Immunization

Polio eradication in India

© UNICEF/45-HQ06-2619Tom Pietrasik/India

Anganwadi worker Pushpa Kumari tallies the number of children eligible for polio vaccination in a household in Bhakra Village, Bihar.

In India, UNICEF-supported social mobilization and communication demonstrated improved access to families. The number of households deciding not to immunize their child was reduced to less than one out of every 400 households on average. Immunization levels were high, with children receiving an average of ten doses of OPV by 12 months of age in areas with intensive UNICEF support. However, with 873 cases of polio in 2007 and 287 so far in 2008, India remains a focus of GPEI immunization efforts. It is encouraging that only 5 cases of Type 1 virus have been reported in 2008 suggesting that India is proceeding towards its goal of eliminating Type 1 infections this year (data from polioeradication.org). To ensure success, India’s Expert Advisory Group (IEAG) recommends that communication should play a key role in the efforts to mop up any Type 1 infection occurring outside the endemic statistics.

Nationwide Efforts
The Government of India has approved and is implementing a revised communication review process. The new system will take a longer and more detailed look at specific issues in key geographic areas where polio transmission remains a high risk. The new approach is expected to produce more specific recommendations to guide the communication effort in achieving the goals set for this year. Targets vary from region to region but focus on themes such as: missed children, the use of influencers, immunisation resistance, getting newborns immunized, and team performance.

The Government has also changed its immunization policy with regards to the Haj, the annual pilgrimage to the Holy City of Mecca. Receiving OPV vaccination is now a required part of the application process. Expectations are that the vaccination programme will reach many senior Muslim leaders for the first time, providing an opportunity to discuss the benefits of the immunization with them. By late March, 27,000 out of an estimated 50,000 applicants in Uttar Pradesh had already been vaccinated (data from UNICEF India Polio Update, November 2008), up from 23,000 for the entire process last year.

Uttar Pradesh
The State of Uttar Pradesh reported its first case of Type 1 virus in May 2008. This was the first case in eighteen months and the IEAG has recommended a high concentration of mop up vaccinations in the State to ensure that they eliminate Type 1 virus. To achieve the goal, work plans will now focus on the sub-regional level and set quarterly goals. This should enable SMNet to better monitor progress and strengthen the efforts to work with influencers, reach newborns and reduce the number of missed households.

The state is also testing sub-regional media plans in the Agra region of Uttar Pradesh.  Local cable television ads with be coordinated with radio spots and newspaper ads. The shift reflects the new emphasis on sub-regional planning and allows for a targeted messaging campaign that addresses region-specific concerns. It has the added benefit of not spreading the message beyond the coverage area of the NID and avoids the heavy costs of a national advertisng campaign.

Bihar
Despite concentrated effort in the State, Type 1 virus transmission is likely to continue in high risk areas. Geography and climate comprise unique challenges to the polio eradication program in the river basin. The swelling of the regions numerous rivers can disrupt life in region especially during monsoon season, reducing the access of vaccinators and giving the virus a chance to multiply. Approximately 200 community organizers (CMCs) have been recruited and UNICEF is constructing micro-plans to handle the challenges of isolated populations and shifting terrain. The CMCs will mobilize local support for the programme and help ensure that households and settlements are listed in the micro-plans.

Communications efforts are also focusing on the reducing the growing number of refusals in a few areas. The number of refusals (data provided by UNICEF India office, 2008) is actually quite low, less than 1%, nonetheless, village-based community organizers are carrying out an “underserved strategy” that directly engages poor and marginalized Hindu and Muslims families to address any concerns about vaccination. These efforts have been supplemented by Mosque announcements and a series or iztemas (women’s meetings where religious instruction is given by women). Evidence suggests that the strategy is working as refusals have dropped from 1,400 in January to 771 by March 2008.

West Bengal
A quick response to West Bengal’s 2002 outbreak led to a correspondingly quick decline in the number of Type 1 cases (data culled from UNICEF India Polio Update, November 2008), down from 48 to 0 three years later. West Bengal was polio free for two years but when a case was reported in 2007 and two in 2008, the region reinvigorated its communication efforts.

The region has undergone numerous rounds of immunizations, yet, the number of missed households has risen in each instance. Even though the number of cases is low, the ongoing transmission suggests that children are being missed. Combined with the rising number of refusals, West Bengal presents a significant communication challenge.

Communication and social mobilization efforts are focusing on the Mahestala municipality. The local government is working to improve operations and is taking an active role in policy formation. Experienced social mobilization organizations such as the Amanat Foundation (website) have been brought in and community organizations such as Engio and Palli Unnayan Samiti are finding community organizers. Ongoing communication efforts by Rotary International and UNICEF have been bolstered by the addition of local cable television messaging. The increased attention on the region is expected to positively impact both the coverage and refusal rates.

Return to communication support for polio eradication page.