The Drum Beat 823 - Working with Local Influencers for Polio Eradication

• 1.Group Influence on Attitudes Towards Polio Vaccination in Pakistan: Role of Group Identification and Perceived Group Support for Polio Vaccines
  by Warda Saleh and Humaira Jami
• This article looks at the moderating role of perceived group normative support on the effect of group identification (GI) on scepticism and advocacy domains of attitude towards polio vaccination in Pakistan. The concept of GI is derived from social identity theory, according to which groups help in defining the self-concept of people and provide them with an identity. The researchers suggest that vaccination can be promoted by appealing to consensus and unity of norms. Furthermore, since GI is what promotes aligning of attitudes with group norms, promoting identification with groups that support polio vaccination can lead to the internalisation of these positive norms. For example, religion matters in polio refusals, so doubts about polio vaccines can be addressed by enlisting the help of influential religious figures. [Mar 2022]
   
• 2.Spatial Clustering in Vaccination Hesitancy: The Role of Social Influence and Social Selection
  by Lucila G. Alvarez-Zuzek, Casey M. Zipfel, and Shweta Bansal
• Vaccine hesitancy behaviour tends to cluster spatially, creating pockets of unprotected sub-populations that can be hotspots for outbreaks of disease. This paper hypothesises that landscape-level spatial clustering in hesitancy may be produced by (i) social selection: geographically proximate communities may independently adopt similar behaviours because they share characteristics that promote the behaviour; or (ii) social influence: vaccination behaviour may diffuse between socially proximate areas through learning of social norms and practices. Informed by the findings, the researchers propose policies that are designed to not only reduce the prevalence of hesitancy but also reduce spatial clustering in hesitancy, with the goal of reducing pockets of vulnerable communities rather than simply eliminating isolated counties of high hesitancy. [Oct 2022]
   
• 3.Vaccine Hesitancy and Perceptions of the Community about Polio in High-Risk Areas of Karachi, Sindh, Pakistan
  by Fayaz Hussain Abbasi, Ahmed Ali Shaikh, Jaishri Mehraj, et al.
• Pakistan and Afghanistan are the last two main reservoirs of wild poliovirus. It was thought that Pakistan was close to achieving the objective of polio eradication, but on the second day of a national oral polio vaccine (OPV) campaign in April 2019, a mob gathered in Peshawar, Pakistan, claiming that OPV had resulted in an unintended incident in the children who received it. The event, which received extensive coverage on electronic and social media, has made future campaigns difficult. In the context of the Peshawar incident, this study aimed to determine the reasons for continued polio vaccine hesitancy in the high-risk areas of Karachi, Pakistan. Among the suggestions made by study participants detailing suitable ways to increase community acceptance of polio vaccination campaigns were: 82 (23.0%) who recommended a famous doctor, followed by 71 (19.9%) who recommended religious influencers, and 58 (16.3%) who recommended the involvement of sports and movie stars in community advocacy on the benefits of polio vaccination for children. [Dec 2022]
   
• 4.National Emergency Action Plan 2022: Polio Eradication Initiative Afghanistan
• 2021 was a challenging year for Afghanistan's polio programme, leaving a significant number of children unreached. Throughout 2021, the programme continued its efforts to address vaccine acceptance issues through a wide variety of community engagement and social mobilisation activities, such as engagement of religious leaders, grandmothers, and local authorities. Going forward, the programme will leverage strategic communication interventions for awareness and commitment from all stakeholders at national and subnational level, including from communities, for a polio-free Afghanistan. One idea for engaging the mass media, for example, is intensifying media roundtable discussions that engage key influencers, including religious leaders, community leaders, and medical experts. [Feb 2023]
   
• 5.Role of Information Sources in Vaccination Uptake: Insights From a Cross-Sectional Household Survey in Sierra Leone, 2019
  by Shibani Kulkarni, Paul Sengeh, Victor Eboh, et al.
• The Government of Sierra Leone has a strong emphasis on community engagement for immunisation services. In this context, caregivers receive vaccination messages through various sources; the goal of this assessment was to understand the differential impact of vaccination information sources to prioritise future investments and strategies. Based on adjusted estimates, caregivers who were exposed to information from health facilities were 26% more likely to have their child vaccinated with the penta-3 vaccine. Similarly, there was a significant positive relationship between vaccine uptake and exposure to information from faith leaders (16%) and CHW and television (13% each). "Based on this analysis, the researchers suggest: "Faith leaders and other important community leaders should be actively engaged not only in the delivery of messages but also in the development of messages that align and resonate with the community's beliefs and values in promoting immunization services to safeguard resilient demand and uptake of life-saving vaccines." [Feb 2022]
   
• See also:
  Engaging Influencers: Building Trust - Influencing Change: Documentation of CORE Group's Engagement in India's Polio Eradication Programme

• 6.Eradicating Polio: Working with Community Influencers for Catalyzing Change
• India's last polio case was reported on January 13 2011. Over the 10 years prior, the majority of polio cases were reported from the state of Uttar Pradesh (UP). In this context, in 2001, the United Nations Children's Fund (UNICEF) established the Social Mobilization Network (SMNet) in UP. While the inroads made by SMNet and religious leaders accelerated social mobilisation in support of the polio eradication programme, further efforts were required at the community and household levels to reach out to resistant families and motivate them. Thus, UNICEF introduced the concept of influencers to their programming. These influencers - individuals with some kind of authority in the community who may or may not have a mass following but who wield significant social, economic, and/or political influence - were perceived as allies for the cause. This document sheds light on the involvement of influencers, who ultimately made an "indispensable contribution" to the Polio Eradication Programme in UP. [Jun 2013]
   
• 7.Key Considerations: Localisation of Polio Vaccination Efforts in the Newly Merged Districts (Tribal Areas) of Pakistan
  by Luqman Hakeem and Riaz Hussain
• This brief reviews the social, cultural, and contextual considerations relevant to increasing polio vaccine uptake amongst vulnerable groups in Pakistan's tribal areas. Vaccine resistance is being addressed successfully in some settled areas through innovative approaches tailored to the community context. For example, civil society, local influencers, celebrities, religious leaders, and frontline workers were involved in the polio vaccination campaign in December 2021, and evidence from the authors' experience indicates that the participation of these trusted local stakeholders encouraged community acceptance of the vaccine and should continue to be fostered. Among the recommendations: Foster long-term engagement with local influencers, including the local Jirga system and local leadership, and enlist local-level religious leaders like imams and notable clerics, as well as tribal elders and maliks (elected elders), to deliver important messages during religious events and congregational prayers. [Sep 2022]
   
• 8.A Local Musician in The Gambia Builds Trust in the Polio Vaccine with the Rhythm of His Drums
• This video by the Global Polio Eradication Initiative (GPEI) introduces the viewer to a 60-year-old cultural musician supporting the vaccination team in The Gambia by raising awareness about polio and encouraging parents to vaccinate their children. Days before the start of a polio vaccination campaign and during the campaign itself, Takatiti walks up and down the streets of villages, playing his drums and using his megaphone to talk to communities about the dangers of polio, how vaccination is the only way to protect children, and that polio vaccines are safe and free. UNICEF supports the government in strengthening engagements with communities based on a belief that the voices of local leaders and influencers like Takatiti play a powerful role in helping allay fears and concerns of parents and caregivers about vaccines. [May 2022]
   
• 9.Facilitators and Barriers to Community Engagement in the Global Polio Eradication Initiative - A Mixed Methods Study
  by Priyanka Agrawal, Abigail Neel, Assefa Seme Deresse, Sue Gerber, and Olakunle Alonge
• Over the years of implementation, the GPEI transitioned to engage more with communities via its community engagement (CE) strategies, which improved its understanding of the importance of buy-in from end users. This study from the Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) project, which is focused on individuals who had been engaged with the GPEI programme from 1988 onward in 7 focus countries, highlights that CE activities were able to go a long way in creating awareness and importance of polio interventions. Participants reiterated the importance of collaborating with local governments and leaders, high-profile residents, and religious influencers in crafting the implementation strategy of the programme. Recruitment of local people for teams has been instrumental in tackling the issue of vaccine refusal, according to a respondent from Afghanistan. [Apr 7 2023]
   
• 10.Thinking Out-of-Box in Addressing Communication and Service Delivery Challenges: Use of a Traditional Communication Method for Improving Immunization Coverage in Remote Rural Hard-to-Reach Areas of India
  by Iqbal Hossain, Parthasarathi Ganguli, Chahat Narula Thakur, Robert Steinglass, Brian Castro, Lora Shimp, et al.
• This paper describes the participatory development and implementation of a coordinated service delivery approach along with an alternative communication method - traditional drum beating - to reach caregivers to improve immunisation coverage in Sirmaur, a largely mountainous, remote rural district in the state of Himachal Pradesh, India. Community mobilisers reached out to local community leaders to inform the people about the drum beating as a new method of informing people about the vaccination sessions. The locally available, culturally acceptable, easily implementable, communication method contributed to increasing age-appropriate vaccination coverage and reducing dropout rates. [Feb 2023]
   

• See, for example, this recent Drum Beat: Gender and Polio - The Drum Beat 821
   

• 11.Engaging Faith-Based Organizations for Promoting the Uptake of COVID-19 Vaccine in India: A Case Study of a Multi-Faith Society
  by Gopal Krishna Soni, Anumegha Bhatnagar, Anil Gupta, Amrita Kumari, Sonal Arora, Surbhi Seth, Apurva Rastogi, Natasha Kanagat, and Rebecca Fields
• This article presents experiences from John Snow Inc. (JSI)'s strategic engagement with faith-based organisations (FBOs) to promote uptake of COVID-19 vaccination in India, especially among vulnerable and marginalised communities. As JSI explains, religious faith represents a key social and environmental driver that can influence an individual's beliefs, health behaviours, and practices. The project team believed that co-creating interventions with faith leaders, who are often the gatekeepers of tight-knit communities, can lead to the creation of positive messages about the COVID-19 vaccine that people in the community can relate to. As a result, a sustainable network of sensitised FBOs from diverse faiths was created that went on to mobilise and facilitate the vaccination of 0.41 million beneficiaries under the project from August 2021 to January 2023. [Apr 2023]
   
• 12.Understanding Factors Influencing Polio Vaccine Uptake in Ghana - Developing Meaningful Community Mobilization and Engagement Strategies in Collaboration with Religious Leaders
  by Anna-Leena Lohiniva, Anastasiya Nurzhynska, Hudi Alhassan, Mrunal Shetye, and Paul Ayiku
• Knowledge about vaccination is rarely a trigger for changing behaviours. Instead, behaviour is influenced by various psychological, social, and environmental factors that must be understood in a given context. This study follows human-centred approaches by engaging religious leaders in vaccine demand creation. The initiative resulted in a set of recommendations to support religious leaders in polio vaccine demand creation, such as enhancing positive attitudes of religious leaders toward polio vaccines so they can act as a catalyst for social norm change around polio vaccines in their communities. [Oct 2022]
   
• 13.Promoting Vaccination: A Toolkit for Collaborating with Faith Communities
• Religious leaders can be supported and encouraged to use their trusted position of influence and understanding of their congregants, along with insights from behavioural science, to engage in personalised vaccine promotion outreach in their networks. From the United States Agency for International Development (USAID)'s MOMENTUM Country and Global Leadership project, this toolkit aims to equip faith actors and related stakeholders with the information and tools needed to raise awareness, reduce misinformation, and address barriers that prevent faith communities from engaging in vaccination. [Dec 2022]
   
• See also:
  Eradicating Polio: Working with Religious Leaders to Enhance Community Ownership
  Effects of Engaging Communities in Decision-Making and Action through Traditional and Religious Leaders on Vaccination Coverage in Cross River State, Nigeria: A Cluster-Randomised Control Trial

• 14.Trends in Childhood Immunisation amongst Muslim Children of Punjab (India): An Empirical Study
  by Gurinder Kaur and Shaik Iftikhar Ahmed
• This study found that religion per se does not appear to influence rates of full immunisation among Muslim children from the northwestern Indian state of Punjab. Geographical location, embeddedness of the community in the larger political and social milieu of their area, and the reach and acceptance of health workers at grassroots level emerge as strong factors contributing to higher rates of immunisation amongst Muslim children of Malerkotla. In particular, the role of community health workers (CHWs) is spotlighted. One auxiliary nurse midwife said: "when MR [measles-rubella vaccine] was introduced, we started facing the...problem of distrust. People believed that this vaccination was government's plan to reduce Muslim population and would make children infertile. Then I took my own child to the school and vaccinated him myself in front of the entire village. Since then people have started coming forward for it." [Dec 2022]
   
• 15.Community-led Strategies to Aid Vaccine Acceptance: Five Case Studies from the Global South
• The case studies in this report from the 2020-2021 Social and Behavioral Research Grants Program explore how research teams and communities designed interventions employing a range of strategies, such as participatory research to equip and empower CHWs and community influencers to dispel rumours and strengthen trust between patients and providers. One grantee out of Pakistan taught lady health workers and vaccinators to effectively communicate about vaccines and vaccination and to engage interpersonally with vaccine refusers. They then conducted home vaccination drives and employed targeted informational outreach with community members and heads of household influencing vaccination decision-making behaviour. Among Sabin's recommendations: that CHWs be equipped to become advocates for vaccine confidence and equitable, expansive vaccine access in their communities. The case studies also point to the value of earning the trust of faith leaders and empowering them with knowledge on vaccine benefits so they may become vaccine champions. [Feb 2022]
   
• 16.PATHOS: A Human Centered Design Toolkit for Engaging Frontline Health Care Providers
• This toolkit highlights how PATH's Living Labs initiative uses a 4D human-centred design (HCD) approach - Discover, Define, Dream, and Design - to engage frontline immunisation healthcare workers to understand factors that affect their motivation and engagement in providing services. [2022]
   
• 17.Immunization Service Experience (SE) Toolkit
• Immunisation service experience (SE) includes the factors within and beyond the interactions between a health worker and a client that influence immunisation delivery and experience. A positive, person-centred immunisation SE can contribute to confidence, acceptance, demand, and uptake of vaccination. Developed by JSI with Gavi support, this toolkit introduces the concept of SE as it applies to immunisation programmes and guides countries in addressing SE in their contexts. [2022]
   

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