Lessons Learned from the Global Polio Eradication Initiative: Implications for Communication Interventions

"What are some of the communication challenges in engaging people on polio immunization issues?"

This is one of the questions asked in this interview of Thomas Abraham, MA, who is affiliated with the Journalism and Media Studies Center (JMSC) at The University of Hong Kong and who is a consultant for the World Health Organization (WHO) and other international organisations on health risk communication. Some of the key points from the interview include:

• When asked "What are some of the most important lessons to be learned from the Global Polio Eradication (GPEI)'s 25-year history in terms of communicating risk within hard-to-reach population settings as well as engaging them and securing their buy-in?", Abraham highlights the importance of culturally competent and community-based interventions, such as the engagement of imams in Nigeria who were brought on board to convince people with religious objections to accept the polio vaccine. "However, a fundamental weakness of the polio program is that it has always been a supply-led program rather than a demand-led program."
• This is where communication becomes a challenge and an opportunity, according to Abraham. He recounts a trip he made to Kano in Northern Nigeria, where some of the biggest causes for morbidity and mortality among children include malaria, diarrhoeal diseases, respiratory diseases and measles. "Does it make sense to save a child from polio if two or three years later, the child is going to fall severely ill, or perhaps even die from diarrheal diseases or malaria? From the parents' point of view, the answer is no." Elaborating on his earlier point about the importance of demand-led communication, Abraham stresses that the role of communication "should be not so much to persuade people to buy into something, but rather to assess and strive to meet people's actual needs and preferences" by engaging in an exchange of opinions with all key stakeholders and the public. This is what risk communication is all about, Abraham explains.
• Amongst the other questions Abraham responds to is one concerning how social norms affect risk communication outcomes (both behavioural and social). He provides an example, frequently encountered in Pakistan and some other societies: a lack of female vaccinators to go house to house. (Given predominant social norms in many cultures, it may not acceptable for a man to enter the house during the day when only the women are at home.) "Although this issue has been understood, it has been difficult to find female vaccinators." He also looks more broadly when replying to this question, arguing that more research is needed into "how social norms are formed in different cultures, the relationships between norms and behavior, the outcomes in different cultures, and also into the societal understanding and expectations of immunization interventions."
• Abraham concludes that: "We need a fundamental change in the way we think about the relationship between public/global health programs and the public, and it cannot be a top-down process anymore. Communication is really crucial to set up a process in which all these different stakeholders and groups can speak with, listen to, and understand each other. Everyone has a role in this process. Communication experts, in particular, need to take a wider role, be more proactive, and find ways to start advocating to bring all these groups together."

(Abraham was interviewed by Radhika Ramesh, MA, Editorial Assistant, Journal of Communication in Healthcare: Strategies, Media, and Engagement in Global Health)