12,588 The Drum Beat 696, Polio: Addressing Challenges to New Vaccine Introduction

The Drum BeatPolio: Addressing Challenges to New Vaccine Introduction – The Drum Beat 696
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From The Communication Initiative Network – where communication and media are central to social and economic development.
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ADVOCACY STRATEGIES AND GUIDES: INTRODUCING NEW VACCINES
  • 1. Communication Planning Guide for IPV Introduction and Routine Immunisation Strengthening
    This guide offers a range of checklists, tools, templates, examples, and best practices to support the effective planning and implementation of communication activities associated with the addition of inactivated poliomyelitis vaccine (IPV) within a national immunisation programme. Under objective 2 of the World Health Organization (WHO)’s Polio Eradication and Endgame Strategic Plan 2013-2018, at least one dose of IPV will be introduced into routine immunisation (RI) programmes globally, after which trivalent oral polio vaccines (OPV) will be replaced with bivalent OPV (bOPV) in all OPV-using countries – setting the stage for eventually ending bOPV use. The guide provides concrete guidance, such as the need to develop strategies to support the establishment or reactivation of a communication coordination committee/subgroup for IPV introduction at national and sub-national levels. [Mar 2015]
  • 2. Bottlenecks and Breakthroughs: Lessons Learned from New Vaccine Introductions in Low-Resource Countries, 2008 to 2013
    From 2008 to 2013, the Maternal and Child Health Integrated Program (MCHIP) provided technical assistance on the operational aspects of the introduction of 15 new vaccines in 10 Global Alliance for Vaccines and Immunization (GAVI)-eligible countries. The lessons learned from these experiences are shared in this document with the hope that, in the future, they will be useful in, for example, responding to the call by the Global Polio Eradication Initiative (GPEI) to add one dose of IPV to their existing schedule of OPV. One of the strategies outlined in the paper: “National launches were well-publicized, high-profile events that in several instances were attended by the country’s president or first lady. Because they attract considerable media attention, launches provide an excellent opportunity to educate the public about the new vaccine and the disease that it prevents and to raise awareness about its availability in the public sector….Local launches were viewed as cr! itical to successful uptake of the new vaccine because they were conducted in local languages, covered by local media, and involved local political and community leaders. In some countries, these local leaders can facilitate or block the local population’s acceptance of a new intervention.” [Jun 2014]
  • 3. Documenting Vaccine Introductions: A Guide for Developing Case Studies and Human Interest Stories
    by Lauren Platt
    The purpose of this guide is to give step-by-step instruction on how to develop a case study and/or human interest story about a vaccine introduction. It is premised on observations such this one: “[T]he lessons learned by national immunization programs often have implications for the broader international immunization community. Without the documentation of key findings, other individuals and organizations cannot benefit from the lessons learned by their counterparts in other countries.” The author notes that case studies and human interest stories can be complementary. “For example, a case study on the decision-making process for the introduction of the IPV could be complemented by a human interest story about a passionate pediatrician who advocated for the rapid introduction of IPV in order to ensure that the children in his/her country would have even stronger protection against poliovirus.”
  • 4. Advocacy for Immunisation Website
    This is an online space for people working to improve immunisation systems and access to vaccines, particularly in resource-poor settings. It aims to help such personnel find ideas, resources, and guidance to advocate for strengthened commitment to vaccines and immunisation to save lives. The publishers say that: “You are invited to work through the modules and learn how to develop an effective and evidence-based advocacy strategy, including key messages, partnerships and, importantly, monitoring and evaluation. There are stories and case studies of how others have developed and implemented effective advocacy and communications approaches.” For example, one story explores communication strategies that have been used to respond to negative messages and anti-vaccine campaigners (regarding the OPV) in Pakistan.
  • 5. Introduction of Inactivated Polio Vaccine and Specific Determinants of Vaccine Hesitancy
    by Maduka Donatus Ughasoro, Beckie Nnenna Tagbo, and Dorothy Omono Esangbedo
    This study was conducted in the context of the strong advocacy effort by WHO (see #1, above). Participants in the study were parents who brought their children for immunisation at the University of Nigeria Teaching Hospital, Enugu, and Federal Medical Centre, Umuahia. “The proportion of parents who were hesitant to vaccinate their children with IPV if OPV is still retained in the immunization schedule was high, but not significant. This means that though parents still prefer OPV, they will reluctantly accept IPV once approved by the ministry of health even if OPV is still retained as an option. Studies have shown that with the right information, and adequate awareness creation and availability of new vaccine, parents vaccinate their child with newly introduced vaccine. Therefore, with adequate information and awareness creation, parents will accept IPV.” [Jan 2015]
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EVENT INVITATION: MEETING THE CHALLENGES OF GLOBAL POLIO ERADICATION
  • Join the Center for Strategic and International Studies (CSIS) Global Health Policy Center on Monday, September 28 2015 as it welcomes keynote speakers Dr. Thomas Frieden, Director of the the United States (US) Centers for Disease Control and Prevention (CDC) and Chair of the global Polio Oversight Board, and Sir Liam Donaldson, Chair of the GPEI’s Independent Monitoring Board (IMB). They and other experts will discuss current and future eradication challenges, including: the vaccine switch needed to address vaccine-derived polio cases; plans to transition polio-related assets and knowledge to national health systems and other health priorities; and measures to address political instability and insecurity hampering vaccination efforts.

    Click here to RSVP for the free event, which will be held on Monday, September 28th from 8:30AM – 2:30PM in the 2nd Floor Conference Room, CSIS, 1616 Rhode Island Avenue, NW, Washington, DC, US. Lunch will be provided.

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LEARNINGS FROM THE SAGE WORKING GROUP ON VACCINE HESITANCY
  • 6. Report of the Sage Working Group on Vaccine Hesitancy
    “…While communication is not a specific factor, like confidence, complacency and convenience, when it is poor or inadequate it can negatively influence vaccine uptake and contribute to vaccine hesitancy. Poor quality services of any type, including poor communication, can undermine acceptance.” This is one of the lessons that emerged from a November 2011 meeting of the Strategic Advisory Group of Experts (SAGE) on Immunization, where SAGE noted the impact of reluctance to accept immunisation on the uptake of vaccines reported from both developed and developing countries. “In LMIC [low- and middle-income countries], scarce communication resources limit the capacity to counter negative information about vaccines and achieve community support for vaccination programs. For instance, the Independent Monitoring Board on Polio Eradication noted deep concern about ‘the Global Programme’s weak grip on the communications and social mobilization that could not just! neutralize communities’ negativity, but generate more genuine demand…” [Oct 2014]

    See also:

  • 7. Strategies for Addressing Vaccine Hesitancy – A Systematic Review
    by Caitlin Jarrett, Rose Wilson, Maureen O’Leary, Elisabeth Eckersberger, Heidi J. Larson, and The SAGE Working Group on Vaccine Hesitancy
    “Overall, our results showed that multicomponent and dialogue-based interventions were most effective. However, given the complexity of vaccine hesitancy and the limited evidence available on how it can be addressed, identified strategies should be carefully tailored according to the target population, their reasons for hesitancy, and the specific context. “This report describes a systematic review of peer-reviewed (January 2007 – October 2013) and grey literature (up to October 2013) that used a search strategy built to capture multiple dimensions of public trust, confidence, and hesitancy concerning vaccines. One finding: “The success of social mobilization interventions for populations refusing polio vaccination could also be attributed to the targeting of, and dialogue with, a clearly defined population…” [Aug 2015]
  • 8. Health Communication and Vaccine Hesitancy
    by Sue Goldstein, Noni E. MacDonald, Sherine Guirguis, and The SAGE Working Group on Vaccine Hesitancy
    The authors note that there is a concern about communication on vaccine hesitancy in that public discussion of hesitancy may, by drawing attention to it, “legitimise” it through familiarity so that it becomes a self-fulfilling prophecy, thus aggravating the situation. In addressing this, SAGE has stressed the importance of reinforcing public perception of immunisation as a social norm. They also reviewed data from the United Nations Children’s Fund (UNICEF) and the GPEI on community and individual concerns raised about polio immunisation in Nigeria and India. “Noteworthy findings were that by 2014, only 1.2% of unvaccinated children in Nigeria were not vaccinated because of refusal, and the refusal rates were highest where insecurity and social strife were highest. Many of the unvaccinated children had been missed, i.e. not at home when called, rather than having refused the vaccine (although in some settings this was interpreted as a ‘silent refusal’). Wh! en organized resistance to polio immunization was present, it was typically correlated with political opposition to the government or an outside group seen to be supporting immunization, and the resistance usually had a dynamic leader at the centre of the movement. Grievances were often linked to lack of other services and amenities (i.e. immunization provided a bargaining chip to leverage access to other services or demands for political actions of government or international players such as ‘stopping the drones’). Addressing vaccine hesitancy, especially through building the trust of the local leaders and community communication did lead to increases in polio vaccine acceptance in communities and reduce vaccine hesitancy.” [Aug 2015]
  • 9. Addressing Vaccine Hesitancy: The Potential Value of Commercial and Social Marketing Principles and Practices
    by Glen Nowak, Bruce G. Gellin, Noni E. MacDonald, Robb Butler, and The SAGE Working Group on Vaccine Hesitancy
    This review examines how social and commercial marketing principles and practices can be used to help address vaccine hesitancy. It provides illustrations such as a partnership as part of the GPEI that led UNICEF and other organisations, including the Government of Pakistan, to use social marketing principles to develop programmes that are designed to address the needs and concerns of those living in the Federally Administered Tribal Areas, where polio transmission has been persistent. Lessons learned are shared, such as: “Ensuring education and knowledge dissemination about vaccines among children, adolescents and young adults – including through school-based programs – may be a good opportunity to foster parental acceptance as well as shape the future vaccine acceptance behavior of parents and other adults….The high levels of social media use among children means it is also possible to reach and influence children outside of schools. Peer-group provision or shar! ing of information is both common and influential, and finding ways to use those channels to educate young people about vaccine preventable diseases and the importance of vaccines, may provide additional opportunities to shape future vaccine beliefs and behaviors.” [Aug 2015]
  • 10. How to Deal with Vaccine Hesitancy?
    by Juhani Eskola, Philippe Duclos, Melanie Schuster, Noni E. MacDonald, and The SAGE Working Group on Vaccine Hesitancy
    “It can be expected, as vaccine hesitancy evolves and new insights and information become available, that further research questions will continue to arise. The research portfolio therefore needs to be expanded to encompass the multiple facets of this phenomenon at individual, community, and contextual levels in a multi-disciplinary effort to reduce vaccine hesitancy…” One of their observations: Thus far, “most studies have not defined vaccine hesitancy in the study population and have only measured change in vaccine uptake, without assessing whether the intervention had any impact on hesitancy…[W]henever strategies to address vaccine hesitancy are implemented, the population should be fully described, and a rigorous evaluation should be conducted of the impact of the intervention and its components on vaccine hesitancy as well as on vaccine acceptance.” [Aug 2015]
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ACCESS TO NIGERIA HEALTH RESEARCH ON HOUSEHOLD AND LOCAL DECISION-MAKING

This new theme site provides access to summaries of, and links to, documents produced as part of a research initiative that The CI coordinated in an effort to support the Nigerian government and GPEI partners in developing evidence-led strategies to leverage household demand for immunisation services in Nigeria.

For navigation on the research process and results, see these recently-published Drum Beats:

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CASE STUDIES: COMMUNICATION FOR VACCINE UPTAKE
  • 11. Dhibcaha Nolosha (Drops for Life): Can Radio Improve the Effectiveness of Polio Vaccination Campaigns?
    This radio magazine/discussion programme aimed to increase awareness of polio and to improve uptake of polio vaccination in Somalia. BBC Media Action conducted post-programme research (30 focus group discussions). “Many listeners attributed their decision to get their children vaccinated to hearing emotionally-affecting stories of real children infected with polio on Dhibcaha Nolosha. The belief that Islam is opposed to polio vaccination is a common barrier to vaccination uptake in Somalia. The fact that religious leaders supportive of vaccinations appeared on the programme was a key factor in building its credibility….Dhibcaha Nolosha provided information and encouraged learning ahead of the vaccination effort, allowing listeners to digest information in advance and making them more amenable to inviting polio vaccinators into their homes.” [Oct 2014]
  • 12. Case Studies of IPV Introduction: Albania, Nigeria, and Tunisia
    by Lauren Platt, Katie Gorham, and Lois Privor-Dumm
    Since the SAGE recommendation was made, 27 countries have introduced IPV (data as of July 2015) into their RI schedule. To share lessons learned with the additional 99 countries working on this issue, IVAC developed 3 case studies of IPV introduction in Albania, Nigeria, and Tunisia. Each case study, accompanied by a short video, details the decision-making process, pre-introduction activities, implementation, and lessons learned. Overarching reasons for success are shared. For example, “[c]lear, positive, and simple messaging to caregivers is effective.” And, in some countries, the most effective messages did not specifically mention polio, IPV, or OPV. Instead, the messages simply stated that a new vaccine was being introduced to improve the immunisation schedule. [Aug 2015]
  • 13. Understanding Immunization and Vitamin A Communication in Rural Cambodia: a Formative Research Study
    This report describes a study whose primary objective was to inform the development of a communication strategy to improve immunisation coverage in Angkor Chum Operational Health District of Siem Reap, Cambodia, while supporting the National Immunization Program’s efforts to enhance national-level programming. Five modules were developed focusing on different aspects of vaccination (including OPV) and vitamin A service delivery: (i) best practices and system constraints, (ii) communications, (iii) interpersonal communication (IPC), (iv) barriers, and (v) key benefits and messaging. One recommendation: “A ‘neighbor-to-neighbor’ campaign should be developed to encourage and formalize the practice of sharing information related to outreach scheduling.” Also suggested: Mothers with fully vaccinated children should teach and motivate their neighbours, such as those with “not-on-schedule” children, to come for immunisation services. [Jul 2006]
  • 14. Bringing Immunization Services Closer to Communities: The Reaching Every District Experience in Ghana
    “Barriers such as inadequate understanding of immunization and insufficient demand for immunization services by families and communities; limited access to immunization services for communities located in hard-to-reach areas; and inadequate numbers of health staff to provide services to very large and scattered communities have hampered the delivery of services to many target populations.” To address these problems, the WHO adopted the Reaching Every District (RED) approach as an extension of RI services in Ghana in 2003. This publication attempts to document and share some of the experiences from the initial implementation of the RED approach in Ghana, such as the fact that experience from previous polio National Immunization Days (NIDs) showed that many children miss the opportunity to get vaccinated because they are taken to the market by their mothers. It is against this background that the Eastern region was given support to organise immunisation sessions ! on market days on a trial basis in June and July of 2004. The funds were used for social mobilisation and motivation of the field staff. [Mar 2005]
  • 15. Community Involvement in Maternal and Child Health in Madagascar: Example from Immunization
    “Community and health system collaboration is needed in an engaged and systematic way that ensures integration and the notion of coordinated preventive and curative care for all target populations…” The report describes the Kaominina Mendrikaa (or Champion Community – CC) approach, which was launched in 1999 to mobilise and link communities and services and improve health goals, particularly in the context of immunisation and the Reaching Every District (RED) goals. “The integrated approach for community interventions allows the commune to create its own communal development plan, with activities chosen and co-managed by the commune.” Amongst the strategies that have been found to be successful: training facilitators and providers on the use of job and information, education, and communication (IEC) tools and conducting regular supervision and evaluation – e.g., supplementary immunisation activities (SIAs) as part of polio eradication campaigns. [Fe! b 2015]
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SELECTED ROUTINE IMMUNISATION (RI) PEER-REVIEWED ARTICLES

This page provides access to a list of (with links to) peer-reviewed journal articles focusing on the use of communication to address RI issues around the world.

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This issue of The Drum Beat was written by Kier Olsen DeVries.
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The Drum Beat is the email and web network of The Communication Initiative Partnership.

Full list of the CI Partners:
ANDI, BBC Media Action, Bernard van Leer Foundation, Breakthrough, Citurna TV, Fundación Imaginario, Fundación Nuevo Periodismo Iberoamericano (FNPI),Heartlines, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Maternal and Child Survival Program (MCSP), MISA, Open Society Foundations, Oxfam Novib, PAHO, The Panos Institute, Puntos de Encuentro, SAfAIDS, Sesame Workshop, Soul City, STEPS International, UNAIDS,UNICEF, Universidad de los Andes, USAID, World Health Organization (WHO), W.K. Kellogg Foundation

The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.

Chair of the Partners Group: Garth Japhet, Founder, Soul City garth@heartlines.org.za

Executive Director: Warren Feek wfeek@comminit.com

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The Editor of The Drum Beat is Kier Olsen DeVries.
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