living in Taliban strongholds. Other military forces also agreed to allow safe passage."

According to this brief, several elements appear particularly important in successful polio vaccine campaigns during armed conflict; communication-related elements include:

• Convincing all military forces and local leaders, including rebel commanders and warlords, to allow the programme to go forward. "In successful talks, the emissaries provide each group with data about the global polio situation, the status of polio in the country and its neighboring countries, the impact of polio paralysis on children, and the nature of the immunization campaign. They also generally convey that because the vaccine is free and operational costs are supported by international organizations, the program would bring modest resources to their area. In Peru, such discussions were accompanied by a media campaign that helped convince Sendero Luminoso that communities would benefit from a vaccination program. Building support for the vaccination campaign must extend down to the community level, which in some cases could include rival leaders."
• Facilitating the participation of rebel groups, warlords, and other anti-government groups in the vaccination process - e.g., by enabling them to become involved in the surveillance system.
• Ensuring transparency and neutrality throughout the vaccination process. "In the DRC [Democractic Republic of the Congo], for example, USAID [United States Agency for International Development] avoided engagement in any discussions with rebel leaders on political or tactical subjects. Because aid workers limited their discussions only to polio eradication and health, maintained low visibility, and provided a consistent message, rebel leaders gained confidence that the emissary was there in good faith and for the stated purpose, without an ulterior agenda."

In the context of an August 2003 situation that involved claims by community leaders that the polio vaccine was laced with anti-fertility drugs to sterilise Muslim girls, the brief notes that the resolution of that boycott was aided by the use of political and diplomatic tools to show political and thought leaders the health and political advantages to be gained by supporting a vaccination programme.

The brief concludes that: "Polio vaccination campaigns have a record of success in areas of armed or serious political conflict far greater than could be expected given the conditions under which they are implemented."