|© UNICEF/HQ2627/Tom Pietrasik|
|Anganwadi worker Pushpa Kumari uses a 'bindi' marker to note the number of children eligible for polio vaccination in a household in Bhakara Village, near Patna.|
The striking decline in new polio cases throughout the world between 1998 and 2005--from 350,000 to 1,800 cases —is tied closely to the Polio Eradication Initiative (PEI) and it sprearheading partners, UNICEF, the World Health Organization (WHO), Rotary International and the Centers for Disease Control and Prevention (CDC). Together they have met formidable on-the-ground challenges with the deployment of focused and closely-monitored communication strategies aimed at behaviour change.
Today, there remain four endemic countries where the polio virus stubbornly resists eradication efforts, putting local populations – as well as those in neighbouring countries and potentially the entire global community – at risk. In these countries, lack of trust in vaccine safety and immunization services has been an issue, fueled by misinformation and rumours. How, then, to engender awareness and confidence where mistrust closes the door to immunization? Two important lessons that UNICEF and its partners have learnt along the way include:
Rely on local religious and community leaders. When, in 2003 in northern Nigeria, a fatwa was issued calling for a halt to polio immunization – alleged to render children sterile -- new polio cases not only surged in the surrounding area but spilled over to other global polio “hotspots”--like the Indian State of Uttar Pradesh. As part of its Polio Eradication Programme, UNICEF and a range of global and national partners began working closely with local imams and other respected community leaders who were supplied with valuable research on polio vaccine safety, and whose prestige and influence were then marshaled to counteract the misinformation. Community based efforts were boosted by the use of mass media – press, radio and television campaigns - that multiplied the reach and reinforced the messages of the imams.
Mobilize community workers and volunteers. In a similar spirit, in Uttar Pradesh in 2003, UNICEF helped launch the Social Mobilization Network (SMNet), which galvanized into action some 5,000 community mobilizers who have proved immensely effective down to the present. As one local observer explains, “Nothing beats a familiar face, the lilt of a local dialect and the genuine concern of the friendly neighborhood aunt who may say, ‘He looks a little pale today. Have you taken him to the doctor?’”These front-line workers and volunteers, almost all women, hail from the high-risk communities in which they serve, and their advice is therefore more likely to be taken to heart. As one local observer explains, “Nothing beats a familiar face, the lilt of a local dialect and the genuine concern of the friendly neighborhood aunt who may say, ‘He looks a little pale today. Have you taken him to the doctor?’” With some training, these community activists have been empowered not only to provide accurate information but also to maintain and update complicated data and records about hundreds of thousands of households —essential for a vaccine that must be administered repeatedly and every few weeks in order to be effective.
“If you miss two, three, or four per cent of these kids, then you are leaving a gap for the virus to squeeze through and infect other kids,” notes Michael Galway, former Chief of Programme Communication in UNICEF’s India office and leader of UNICEF’s Polio Eradication Campaign, adding “the programme has developed monitoring into a precise art”. As a result of consistently employing this strong data-driven, epidemiologically-guided and localized strategy, some 50 million children are today successfully immunized against polio during every “round”.
An example of its effectiveness: between March and October 2007, the number of households in Uttar Pradesh resistant to immunizing their children dropped by half. In 1979, the smallpox virus was successfully eradicated from the planet, the first infectious scourge to be wiped out entirely. To successfully eradicate polio and ensure that it does not revisit coming generations, persistent, vigilant and localized communication action is critical to cover the “final inch”.