The Drum Beat 373 - Strategic Thinking on Polio Communication

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This issue of the Drum Beat highlights some of the summaries posted in the past year on The Communication Initiative website that explore new ways of viewing, connecting, addressing, and assessing polio eradication through communication.

Please also click here for summaries of and links to the full presentations from the Annual Meeting of the Technical Advisory Group (TAG) on Communication for Polio Eradication (convened jointly by the United Nations Children's Fund (UNICEF)/World Health Organization - WHO), held in Yaoundé, Cameroon, June 22-24 2005. For an issue on immunisation, generally, in Colombia, click here In addition, The Drum Beat 346 - Immunisation & Vaccine Resources - may be viewed by clicking here.

We welcome information about your polio-related activities, materials, thinking pieces, and evaluations. Send details to Deborah Heimann at dheimann@comminit.com

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REGIONAL POLIO WORK: VIEW FROM WEST & CENTRAL AFRICA

1. Francophone Discussion Forum on Communication to Support the Eradication of Poliomyelitis in West and Central Africa

Nine West and Central Francophone African countries (Benin, Burkina Faso, Cameroon, Chad, Cote d'Ivoire, Guinea, Mali, Niger, and Central African Republic - RCA) participated in the June 2005 TAG meeting on Communication for Polio Eradication in Yaoundé (referenced above). The Communication Initiative (The CI) has developed an online forum in an effort to provide this group with the opportunity to share their experiences and to discuss issues related to the Global Polio Eradication Initiative (PEI) and routine immunisation. Launched in March 2006 and conducted in French, this online forum has 3 core objectives: 1) to promote exchange of knowledge and experiences on communication actions and strategies being used to support polio eradication within the region's individual countries; 2) to bring more visibility to the specific contribution communication is making to child survival goals by fighting polio; and 3) to promote the work being done by health professionals and those advocating the centrality of communication in the vaccination framework as well as in other child survival interventions. The forum began with a discussion of the level of commitment of leaders, policy makers, and other authorities in the PEI and routine immunisation at the country level, as well as the impact of their actions and involvement. Participants contributing to this first topic hailed from Cameroon, Chad, Côte d'Ivoire, and Guinea.

2.Synthesis of the Major Realisations in EPI Communication for West and Central Francophone African Countries - Period: From January to September 2006

This is a report on progress since the June 2005 Yaoundé meeting from 8 of the 9 participating Francophone African countries with regard to the follow-up of the communication plans and the implementation of the recommendations - through September 2006.

SPECIFIC COUNTRY PROGRESS

3.Building Communication Skills: Training Community Mobilizers for Polio Eradication in Uttar Pradesh

by Gitanjali Chaturvedi

This document examines UNICEF India's experience in working with local community members as front-line communicators to promote and maintain positive immunisation behaviour. This organisation has developed strategies to build the interpersonal communication (IPC) skills of community-level workers - also known as community mobilisation coordinators (CMCs) - in Uttar Pradesh who are working to eradicate polio. Though raising the technical competency of CMCs is central, the approach is also designed to instill CMCs and community members with a strong sense of social service and voluntary action. The initiative, which kicked into high gear in 2002 (following a polio outbreak that infected over 1,600 children across India), centres around training modules designed to equip CMCs with the skills to communicate effectively with families, mobilise their communities in response to the threat from polio, and effectively track on the immunisation status of all eligible children in their community. The document provides quantitative and qualitative data on the effectiveness of IPC training to address polio in this region.

4.Drop by Drop: The NGO Contribution to the Polio Eradication Initiative in Angola

by Julia Ross (editor)

This document, the result of a 10-day qualitative methods and 'case story' writing workshop carried out by The Child Survival Collaborations and Resources (CORE) Group's Angola partners in March 2004, examines how a heterogeneous collection of non-governmental organisations (NGOs), government agencies, and bilateral and multilateral organisations worked closely together to determine coverage rates, and then build infrastructure for the intensification of immunisation and disease surveillance. CORE's polio eradication initiative is not a stand-alone programme; member NGOs have integrated their polio work with other types of development programmes underway throughout Angola. Along these lines, local village leaders identify health volunteers from many different fields (farmers, teachers, religious leaders, traditional healers, and birth attendants) and all levels of formal education to collaborate in the fight against polio.

5.Communication for Transition in Mauritius

by Stanislaw Czaplicki

This report comments on the communication strategies used in Mauritius during the 3-year period of transition toward "graduation" from UNICEF cooperation. Considerable progress has been achieved in the promotion of children's rights, child protection, and growth - including eradicating malaria and polio. "Communication for transition in Mauritius used simple, traditional approaches such as advocacy, public meeting speech amplified by mass media, opportune press interview, press release, workshop and group discussion, publications and leaflets. Only use of evaluation as guide for transition was original and novel. What was quite unusual and challenging in this exercise was a dimension of the communicational objective: to gradually build national awareness and confidence in national capacity to take care for children's rights without external co-operation."

6.Pak Seeks Indian Faces for Polio Campaign

by Toufiq Rashid

This article describes a joint effort between the Pakistan and Indian health departments to create a shared media campaign in support of polio eradication efforts; the proposed initiative would feature a music video to be aired in both countries. Organisers believe that collaboration between the 2 countries will provide the necessary impetus for the eradication effort.

7.Polio Vaccines - Difficult to Swallow: The Story of a Controversy in Northern Nigeria

by Maryam Yahya

This paper examines the oral polio vaccine (OPV) controversy in Nigeria, where rumours that the vaccine was part of a Western tool to sterilise Muslims prompted a boycott of the vaccine by Muslim leaders. According to the author, the OPV story in Nigeria offers valuable lessons to inform practice in dealing effectively with the political and cultural dynamics of immunisation campaigns through community-centred relationships and practices. Some of these lessons include the key role of religious and traditional leaders as advocates within their communities, the importance of building partnerships with civil society groups and opinion leaders, and the centrality of continuous social mobilisation, knowledge, and awareness creation. The article concludes that, while the boycott "has proved costly in both economic and human terms, it has opened up important lines of communication at both global and national levels, deepening dialogue, participation and sensitivity."

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Pulse Poll

It is crucial for promoters of behaviour change projects to be role models of the desired behaviour.

Do you agree or disagree?

[For context, please see The Drum Beat #372]

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COMMUNICATION CHALLENGES

8.Djibouti: New Five-Year Vaccination Strategy

While Djibouti, in Africa, has undertaken vaccination initiatives against polio since 1988 (with a campaign that has vaccinated up to 95% of all children in the capital), poor communication and the need for greater resources have been identified as challenges for future vaccination programmes.

9.Rumors in Developing World Slow Vaccine

by Maria Cheng & John Alechenu

The rumours that were spread by Nigerian politicians in 2003 are said to be largely to blame for the re-emergence and spread of polio in countries where it was once eradicated. Failure of health workers to educate people in developing countries about vaccine-related risks, complicated by the challenge of educating illiterate and remote populations about the value of the polio vaccine, have exacerbated the problem.

10.In Old City, They Drive Away Polio Team

by Maulshree Seth

A dramatic increase in the number of polio cases reported in Uttar Pradesh, India is reportedly occurring despite a mass vaccination campaign being carried out across the city. Immunisation volunteers are being turned away because of the common belief that immunisation will harm children.

11.Rumor, Fear and Fatigue Hinder Final Push to End Polio

According to this article, while rumours and fear have played a large role in impeding the fight against polio, other challenges include cultural suspicions, logistical nightmares, competition for resources from many other afflictions, and simple exhaustion.

12.Pakistan: Ignorance Hinders Battle Against Polio

There have been 12 cases of polio detected in Pakistan since Jan. 2006. Health officials state that parents are refusing to vaccinate due to ignorance, the belief that the vaccination programme is anti-Islamic, and rumours that the vaccine causes infertility.

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Curious about polio-related initiatives or resources - in addition to the strategic thinking shared here? Our Polio Theme Site offers a lens through which to search and browse various sections of our website for information on polio and communication.

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OPPORTUNITIES & WAYS FORWARD

13.Polio Vaccination Dismissed as Devil's Work across Africa

by Maria Cheng & John Alechenu

This article explores a communication challenge for public health teams that are seeking to meet polio eradication deadlines: rumours spreading through vulnerable African populations about the purpose and safety of the polio vaccine. It is suggested here that some Africans believe the vaccine is a conspiracy to sterilise Nigerian girls, that it is a tool for devil worship, or that it spreads HIV. Such fears have apparently led some Kano villagers to flee from their homes when polio vaccination teams arrive, or to try to trick health workers into believing that their children have been vaccinated. One explanation for the communication breakdown is the failure to establish or enforce informed consent standards in "the developing world" - with the consequence that health workers may not inform people about real (even if very rare) risks, such as paralysis by the live virus in the vaccine itself. The suggestion is that being transparent about adverse effects would spur trust and thus help to open up lines of communication that could effectively quell misunderstanding.

14.Steep Decline In Polio Cases But Target Still Elusive

by Asra Pasha & Muhammed Zeeshan Azmat

According to Dr. M. Azmoudeh, a medical officer for the WHO Polio Eradication Program, Sindh, the eradication of polio in Pakistan is not occurring largely due to public insensitivity to the disease. Some of the reasons for this include unmotivated community leaders, unhygienic conditions, and inadequate coordination among the districts during the vaccination campaign. Dr. Azmoudeh attributes this failure to the fact that the public is not adequately educated about the early vaccination programme. He believes that both the media and community members who are "privileged and better educated" have key roles to play in disseminating vaccination information, such as by printing the vaccination schedule during campaign days, and in motivating people to take part in campaigns.

15.Polio: A Fight in a Lawless Land

by John Donnelly

This article chronicles WHO's Dr. Elias Durry, who recently took over the coordination of the Somalia polio eradication campaign. Efforts to wipe out polio in this country are hampered by intertribal warfare which threatens the safety of polio vaccinators. Durry's strategy has involved personally going door-to-door and hut-to-hut multiple times during 2006. To deal with the problems that often arise working in the war-torn land, Durry has asked elders and religious leaders for help with parents who refuse the vaccine, as well as advocated for the wide reporting of cases of children crippled from polio. Durry has found that, with the latter strategy, parents are more willing to accept the vaccine when cases of polio have been reported in areas where they live.

16.Understanding Barriers to Polio Eradication in Uttar Pradesh: Final Report

This document describes the motivation behind, methodology of, and results from a study that was carried out in 3 districts of Uttar Pradesh, India. It offers strategic directions for overcoming barriers to increase OPV coverage in areas with high levels of unreached children - with the caveat that specifics need to be worked out in relation to the local contexts within which the programme will operate and in collaboration with district-level implementers. Research participants stressed the importance of village-level involvement in terms of planning and implementation, and shared several ideas for increasing polio awareness in the community, including: offering baby shows, games, and cultural melas; inviting well-known personalities; using radio for information and awareness; carrying out specific campaigns to counter rumours; and involving local leaders, cooperatives, schools, and NGOs in awareness programmes.

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Now Available in PDF Format - The CI Network Survey Summary Report!

This survey of The CI Network, including The Communication Initiative, La Iniciativa de Comunicación, and Soul Beat Africa, was open from March 17 through April 26 2006. Within those 5 weeks there were a total of 2,334 respondents from 152 countries. This report provides a summary of how many people responded to each question and what their responses were.

To download a PDF file of this summary report,
please click here.

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ASSESSING GLOBAL ERADICATION EFFORTS

17.Is Polio Eradication Realistic?

by Isao Arita, Miyuki Nakane & Frank Fenner

This paper critically examines the rationale behind - and the (in)effectiveness of - the global polio eradication campaign, which was launched by the WHO in 1988 with the goal of wiping out polio by 2000. The authors begin by citing statistics to demonstrate the failure of the campaign, despite its high cost. For instance, in 2005 a total of 1948 cases were reported in 16 countries; from Jan. 1 through March 21 2006, 91 total cases were reported, as compared with 52 from Jan.-March 2005. A number of communication-related challenges and components emerge from their outline of the 4 main reasons why the eradication of polio has proved so much more difficult than the eradication of smallpox. The authors argue that attention should be turned to an "effective control" alternative to eradication, which they describe here.

18.Control, Elimination, Eradication and Re-emergence of Infectious Diseases: Getting the Message Right

by David L Heymann

This article, published in the Bulletin of the WHO, discusses the importance of continued intervention measures to prevent the re-emergence and re-establishment of transmission of infectious diseases. For example, the 2003-2005 spread of poliomyelitis from Nigeria led to re-introduction of poliomyelitis into polio-free countries in Africa, the Middle East, and Asia; many of the routine polio vaccination programmes had been neglected after the countries were declared polio free. Clear communication about the need for continued intervention even after elimination or control targets are reached is thought to be key in preventing confusion among health policy makers, public health workers, and politicians.

19.Polio Eradication: Is It Time to Give Up?

by Leslie Roberts

This Science article outlines the setbacks and shortcomings of the WHO global campaign to eradicate polio, explaining why the critics have called for a reassessment. Skeptics point to the explosion of polio out of Nigeria in 2003 with re-infection in many conflict-torn places where it is too dangerous to send health workers - as well as evidence that the virus can circulate undetected even longer than people feared. Social and political problems, some of which pose communication challenges, seem to be overwhelming the campaign's scientific strategy. For instance, amid allegations that the polio vaccine was contaminated with the AIDS virus or tainted with hormones to sterilise Muslim girls, several states in the northern part of the country halted polio vaccination. Intense lobbying and research (tests to confirm the vaccine's safety) were strategies used to quell fears. Although Nigeria resumed vaccination about a year later, "the virus still rages out of control." For his part, the campaign's David Heymann wishes to keep dialogue flowing: "policies on whether to vaccinate posteradication are still wide open to debate, which he welcomes...."

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This issue was written by Kier Olsen DeVries.

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