A Massive Movement to Prevent Polio in Aceh

“Peace be upon you!” The voice of health worker Imran Nazmi breaks the tranquillity of a quiet morning in the Suka Makmur village in the Aceh Tamiang District. He speaks loudly and with a sense of urgency: “Polio is back! It is dangerous, easily transmitted and causes lifelong paralysis. Yet it is easy to prevent through vaccination.”

Indonesia has remained largely polio-free in recent years, but in November an outbreak emerged in Pidie, Aceh – prompted by a dangerous combination of consistently low routine immunization and unhealthy environmental conditions. In 2021, only 50.9 per cent of infants born in Aceh received polio vaccination. 

Once the Government of Indonesia declared the outbreak, UNICEF, the World Health Organization (WHO) and government partners sprang into rapid response mode to prevent more cases. Teams of health workers fanned out across communities to provide essential information about polio and to increase demand for immunization. Life-saving vaccines arrived in record time to kick off a major polio immunization campaign targeting some 1.2 million children under 13 years old in 23 districts.

Staying committed through challenges 

Day by day, Imran joined other health workers in door-to-door visits to talk with community members. Their commitment never wavered even through difficult conditions - sometimes walking on rough, unpaved roads, braving downpours of rain and traversing muddy terrain. 

“During the rainy season, I had to bring spare clothes just in case I got trapped on the road because of landslides or floods,” said Imran. “Many villages here practice open defecation, and since this is one of the causes for the spread of the polio virus, we had to take quick action to ensure children here are polio free.” 

Trisnawani, an immunization programme manager in the neighbouring district of Langsa, had to travel by sea from her hometown to participate in the campaign for a few hours each day.

“Crossing the sea is a challenge particularly when I know that dealing with the local people on the island is not easy. But my motivation is much bigger and stronger to immunize children against polio. Protecting them from polio is like protecting my very own child,” she said.

Tackling vaccination fears 

Community members in Aceh have long been hesitant about vaccination due to religious beliefs and lack of awareness about vaccine preventable diseases.  

“In Aceh, Ulama or leaders of dayahs – islamic boarding schools – have a prominent role in our society. Many people seek their advice for concerns about whether immunization is good or bad, prohibited or allowed for their children according to Islamic Law,” explains Abdul Wahab, the leader of Darul Fikri Islamic Boarding School in Aceh Tamiang.  

Since 2021, UNICEF has collaborated closely with the Association of Religious Leaders from Islamic Boarding Schools in Aceh (HUDA) to raise awareness about COVID-19 and routine immunization. As a result of their support, public acceptance towards immunization has been increasing.  

For the polio immunization campaign, UNICEF engaged highly influential Islamic religious leaders to share information with their congregations in mosques, churches, viharas and other places of worship.  

According to UNICEF’s pre-campaign assessment, fear of adverse side effects is the key reason for parents rejecting immunization. Sitti Saniah and Nur Pradipta are mothers who were reluctant to immunize their daughters until they talked with health workers in their village about vaccine preventable diseases and ways to prevent them. 

“When I found out that my daughters got a fever after receiving the vaccine, I was terrified until I talked to a health worker and she said that’s a normal reaction,” says Nur. “Now, I will keep doing it as long it is good for them.”  

“Polio made me really anxious about the future of my daughters. Now that they have been immunized, I could not be more relieved,” explains Sitti.

The power of community engagement 

During the campaign, UNICEF deployed Social and Behaviour Change (SBC) Officers who have been trained in the use of interpersonal communication skills to engage with parents like Sitti and Nur.  

“We wanted to use this momentum not only to achieve the targeted immunization against polio, but also to help break the years of chronically low routine immunization coverage in Aceh through our social and behaviour change approach,” explains Emeralda Aisha who worked with households in the Aceh Tamiang District.  

The coordinated life-saving efforts on the ground have led to success – by mid-December, 77% of the children targeted had been immunized. The campaign will continue in the new year, bringing renewed hope for children in Aceh to have a future free of polio.         

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